Salt Lake City Estate Planning

Medicaid Misunderstandings Costly

Some Medicare beneficiaries who visit the hospital are getting surprised by big bills because their stays weren't considered inpatient services.

When an elderly person is ready for the nursing home, some families are entirely understanding, in agreement, and financially able. As a result, the transition happens smoothly. Unfortunately, for a far larger number of families and elderly persons, some trip to the hospital will happen in between and may even immediately precipitate the transition to nursing home care.

If that’s the case, then there are important hospital and Medicare policies of which you should be forewarned. Enter “observation care” which can make for a big bill upfront and even far bigger ones down the line.

According to a recent article in the Wall Street Journal, and their sources at the Medicare Rights Foundation, the number of “observation hours” has been steadily growing for years. Tragically, such observation hours count as “outpatient services,” even if the service lasts for several days (as it sometimes does with the elderly) and Medicare pays for inpatient and outpatients services in entirely different ways.

As you likely know, Medicare Part A pays for inpatient bills, so those are usually taken care of, but Medicare part B is what takes care of outpatient services. And those services can add up to a far greater cost.

It’s often vital to know the distinction between the two types of services from the hospital, and yet it’s also fairly difficult. Medicare advises to simply ask, but then there are certain documents such as the “Important Message from Medicare” which accompanies inpatient care, but not outpatient. Still, the hospital can switch with little to no notice.

It’s actually even more important than the size of the immediate bill. Medicare will only pay for nursing home expenses if the person was admitted inpatient at a hospital for at least three days, excluding the discharge day.

For so many families that’s the sole reason why it takes a hospital visit to arrange for the transition to nursing home care in the first place, but if you are put under observation or other so-called “outpatient” care, and without your notice, it can literally mean thousands of dollars out-of-pocket down the line.

Bottom line: It all hinges on hospital practice and Medicare definitions.

Reference: The Wall Street Journal (February 5, 2012) “Check Hospital Tab”

 Please visit the Elder Law section of our website to see how we can help you better understand your Medicaid and Medicare options.

 

 

Obama's Alzheimers Agenda

The Obama administration announced plans Tuesday for a two-year, $156 million cash infusion for Alzheimer’s research and care. The money will help solidify a still-developing national plan to better treat and even prevent the illness by 2025.

With budget plans just now coming to a head, it’s good news for many of us that Alzheimer’s has become one of the “we can’t wait” initiatives in President Obama’s plan.

Such measures still need to be passed through Congress, and positive advances may not be immediately forthcoming. However, it is heartening to see fiscal support for an issue that affects so many of us and our loved ones.

If all goes to plan and the approach makes it through Congress – a politically trepidatious journey these days even for the most common-sense and appealing legislation – then the budget will earmark an infusion of $156 million for Alzheimer’s research and care.

In many ways it’s the flesh and bones to an earlier announcement from the administration regarding a national plan toward treating Alzheimer’s that came out to some guffaws due it’s lack of a clear source of funding.  The full details on allocation are still forthcoming, but at least a small portion of that infusion, some $26 million, is intended for immediate use and care of Alzheimer’s patients. The rest is to go toward research and the hope of improving future care, and also perhaps systematic prevention.

How this news will affect us, and whether it will weather violent political and economic seas is yet to be seen, but it’s a powerful promise for many. 

Reference: The Kaiser Health News (February 7, 2012) “Alzheimer’s Research Gets Funding Boost”

Please visit the Elder Law & Long-Term Planning section of our website today.

 

Why it's Harder Finding a Nursing Home for Dad

Searching for a nursing home for his hospitalized father in semirural Massachusetts, a friend of mine recently came up against an unexpected barrier. It’s harder to find a bed for a man than for a woman.

Finding a nursing home for an ailing loved one, and a good nursing home that is affordable, is already a fairly difficult task. Unfortunately, it’s only likely to grow in difficulty as the number of elderly in need of care begins to peak. Unfortunately, too, there are some factors that you just might not think of. Like this: it is disproportionately difficult to find a nursing home for a male patient.

This fact was recently pointed out over at the New Old Age Blog and I thought it was worth sharing. What is working against our male elderly loved ones is not much more than simple math, with a bit of Medicare policy work at play. As you are likely aware, women have a longer life span on average and therefore there are more women in nursing homes to begin with; that’s already a bottleneck based on population statistics. Then you throw in the fact that, under Medicare rules, most rooms in nursing homes are no more than “semi-private”, a delicate euphemism, and co-ed rooms aren’t allowed either. Thus, with more women already in such rooms the more that only women can be admitted into a facility. The math is fairly easy to figure out, but it’s a strange and unintended consequence nonetheless.

Reference: The New York Times The New Old Age Blog (January 30, 2011) “Fewer Beds For Men Entering Nursing Homes”

Please visit the Elder Law Section of our website and see how we can start helping you with all of your Elder Law questions today.

 

Retirement Perspectives from Small Business Owners

Retirement plans have their place, but many entrepreneurs starve their business of needed working capital by putting money instead into tax-deductible accounts such as traditional 401(k)s. They think they are saving taxes. 

Small business owners, by and large, have a hard time thinking beyond their business. It is a significant part of their very lives. If you are a small business owner, now may be the time to start thinking of your business as its own retirement vehicle, at least according to a recent guest columnist over at Forbes.

For retirement planning, a business owner typically has to take out of the business what would otherwise be capital for growth. You’re taking it out to put into a tax advantaged plan like a 401k, hoping it will grow there enough to make up for the taxes to be paid later. In addition, you are doing so in the belief that you’ll be in a lower tax bracket when you call upon those funds later on. But what are the returns on that account? It may be that a properly capitalized company will give far greater returns.

According to the Forbes article, a small business owner has to exist in a couple capacities, and the self that is an “individual” cannot be eclipsed by the self that is the “business owner,” nor the other way around. Ideally, perhaps, they can work in a synergy.

It is a risky strategy, especially for those nearing retirement, but it may be worth looking into the original article’s numbers.

Reference: Forbes (January 25, 2012) “Fund Your Business Before You Stuff  Retirement Accounts”

Please visit the Estate Planning for Small Business Owners section of our website and contact us today to see how we can start helping you.

 

You're Not Alone - Medicare Confuses Many Seniors

Most seniors on Medicare will pay $99.90 per month this year for Part B outpatient coverage. But how would you like to pay 10 percent more for that coverage, or 50 percent more?

As many readers will know, it’s fairly critical to understand the rules for filing for Social Security. Likewise, the rules for filing for Medicare benefits can make or break your retirement. Unfortunately, it’s also fairly easy to forget about the basics of Medicare filing, as a recent article out of Reuters highlights the importance of filing earlier rather than later.

For each full 12-month period that a senior could have had coverage but didn't sign up, the monthly Medicare Part B premium jumps 10 percent. The average monthly cost of Part B coverage is $99.90, so just a few years delinquency will result in $20, $30, or more a month; that adds up, is unnecessary waste, and is permanent.

Suffice it to say that the government really wants you do sign up when it’s time. But why is that difficult? Well, for one, the full retirement age for Social Security is no longer the age for Medicare enrollment. As a result, many otherwise forward-thinking people are waiting until age 67 to enroll in Social Security (for the maximum monthly benefit), but 65 is the age for Medicare.

In addition, with so few people actually leaving the workforce it’s easy to forget (or fail to realize, since you’re not really retired) that it might be time for Medicare. That also can depend on the nature of your employment. For example, if you are still working at age 65 and your employer has fewer than 20 employees, Medicare is the primary payor; at companies with more than 20 workers, the employer's plan is primary. In the latter situation, a senior can postpone filing for Parts A (hospitalization) or Part B, although many choose to enroll for Part A anyway, since it doesn't require premium payments. If you delay your Part B coverage, you can enroll without penalty when you do retire for up to eight months following that point.

The bottom line is to keep all of this on your radar, regardless whether you will be relying on Medicare. In fact, not relying on Medicare may be the source of the problem.

If you are employed it may be worth a visit with the company accountant to be sure on which side of the line the company falls, and therefore what your insurance ought to be like.

Reference: Reuters (January 20, 2012) “Big penalties await those who delay Medicare filing”

Visit the Elder Law section of our website to see how we can start guiding you through the medicare maze today.

ELDER LAW

Craig Reaves, past president of the National Academy of Elder Law Attorneys, practices elder law in Kansas City, Mo., and fields occasional questions from New Old Age readers.

On the topic of disclosures, a reader inquired about what to do about her family of eight siblings and one elderly father. Long ago the siblings got together and put two of the sisters in charge of their father, largely because his will and other directives advised as much. As a result, they were granted power-of-attorney and access to his accounts.

Now, the reader has discovered that they aren’t forthcoming with information about their father, his care, and his finances. The reader is worried that she won’t hear anything until there’s a demand for money to care for their elderly father, and, perhaps, that the original funds weren’t adequately used.

The response of Craig Reaves is tailored to the reader’s unique situation, but his advice is applicable for many in this same or similar position. As a preliminary caveat, there are specific state laws (i.e., like those regarding “powers of  attorney”) that govern the authority, responsibility and liability of agents and fiduciaries.

Read Craig Reaves’ enlightening response in his original post.  

Reference: The New York Times – The New Old Age Blog ( January 18, 2012) “Ask the Elder Law Attorney: Disclosures and Loans”

Please visit our Elder Law & Long Term Planning section of our website to see how we can start helping you today.

 

 

Hospice: Medicare and Medicaid Profit Center?

A national hospice company improperly cycled patients through nursing homes and hospice with a goal of making as much profit as possible from Medicare, according to a whistleblower lawsuit announced this week.

Healthcare lawsuits involving the various ways that the elderly can be taken advantage of turn up in the news on a daily basis these days. Why? Well, partly for political reasons and partly for the sheer number of egregious situations that have been created.

As an informed citizen/taxpayer, it’s important to think about and understand the big picture. However, as a family member, it’s vitally important to remember them for the sake of your elderly loved ones.

A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services.

Such companies are compensated by Medicare based on the length of time patients receive care. Medicare picks up the entire nursing home tab for the first 20 days (after that the patient has to contribute), and conversely, if a patient spends too much time in hospice care, Medicare demands their money back since the patient was clearly admitted to end-of-life care under false pretenses.

Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts, and that’s the issue.

The legal battles, as well as the politics and economics aside, stories like these also demand a certain amount of attention since they could directly impact your family.

If you have a loved one in need of nursing home and/or hospice care, it’s important that they find and receive that care… and that they not be abused by an uncaring system.

Reference: Kaiser Health News (January 4, 2012) “Lawsuit Accuses Company of Fraudulently Cycling Patients through Nursing Homes, Hospice Care.”

Visit the Elder Law section of our website to see how we can start helping you today.

 

Keeping An Eye On Change – Your Estate Plan

Once you've created an estate plan, it is important to keep it up to date. You will need to revisit your plan after certain key life events.

The Ball has dropped and that means another year is upon us. Likely, you’ve made some New Year’s Resolutions.

Hopefully, one of your resolutions is to update your estate plan.

In reality, your estate plan is like a living thing, at least inasmuch as you are. As things change in your life – and the lives of your loved ones, so, too, do your goals to protect everyone you love and everything you have.

As a rule of thumb, then, whenever your life changes in a significant way remember to review and maybe even change your plans. For a little additional reading on this topic, check out a recent Elder Law Answer’s article here.

Unfortunately, there also are other reasons to review your plans unrelated to life changes. Yes, the ever changing legal environment requires careful monitoring. What may have worked before may not work now if the laws have changed.

We are leaving a politically turbulent year and are plunging straight into one that may prove even more troubling. Indeed, by the end of the year we will have to rewrite the laws about the estate and gift taxes, amongst many other important provisions, and that may mean radical change.

Make 2012 a year for awareness of your estate planning and how it reflects the course of your life and, what is more troublesome, with the course of law.

Reference: Elder Law Answers (updated December 12, 2011) “When Should You Update Your Estate Plan?”

Visit the Estate Planning Section of our Website to see how we can guide you through all your estate planning needs.

When Medicine Becomes a Menace

An estimated 100,000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from four common medications, a new study finds.

Seniors are increasingly reliant upon their medications. It’s a fact of life. Literally.

However, with so many different kinds of medications to do so many different things, sometimes the medications themselves can cause more harm than good. Nonetheless, according to a recent study from the Center for Disease Control, as reported here, two-thirds of drug-related emergency hospitalizations result from just four types of medications.

The four types of medicine are also very common. Listed below in order, from the greatest to the least percentage of adverse instances per drug, whether taken together or separately:

1. A blood-thinning medication called warfarin (Coumadin, Jantoven)
2. Insulin
3. Antiplatelet drugs used to prevent blood clots such as aspirin and clopidogrel (Plavix)
4. Oral hypoglycemic agents – a diabetes medicine

The most important fact, however, is that nearly two-thirds of all such cases were not just the drugs themselves; they were the result of unintentional overdoses.

It’s scary to see such common medicines listed, and if you or loved ones use them there is cause to take notice, but the real lesson is awareness and care. There are real consequences when care is not received properly or when an elderly person is not able to accurately gauge their medications. 

Reference: USA Today (November 25, 2011) “Four Common Meds Send Thousands of Seniors to Hospital”

 

 

Filling the Medicare Donut Hole

Medicare's prescription coverage gap is getting noticeably smaller and easier to manage this year for millions of older and disabled people with high drug costs.

There is some good news for many Medicare recipients, present and future. According to new Medicare figures, the cost of falling into the “doughnut hole” is shrinking.

The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).

It’s an easy hole to fall into, especially if you have a special medication. With the new health law, however, pharmaceutical companies have begun offering a 50% discount on medications to beneficiaries in the gap, and that has meant a great deal of savings.

According to the figures, the average beneficiary who falls into the coverage gap already would have spent $1,504 this year on prescriptions. Yet, with the new law, that cost fell to $901, with each individual doing better or worse depending on which medicines they use. 

Reference: ABC News (November 27, 2011) “AP Newsbreak: Medicare’s Drug Coverage Gap Shrinks”