Jan Neal Law Firm LLC

Alabama Estate, Elder and Special Needs Law


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Case Study: The Value of Medicare Open Enrollment Plan Comparisons

medical technology concepts illustration designThe importance of Medicare plan comparisons during Open Enrollment are published everywhere you look, but sometimes I think that those warnings go unheeded because folks just do not understand how drastically coverage by the same plan can change year to year.

I saw up close and personal how beneficial the SHIP program is and the importance of Open Enrollment this week.  A gentleman we will call Mr. A came to a State Health Insurance Assistance Program (SHIP) Open Enrollment event in the South Central Alabama Development Commission region.  He drove 20 miles to check out his coverage because he was unsure of whether he needed to keep or change his Medicare Part D prescription drug plan (PDP) for 2017.  He opted to do the safe thing and  check it out.  Thank goodness he did.

Mr. A’s prescription drug plan for 2016 had a zero premium and covered his 10 medications prescribed by his doctor.  That all worked out well, and during 2016 Mr. A’s total out of pocket expenses related to his prescription drug plan totaled $542.00.  This was a manageable arrangement for him.

When a comparison of plans was run Mr. A was shocked to learn that his 2016 prescription drug plan would have a premium of $26.80,  a deductible of $400.00, and his 10 medications had been reconfigured on the plan formulary resulting in 2 of his medications no longer being covered and 3 of his medications reclassified as Tier 3 medications, meaning that his copayments would be higher. In all, Mr. A would have had to pay $3276.00 in out of pocket expenses related to his prescription drug plan during 2017 if he made no changes in coverage.

The comparison provided Mr. A with several options, and he selected a plan that would result in $360.00 in total out of pocket expenses for 2017, saving him $2916.00 over what he would have had to pay if he had not had a comparison run.

While Medicare enrollees can run their own comparisons, they will need to use the online plan finder provided by Medicare.  Comparisons are performed free and counseling provided through the SHIP program funded through the Alabama Aging and Disability Resource Centers.  To learn more call 1-800-AGE-LINE.


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Medicare Open Enrollment

Caution - Open Enrollment AheadIt is that time of year to reexamine your Medicare coverage to determine if you like what you have or need to make changes.  Medicare’s Open Enrollment Period (OEP), during which you can enroll in or switch plans, runs from October 15 to December 7 every year, so now is the time to review your options to determine if switching plans could save you money and to determine if your coverage will continue to meet your needs.

During this period Medicare eligible people may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. This is an important consideration since each year insurance plans have the option to change which drugs they cover.  What was covered during the immediate past year may no longer be covered.  Also during the seven-week OEP you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change from one to a different  Advantage plans. While beneficiaries can go to http://www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage, a terrific resource to determine the available options is the State Health Insurance Program operated by local aging and disability resource centers.  Counselors can provide unbiased assistance in helping you maneuver through the maze of options.

Even beneficiaries who were satisfied with their plans in 2016 need to review their choices for 2017. Be sure to carefully review the plan’s “Annual Notice of Change” letter that you should receive. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks.

As an example of how drastically coverage can change year to year, Avalere Health, a consulting and research firm, reports that premiums for the 10 most popular drug plans will rise an average of 4 percent next year. According to the Centers for Medicare and Medicaid Services, the average Medicare Advantage premium is expected to decrease from $32.59 on average in 2016 to $31.40 in 2017.

This is a time when you will see advertisements all over television offering help with open enrollment.  Understand that these companies are advertising to sell you their product.  While their product may be what you want, it might not be, and you should not make a decision about that coverage without knowing all of the options available to you.  Also remember that people who are perpetrators of fraud will inevitably use the open enrollment period to try to gain access to individuals’ personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited. If you think you’ve been a victim of fraud or identity theft, contact Medicare. For more information on Medicare fraud, click here or here.

Some resources to help you navigate open enrollment include:

The 2017 Medicare & You handbook, which all Medicare beneficiaries should have received. The handbook can also be downloaded online at here.

The Medicare Rights Center provides  good educational materials to help.

You can find the State Health Insurance Assistance Program that serves your area here.

The online Medicare Plan Finder can be located here.


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Elder Law Training at OLLI

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On October 10, 2016, Jan taught the first of a two part presentation on Elder Law at  Osher Lifelong Learning Institute (OLLI) at Auburn University entitled Elder Law:  Enhancing the Lives of Seniors Through Education, Planning For What Comes Next.  The second session will be taught on Monday, October 17, 2016, at 2:30 p.m. at The Clarion in Auburn, Alabama.  

Topics covered in this training include:  Older Americans Act Legal Assistance; Important Documents Needed for Proper Planning; Authority Issues; Long-term Care Levels of Care and Payment Options; Medicaid for Long-term Care; Special Needs Planning; Probate; Administration of Estates; Planning for Last Remains and Funerals.

A 39 page Keynote presentation covering these topics is provided to course participants.

Anyone interested in this and the many other learning opportunities available through OLLI can learn more by visiting the OLLI website.


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Nursing Home Residents Win Back Right to Sue

shutterstock_236328151According to ElderLaw Answers:

In recent years, nursing homes have increasingly asked — or forced — patients and their families to sign arbitration agreements prior to admission. By signing these agreements, patients or family members give up their right to sue if they believe the nursing home was responsible for injuries or the patient’s death.

Now, in an unexpected move, the federal Centers for Medicare and Medicaid Services (CMS) is forbidding nursing homes from entering into binding arbitration agreements with a resident or their representative before a dispute arises. The agency has issued a final rule prohibiting so-called pre-dispute arbitration agreements in facilities that accept Medicare and Medicaid patients, affecting 1.5 million nursing home residents. After a dispute arises, the resident and the long-term care facility could still voluntarily enter into a binding arbitration agreement if both parties agree.

For years, patient advocates have contended that those seeking admission to a nursing home are in no position to make a determination about giving up their right to sue. Families are focused on the quality of care, and forcing them to choose between care quality and forgoing their legal rights is unjust, the advocates said. Courts have sometimes struck down arbitration agreements as unfair, but others have upheld them.

“Clauses embedded in the fine print of nursing home admissions contracts have pushed disputes about safety and the quality of care out of public view,” the New York Times wrote in its coverage. “With its decision, [CMS] has restored a fundamental right of millions of elderly Americans across the country: their day in court.”

The nursing home industry has countered that the new rule will trigger more lawsuits that could increase costs and force some homes to close. Mark Parkinson, the president and chief executive of the American Health Care Association, said that the change “clearly exceeds” CMS’s statutory authority.

Although the rule could be challenged in court, for now it is scheduled to take effect on November 28, 2016, and will affect only future nursing home admissions. Pre-existing arbitration agreements will still be enforceable.

 


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Medicare Aneurysm Preventive Services

Did you know that Medicare pays for many preventive medical services?  An important preventive service provided by Medicare includes the following:

Abdominal aortic aneurysm screening is available for persons at the highest risk for aortic aneurysms.

WHO: People at risk for abdominal aortic aneurysm, which typically includes men 65-75 who have ever smoked

HOW OFTEN: One time and must have received a referral for screening during your Welcome to Medicare exam

YOUR COST: Free


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Medicare Wellness

Medicare provides many disease prevention and early detection services to help Medicare beneficiaries stay healthy and detect health problem early when treatment works best.
With Original Medicare a yearly Wellness Visit is available at no cost.
With Medicare Advantage Plans, the subscriber should check with the plan.
From time to time we will be highlighting here preventive services Medicare beneficiaries can get at no cost.


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Elder Law at OLLI

Jan is teaching a two part course on Elder Law at Osher Lifelong Learning Institute at Auburn University (OLLI at Auburn).  See page 11 of the OLLI Spring 2016 catalog for the course description.  The first session is Wednesday, March 30, 2016, from 10:15 a.m. – 11:45 a.m., and the second will be on Wednesday, April 6, 2016, from 10:15 a.m. – 11:45 a.m.  Topics to be covered include Older Americans Act Legal Assistance, Authority Issues and Advance Directive Options, Long-Term Care Planning, Long-Term Care Payment Options Including Medicaid, Special Needs Planning, Probate, Administration of Estates and Funeral Planning.  If you aren’t a member of OLLI, check out all the benefits and learning opportunities here.

Materials for the training can be downloaded at elder-law-training-for-olli-at-auburn-033016-60244085 and will be posted at this site soon.


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Alabama Benefit Checklists Updated

The Alabama Benefit Checklists have been updated for 2016.   They are archived in Resources at this site.

 

 

 


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Who Isn’t Online?

1200 wide shutterstock_266064506For years I have been arguing with folks who say that older people don’t use the internet and can’t engage through that medium.  That didn’t make sense  to me.  For instance, people who are 70 today were 50 when personal computers began to emerge as a household staple, and they were often more likely to have the resources to explore new technologies coming into the consumer marketplace.  People who are 60 today were 40 then and at the height of their careers where the gradual integration of technology was a job requirement.  Retirees today connect with old and new friends on Facebook, tweet about their favorite subjects, pin their favorites, check email and text to communicate with family, friends and groups.  In fact entire industries of online caregiving have developed.  Sadly entire online industries of fraud have also developed requiring a great deal of poise for anyone online to stay safe.  With that said, there are people who never went online, but I’m pretty sure that their caregivers, both personal and professional, did.  But the question remains, who is not online these days?

I am not the only person wondering about that.  A Pew Research Center Study shows that 15 percent of the American population is not online, but the number is shrinking quickly.  From that study:

“For example, 86% of adults 65 and older did not go online in 2000; today that figure has been cut in half. And among those without a high school diploma, the share not using the internet dropped from 81% to 33% in the same time period.”

With that said, some people will never go online.  Some people never drove a car, but someone gave them a lift.  Today we recognize that by 2030 25 percent of the population will be 60+, and almost all of them will be online.  Recognizing this trend, The 2015 White House Conference on Aging produced some interesting tech related announcements worth exploring.  Among the 2015 WHCoA ideas, is development of a web site named aging.gov:

“to provide older Americans, their families, friends, and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.  The Web site links to a broad spectrum of Federal information, including how to find local services and resources in your community for everything from healthy aging to elder justice to long-term care, as well as how to find key information on vital programs such as Social Security and Medicare.”

An innovative perspective is provided by The Center for Technology and Aging’s 2014 report (updated) titled The New Era of Connected Aging:  A Framework for Understanding Technologies that Support Older Adults Aging in Place.  The report provides an overview of how technology can improve the lives of seniors and help them remain in independent living arrangements.  The report examines some of the products emerging to support monitoring and management of physiological status and mental health, chronic condition management, technologies to support safe functional status at home, technologies to promote connectedness and products to support caregivers.

The debate is no longer whether technology will be used by and for seniors; the question is how.  The challenge will be to use technology to enhance the lives of seniors and their caregivers and promote the well-being and independence of seniors as they age.  What an exciting era in which to age and work with seniors!


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Changes Likely To Come To VA Pension Eligibility Standards

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In January the Department of Veterans Affairs (VA) announced changes to agency regulations for calculating eligibility for Special Monthly Pensions (such as New and Improved Pension, Aid and Attendance and Housebound Benefits). When the rule is adopted it will result in sweeping changes in how the VA calculates eligibility for pensions, and it will result in penalties for transferring assets out of the veteran’s name within three years of application. Through this change, the VA will look more like Medicaid.

Special Monthly Pensions are for veterans who served for 90 days or more during active wartime who were honorably discharged. They may qualify for benefits if their health care expenses leave them without adequate resources to live. Surviving spousal benefits are also available when the veteran is deceased.

Income and Asset (Net Worth) tests are performed to determine eligibility, and there is currently no penalty for transferring assets.

Currently to calculate Income, qualifying medical expenses are deducted from the veteran’s (or spouse’s) income to calculate adjusted income. In 2015 a veteran with no dependents applying for A&A who does not have $1789 per month in adjusted income may be eligible for an amount to bring his or her income up to $1789 (referred to as Maximum Annual Pension Rate or MAPR). The monthly MAPR for a veteran applying for A&A with one dependent is $2120. There are different minimum eligibility standards for different categories of benefits (such as New and Improved Pension, A&A, Housebound Benefits and veteran alone or with dependents, widows, surviving children, etc.), but that is the general scheme. Income minus qualifying medical expenses = adjusted income which is subtracted from the MAPR to determine the amount the veteran or spouse is eligible to draw.

Currently to calculate Assets (Net Worth) the VA has allowed the applicant to have $80,000 or less to qualify with the residence and automobile excluded.

So remember, the VA already looks at Income and Assets (Net Worth), and you have to meet both tests to qualify for a Special Monthly Pension.

The Proposed Rule

Under the proposed rule Income and Assets (Net Worth) will still be considered, but there will be more some changes in what counts and how it counts.

Transfer Penalty:

 Applicants who give away their property within three years of applying for benefits will be penalized. In other words, there will be a three year look back, and transfers can result in a penalty lasting as long as ten years, meaning that the veteran cannot draw benefits for the length of the penalty. To calculate the penalty the amount transferred within three years of application will be divided by the monthly MAPR in effect at the time of the application to arrive at the number of months of penalty. The penalty begins to run at the time of the transfer.

The New Income Calculation: Gross income will continue to consist of payments from any source except for casualty losses and capital gains from the sale of an asset. Medical expenses will continue to be deducted from gross income to calculate adjusted income. The applicant’s adjusted income must fall below the MAPR to qualify for a pension.

The New Asset (Net Worth) Calculation: Allowable net worth will line up with Medicaid’s community spouse protected amount of $119,220. This amount is calculated by adding all the resources not excluded plus annual adjusted income for the year.

To determine net worth the VA does exclude the principal residence and a “reasonable amount of land” around the house, capped at two acres. As under current rules, the automobile and household items do not count so long as they, too, are “reasonable.” Basic living expenses such as food, clothing and shelter can be deducted from the year’s income that is included in the calculation for Net Worth level.

There is one more possible adjustment required to arrive at the final Net Worth. Remember those proceeds from casualty losses and capital gains from the previous year that did not count as income? In calculating the Assets (Net Worth), those amounts may be added to this year’s assets to arrive at countable Net Worth.

Contact your County VA Office to apply for a Special Monthly Pension or to obtain more information about eligibility.

Veteran Pension Rates (MAPR) are published yearly.