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3 Reasons Veterans Should Have a Professional Advocate

3 Reasons Veterans Should Have a Professional Advocate

The number of sad stories of veterans’ benefits getting tied up in the system is not only sad but startling. A quick internet search can lead to story after story of veterans who have struggled to receive the benefits that are owed to them. Robert DiCicco spent his final years battling through the red tape to get his benefits and pay for the bills to his assisted living facility. The sad part is he didn’t live to see it. The benefits he was owed did come through ten days after his death, but they were taken back by the Veteran’s Administration. The DiCicco family had to begin again as his wife was left to fight for the benefits as his beneficiary. The unfortunate part is that these stories are far too common. In fact, many veterans die or give up before they ever receive benefits. Knowing how and finding a professional advocate is a veteran’s best option.

1. Success rates are boosted with a professional advocate.

The National Organization of Veteran’s Advocates, Inc. (NOVA) reports that veterans represented by attorneys have the lowest denial rate in front of the Board of Veteran’s Appeals (BVA). NOVA also notes that veterans with attorney representation are more likely to have their appeals allowed by the BVA. Another great benefit to having an attorney is the Equal Access to Justice Act. This act says that if the attorney wins the appeal, then the government must pay the veteran’s legal fees. Therefore, the attorney gets paid without affecting the veteran’s benefits.

2. Qualified attorneys know their way around the process.

Attorneys who specialize in veteran’s benefits cases understand the process. These attorneys know what paperwork needs to be filed and when. They can also walk the veteran through the process. Attorneys can read and understand the case files and records which can help the veteran maximize their benefits and even find benefits the veteran may not be aware of. After assessing case files, the attorney can determine the most efficient path to take to achieve these goals. In a system where many veterans are waiting years for benefits, there is a huge benefit to using an attorney.

3. Having a professional advocate provides personalized help.

A veteran with an attorney advocating for their case has personalized help. Case managers and people within the system cannot provide this kind of assistance to their clients as they are dealing with a multitude of cases. Attorneys and firms generally only take on the number of cases they have time to give attention to, allowing them to fight on your behalf. In addition, an attorney is able to answer claims related questions the veteran may have in a timely manner. Without an attorney, the only way the veteran can get answers is by calling the VA and often waiting long periods of time for answers. An experienced attorney can also help the client to know what records are needed to support claims and to provide sworn statements when necessary. You can be assured that if the BVA is hearing an appeal, they have an attorney. Therefore, it stands to reason that the veteran would want to even out the playing field by having an attorney as well.

When it comes to something as important as veteran’s benefits, it only makes sense that a veteran is better off with someone who knows the ins and outs of the process. It is the job of the attorney to advocate for their client, but they also provide support and information which is invaluable. If you don’t want to end up like Robert DiCicco and countless others like him, consider getting an attorney as soon as possible to help with your claim.

If you have any questions about something you have read or would like additional information, please call us at 1.800.660.7564 or visit our website:  www.covertlaw.com.

Medicare Advantage Plans to Offer Greater Benefits in 2019

Medicare Advantage Plans to Offer Greater Benefits in 2019
 

On April 2, the Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. As a result, when these plans roll out their coverage for 2019, new benefits may include air conditioners for people with asthma, healthy groceries, rides to medical appointments, home-delivered meals, and non-skilled home-care services.

In this issue of The ElderCounselor, we will look at how Medicare Advantage Plans work, the benefits they provide, what the expansion means, and how it may impact both seniors and the plan providers.

Background

Medicare is government-sponsored health care for those age 65 years and older. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers doctors’ services, outpatient care, medical supplies, and preventative services.

However, there are deductibles and copayments for Medicare that can add up quickly. Also, there is no limit on annual out-of-pocket expenses. Most people buy a supplemental insurance policy, called Medigap insurance. It “fills in the gaps” of Medicare and pays deductibles and copayments. These policies are sold through private insurance companies approved by Medicare. Prescription drug coverage is also sold separately as Part D through private insurance companies.

Many seniors like the flexibility this combination provides because they can go to any health care provider or facility that accepts Medicare. Medicare pays its share of the approved amount for covered health care costs first, and then Medigap pays its share. However, Medicare can and does deny coverage for a procedure or treatment that it rules is medically unnecessary, and Medigap will only pay its share if Medicare pays first.

Also, there are some expenses that Medicare does not cover that are important to seniors, including hearing aids, vision care and dental care.

What Are Medicare Advantage Plans and How Do They Work?

Medicare Advantage Plans, sometimes called Part C, are sold by private insurance companies as an alternative to Original Medicare. If you join a Medicare Advantage Plan, you still have Medicare, but you receive Part A (hospital insurance) and Part B (medical insurance) coverage from the Medicare Advantage Plan, not from Original Medicare. However, Original Medicare will still cover the costs for hospice care, some new Medicare benefits, and some costs for clinical research studies.

Medicare pays a fixed amount for care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare and they must cover all of the services that Original Medicare covers. However, if one chooses a Medicare Advantage Plan, they cannot use a Medigap policy. In fact, it is against the law for someone to sell a senior on a Medicare Advantage Plan a Medigap policy unless that person is switching back to Original Medicare. (Changing plans is allowed once each year, during open enrollment in the fall.)

Medicare Advantage Plans work like HMOs and PPOs. Generally, a Medicare recipient must use facilities, physicians, and pharmacies that participate in the plan’s network. Some allow for non-network coverage. Emergency and urgently needed care are covered both in- and out-of-network.

One of the draws for seniors is that Medicare Advantage Plans offer benefits that Medicare does not, including vision, hearing, dental, gym memberships, and health/wellness programs. There are also cost savings. The monthly premium usually includes Medicare prescription drug coverage (Part D). And, while there may be a copayment for covered services, there is an annual limit on out-of-pocket costs. So, once a senior reaches a certain limit, they will pay nothing for covered services for the rest of the year.

Some Shortcomings of Medicare Advantage Plans

There is a multitude of Medicare Advantage Plans, even within one service area. This can be confusing to consumers who must re-evaluate them each year. Each plan can charge different out-of-pocket costs. They can also have different rules for how services are received, such as whether a referral is needed to see a specialist. And they usually have different networks of facilities and providers.

Each year, plans set the amounts they charge for premiums, copays, deductibles, and services. The plan (rather than Medicare) decides how much someone pays for the covered services, and it is allowed to change how much the insured would pay only once a year, on January (This is the effective date of coverage for each fall’s open enrollment.) However, they can change their network providers and facilities at any time during the year.

When considering a Medicare Advantage Plan, consumers must be diligent about understanding which facilities and physicians are included in its network, where they are located, and how to use the plan for routine and emergency care.

A plan can also choose not to cover the costs of services that are not medically necessary under Medicare, so it is advisable for a patient to check before they have the service or procedure done. If someone needs a service that the plan says is not medically necessary, they may have to pay all the costs of the service. But that patient would have a right to appeal the decision. They can also ask for a written advance coverage decision to make sure a service is medically necessary and will be covered.

Still, of the 61 million people enrolled in Medicare last year, 20 million have opted for a Medicare Advantage Plan. One reason may be that, in recent years, many families have become accustomed to HMOs and PPOs for their health insurance as lower-cost alternatives to traditional health care.

What the CMS Ruling Means

According to the CMS, the new rules will expand benefits to items and services that may not be directly considered medical treatment but will provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care. The goal is to keep people healthy and well, making it easier for them to live longer and more independently. A physician’s order or prescription will not be required, but the new benefits must be “medically appropriate” and recommended by a licensed health care provider.

Details of the Medicare Advantage Plan benefit packages for 2019 must first be approved by CMS and will be released in the fall when the annual open enrollment begins. But plan providers already have ideas of what they could include.

In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating, and other personal care needs. The goal is to focus on avoiding injuries or exacerbating existing health conditions.

Non-skilled in-home care services will also be allowed for the first time as a supplemental benefit, providing they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room use.

Home health care providers have already partnered with Medicare Advantage Plans, and many believe the plans will be willing to pay for non-skilled in-home care with an eye on saving money over the long-term. Medicare Advantage Plans have greater flexibility than the fee-for-service providers have, and in many cases do not have a homebound requirement. Because they receive a set amount per patient from Medicare, they would be more inclined to provide any services, including private duty nursing, to ensure the patient doesn’t cost them more money than necessary.

What to Watch

Seniors on Medicare have said that when considering Medicare Advantage Plans, access to certain hospitals and doctors is a top priority for them. Original Medicare includes the vast majority of providers and the broadest possible provider network.

But Medicare Advantage Plans are gaining in popularity. According to CMS, in 2015, 35% of Medicare beneficiaries were participants in Medicare Advantage Plans. That number is expected to grow quickly over the next several years. New, attractive benefits coming in 2019 (especially non-skilled in-home care) will likely persuade even more seniors to join Medicare Advantage Plans.

That’s certainly good news for the Medicare Advantage Plan industry. And it will be good for seniors if it lets them stay in their homes longer and lead healthier, more independent lives.

Sources

https://homehealthcarenews.com/2018/04/cms-officially-adds-non-skilled-in-home-care-as-medicare-advantage-benefit/

https://khn.org/news/medicare-advantage-plans-cleared-to-go-beyond-medical-coverage-even-groceries/

https://www.medicare.gov

To comply with the U.S. Treasury regulations, we must inform you that (i) any U.S. federal tax advice contained in this newsletter was not intended or written to be used, and cannot be used, by any person for the purpose of avoiding U.S. federal tax penalties that may be imposed on such person and (ii) each taxpayer should seek advice from their tax advisor based on the taxpayer’s particular circumstances.

Senior Living Options When Care is Needed

Senior Living Options When Care is Needed

As Americans age, living options can become a concern. Available options are tied to the resources a senior has to cover living costs, and vary widely in cost, assistance, and care provided. In addition to budget considerations, seniors must also realistically consider the needs they have and what senior living option best fits those needs.

Nursing Homes

Nursing homes, or skilled nursing facilities, are one option for senior living. These facilities are for seniors who can no longer live independently. They provide care for seniors with illnesses or mental conditions that cause them to require monitoring and medical care on a full-time basis. For example, many nursing home patients have dementia, are confined to a wheelchair, or spend most of their time in bed. Their conditions require that medical attention be available around the clock.

Nursing homes also provide the option for short term care, where patients come and stay for a limited time after major medical events such as strokes or heart attacks. In these facilities, the residents generally live in semi-private rooms and all meals are provided. Medicare may help cover the cost of skilled nursing facilities, assuming the resident meets certain financial requirements. Long term care insurance may also pay for nursing home care. Otherwise, a nursing home resident pays privately, which can often bring financial hardship upon the family. As a result, many families work with an elder law attorney to discuss care options as well as payment options for that care.

Assisted Living Facilities

Another option for senior living is assisted living facilities. These facilities are ideal for seniors who are still independent but may need some assistance with activities of daily living, as well as meals, cleaning, or other daily self-care tasks. These facilities usually offer a more private living conditions. Since residents may be fairly independent, assisted living facilities are an appealing option because they often offer a variety of activities and opportunities for seniors to interact with one another and to stay active. Assisted living facilities are generally paid for privately with a few exceptions, including long term care insurance or partial assistance from Medicaid.

Independent Living Communities

An independent living community is another viable option for senior living. These communities are for independent, active seniors who enjoy the idea of living in a community. Independent living communities are much like living in a condo or as a part of a community with an HOA. Often maintenance, housekeeping, and landscaping are part of what is included with living in these retirement communities.  Many seniors choose this type of community when they are no longer able or no longer wish to maintain a home. The housing options for independent living communities range from detached homes to apartments. Another benefit of retirement communities is the wide range of amenities and activities available. Seniors are often lonely and living among other seniors can provide friendship and companionship. Residents in independent living communities pay privately, and the cost varies from one community to another.

Memory Care

Memory care facilities provide a more specialized senior living option for seniors who have serious cognitive impairments, such as Alzheimer’s or dementia. These facilities are much like assisted living facilities, but cater to cognitive impairments. They may even be a specialized part of an existing assisted living facility. The staff at memory care facilities have specialized training that helps them better assist residents with cognitive impairments. They are often planned intuitively to help patients who may become easily disoriented. These facilities also give extra consideration to security for residents who may wander due to their cognitive impairment. If a senior needs this kind of care, it is important to plan and look for facilities that provide it ahead of time.

Senior living options vary greatly in care and cost. It is important that seniors have conversations with their families about the needs they have or may have in the future, as well as the cost of the type of care they wish to have. The earlier the planning begins, the better off the senior and the family will be when the time comes to seek alternative living options. This planning should be a part of the overall legal and financial plan of the senior.  If you have any questions, please contact us at 1.800.660.7564 or visit our website: www.covertlaw.com.

Vocational Rehabilitation: A Powerful Tool for Veterans Wanting to Enter the Civilian Job Market

Vocational Rehabilitation:  A Powerful Tool for Veterans Wanting to Enter the Civilian Job Market

Prospects for veterans looking to enter the job market have drastically increased since the Great Recession. In 2016, the unemployment rate for veterans (4.7%) was actually slightly lower than the rate for the entire population (4.85%). One factor that has contributed to veteran’s success in the workplace is the Vocational Rehabilitation and Employment (VR&E) service provided through the Department of Veterans Affairs.

 

Through VR&E, eligible veterans or active duty service members are given a wide range of services to assist with job training, employment accommodations, resume development/review, and personalized coaching to assist with job seeking skills. If you want to fan your entrepreneurial flames after returning from duty, VR&E also provides guidance in starting your own business. Lastly, VR&E provides assistance for service members who are severely disabled and unable to work in a traditional work environment.

 

Eligibility requirements for active duty servicemembers:

  • Expect to receive a discharge other than dishonorable when leaving active duty
  • Acquire a memorandum rating of 20% or more from the Department of Veterans Affairs
  • Apply for VR&E services

 

Eligibility requirements for veterans:

  • Discharged with a status other than dishonorable
  • Have the VA declare you have a service-connected disability rating of at least 10%
  • Apply for VR&E services

 

The period of eligibility to register for VR&E services is 12 years from being notified of the latter of either the date of separation from active duty, or date you were first notified of a service-connected disability rating from the VA.

 

After eligibility has been established, you will be directed to a Veterans Resource Center in your area where you will be evaluated to determine your specific abilities and needs. This evaluation includes an assessment of your interests, aptitudes, abilities, and whether your service-connected disabilities impair your ability to obtain/hold a job. Post-assessment, you will be given vocational-specific training aligned with your interests. You will be assigned a case manager who will be in charge of guiding you through this process. Generally, the case manager will directly instruct you on subjects where he/she has expertise, and provide supervision to other instructors who provide supplementary services.

 

During your evaluation, if it is determined that your service-connected disabilities are too severe to participate in the traditional work environment, you may be provided with independent living services. You can only take advantage of these services for 24 months because they are meant to be a point of rehabilitation to help you transition into the workplace, rather than a place to stay. Some of the benefits provided include: making arrangements for consultations with health professionals, counseling services to aid in determining your individual independent living needs, and providing information for home modification benefits you may be eligible for, such as the Specially Adapted Housing grant.

 

By now, you’re probably thinking that this investment will take up a good chunk of your time, and you may be worried about maintaining an income while participating in this program. Another great feature of VR&E is that you may be eligible for a subsistence allowance provided by the VA. The amount you receive depends on your rate of attendance in the program, the number of dependents, and the type of training. To view the different rates, click here.

 

VR&E is just one of the many opportunities offered to veterans seeking to enter the civilian job market. If you would like to learn more about other programs, or need assistance in understanding your rights if you are a disabled veteran, please do not hesitate to contact our office.  Give us a call at 1.800.660.7564 or visit our website:  www.covertlaw.com.

3 Tips for Traveling with Disabilities

 

3 Tips for Traveling with Disabilities

Traveling with disabilities or accessible traveling can seem, for some, like an overwhelming task with so many extra considerations. However, it doesn’t have to be if the right research, planning, and preparations are done ahead of time. There are even travel agencies that specialize in disabled travel. The most important thing is to be prepared.

 

1. Consult with a Physician

Whenever a disabled person is planning to travel, one of the first steps to take is to discuss the travel plans with the person’s physician. Be sure to give the doctor an accurate picture of what the trip will entail. In many cases, the physician can help plan for medical needs while traveling. The doctor can prescribe certain measures to help make travel easier and can provide you with a medical statement for emergency situations. It is also helpful to have your doctor’s name and phone number available while traveling, as well as to identify medical care at the travel destination. Be sure to carry extra medication in case of unforeseen delays and have all medication in carry-on bags to prevent loss. Be prepared because the doctor may also advise against certain types of travel depending on the disabled person and their disability.

 

2. Know Your Rights

When planning for accessible travel, it is important to know the rights of people with disabilities. The Transportation Security Administration (TSA) has certain procedures for travelers with disabilities and medical conditions. It is important, before going through airport security, to understand these procedures. The Air Carrier Access Act and the Americans with Disabilities Act (ADA) also provide information regarding the laws for those traveling with disabilities. Unfortunately, many employees of airlines, cruises, theme parks, and other travel destinations will not know the law regarding those with disabilities, so it is always best to obtain the information ahead of time.

 

3. Plan Ahead

Planning ahead is the most important tip and encompasses all the other tips. One easy way to plan ahead is to hire a travel agency that specializes in accessible travel. These agencies can plan for the specific disabilities and needs of the traveler with disabilities. If you wish to plan your own travel, then begin to plan early. First, research and create an itinerary for your trip. Websites can be helpful in obtaining information about accessibility and services offered. Even with websites, calls should be made to schedule the necessary accommodations that are needed to make each stop on the itinerary enjoyable. Remember to be detailed when describing the disability, so that everyone understands the limitations accurately.

 

Planning ahead for flights can also be very helpful for people with disabilities. If possible, avoid connecting flights and fly direct to the destination. It is also recommended to check in with the flight attendant before landing to make an exit plan. Once you’ve disembarked, if a wheelchair is necessary, make sure you have set up accessible ground transportation to and from the airport. All of this can be done ahead of time to help ensure more relaxing travel for everyone involved in the adventure.

 

The experience of travel can be smooth and enjoyable with the right information and planning. Of course, even the best plans can experience turbulence along the way, but planning and documenting can help to lessen any bumps along the way. Just remember, after calling and booking for the special needs, call again and touch base 24-48 hours in advance of traveling to ensure all appropriate accommodations are in order.

 

If you have any questions about something you have read or would like additional information, please feel free to contact us.

Visit our website at:  www.covertlaw.com

 

Identity Fraud Targeting the Elderly

The largest coordinated sweep of identity fraud involving US seniors has recently been conducted. The US Department of Justice has reported that more than one million elderly people have collectively lost hundreds of millions of dollars because of this targeted financial abuse. The Department has criminally charged 200 out of 250 defendants identified in the sweep. These third party scam artists account for 27% of seniors who are financially exploited. 

Con artists and scammers employ many different schemes to defraud seniors of their identity information and money. A large number of them are conducted over the telephone, for instance posing as an Internal Revenue Service agent claiming back taxes are owed, or frightening a grandparent to think that their grandchild has been arrested and needs bail money wired to them. Other schemes include the promise of a prize or lottery cash if they just send a large fee in order to collect their “winnings.”. Seniors become easy victims when targeted by these social engineering schemes and it is likely to get worse because of the proliferation of smart phones and other devices that get seniors to explore the online world.

USA Today reports that while phone scams target one senior at a time the online environment is opening doors to thousands or even millions of seniors falling prey to a single scam. Email and other online channels can reach a vast number of potential victims and more elderly people have an online presence than ever before. 

Romance scams that use to be conducted in person can now be achieved in the online dating environment and even in social media. The attacker can befriend multiple seniors online and then ask for money to cover “travel expenses” to visit them. This is particularly successful as many seniors are dealing with isolation and loneliness. 

The online shopping world is another vehicle employed by scam artists to defraud seniors of money. All that is needed is a picture of an object that seems to be owned by the scammer and you have the potential to sell that item over and over again to thousands of seniors. All the scam artist has to do is set up a mirror web site that appears to be a legitimate online auction house such as E-bay to drain seniors of their money as well as obtain credit card and other identity information. These mirror sites masquerading as official websites are often in the email accounts of seniors and a mere click on a link can download malicious software to their device that is designed to steal critical identity information. 

Of the 27% of seniors who do become financially exploited by a third party, 67% do not exhibit symptoms of cognitive decline. That is a huge number of mentally fit seniors being financially exploited. This is a pervasive problem in the elderly community. According to the Federal Trade Commission’s “Consumer Sentinel Network Data Book 2017” identity fraud is second only to debt collection with regard to consumer complaints. Identity fraud accounted for 14% of all consumer complaints last year. The Commission also reported that seniors who are financially exploited suffer higher median losses than other age groups. 

Many seniors who have been targeted are embarrassed, ashamed, or scared as a result. Many never saw themselves as being at risk, they fear retribution from the perpetrator, and they fear that government agencies or family members will label them unfit to care for themselves. 

Systems can be put in place to monitor senior accounts and make their money less easy to access by scammers. In addition, there are legal documents that can protect the accounts of seniors during their lifetime, and eliminate the chance of fraud or abuse.  Please contact us for more information on how we can help you or your loved ones reduce the chance of financial fraud or abuse.

Medicare and Medicaid: Unlocking the Mystery

Medicare and Medicaid: Unlocking the Mystery

Medicare and Medicaid have long been a mystery to many consumers. In fact, it can baffle and confuse even some of the smartest citizens. Like me, you might have thought, “I don’t need to worry about this right now.” However, it is never too early to gain a little understanding and awareness that just might help you help an aging loved one or yourself down the road. As the saying goes, “Time flies.”, and you will be there sooner than you think. Let’s break it down and learn some of the differences and basics of Medicare and Medicaid to unlock the mystery.

Medicare

Medicare is a health insurance program provided through the federal government. In order to receive Medicare, a person must meet certain requirements. A person must be 65 years old or older or have a severe disability. In order for a disabled person under the age of 65 to be eligible for Medicare, they must have received Social Security Disability Insurance (SSDI) for two years. In order to be eligible a person must have Social Security retirement benefits or Social Security disability benefits. Because Medicare is run and administered by the federal government, it is uniform from state to state. If a person meets Medicare eligibility requirements, they can receive Medicare no matter their income or assets. Costs for Medicare are based on the recipient’s work history. This means that costs are determined by the amount of time a person paid Medicare taxes. These costs like all insurance include premiums, copays, and prescriptions.

Medicare can be confusing because there are four parts. The commercials talk about Parts A, B, C, D. What does it all really mean? Parts A, B, and D can be somewhat simplified. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. Parts A and B are covered in Original Medicare offered by the government. Part C is often called the Medicare Advantage Plan. This is a private health plan. The Medicare Advantage Plan or Medicare Part C plan are required to include the same coverage as Original Medicare but usually also include Part D as well. It is important to do your homework on these plans to find what works best and is most cost effective for you.

Medicaid

Medicaid is a health care assistance program. Its guidelines come from the federal government, but it is administered by each state. Medicaid is for people who cannot afford to pay for their care on their own. It is based on income and assets, and is available to people who belong to one of the eligible groups. The eligible groups are children, people with disabilities, people over age 65, pregnant women, and the parents of eligible children. Seniors who require nursing home care can qualify for Medicaid and only pay a share of their income for the nursing home. Medicaid then pays the rest.

Dual Eligibility

A person can be eligible for both Medicare and Medicaid and can have both. The two programs work together to help the recipient best cover the expenses of health care. For example, Medicare costs include premiums, copays, and deductibles. Full Medicaid benefits can cover the costs of Medicare deductibles and cover the 20% of costs not covered by Medicare. Medicaid can also help with Medicare assistance and may cover costs of premiums for Part A and/or Part B.

Although Medicaid and Medicare can be quite confusing, it is important at a minimum to know the basics. When you or someone you love is eligible or in need of the benefits, there are organizations willing to help and your elder law attorney is also a valuable resource.

If you have any questions about something you have read or would like additional information, please feel free to contact us.

Medicare’s Expansion of Telehealth Benefits

 

Medicare’s Expansion of Telehealth Benefits

Medicare is expanding telehealth benefits for its members. Telehealth is defined by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as the use of electronic information and telecommunications technologies to support and promote long distance health care, patient and profession health-related education, public health and health administration. Through telehealth services, Medicare beneficiaries can save money and the time of running back and forth to the doctor. A variety of telehealth benefits will be more readily available to Medicare beneficiaries, especially for chronic medical issues, but these can be dependent on qualifications for the services as outlined by the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act.

All Medicare recipients will be eligible for telestroke evaluations. The geographic restrictions for telestroke consultations will be eliminated beginning in 2019. Emergency medical workers will be able to call in to doctors if they suspect that a patient is having a stroke. The doctor can evaluate the symptoms on the spot, allowing emergency workers to begin treating a patient on the way to the hospital. Another service available to Medicare beneficiaries remotely will be the monitoring of dialysis patients. Telehealth services for dialysis had been only available to patients deemed living in remote areas, but these restrictions will also be lifted beginning in 2019. The benefit of both of these services is evident. One allows patients to begin treatment earlier and the other lessens the time patients must spend going to the doctor’s office for treatment.

The legislation that provides for the expansion of benefits provides more telehealth services to Medicare Advantage Plan B holders with multiple chronic diseases. With telehealth services, beneficiaries can receive more services. Some of these services include changing medication doses and monitoring blood pressure. In addition, patients with chronic diseases such as heart disease, cancer, or diabetes can receive telehealth services. This limits how often they have to go to a doctor’s office, which can be of great benefit to patients who may have issues with mobility. Beneficiaries will spend less time waiting and more time receiving the quality health care services they need while also cutting costs.

Long term care providers are also benefitting from Medicare’s expanded telehealth services. In many cases long term care providers do not have physicians readily available on staff and the time it takes to get a physician, especially in rural settings can be a problem. Therefore, patients have had possible avoidable transfers and admissions to other health care facilities. This can put fragile older adults at greater risks for other illnesses. Through telehealth services, physicians and practitioners can be available 24 hours a day to assess needs of patients and determine whether transfers and admissions to other facilities is necessary. This can improve the quality of care patients receive, reduce costs for the patient and long-term care facilities, and improve patient satisfaction.

Medicare beneficiaries, long-term care providers, and Accountable Care Organizations will find more flexibility in using telehealth services. These groups may find it beneficial to explore all their telehealth options and the scope of telehealth services available. Telehealth services will slowly become more commonly accepted and more readily accessible for Medicare beneficiaries. Hawaii Senator Brian Schatz tweeted about the bill, “It will increase access and quality of care, and reduce costs using tech that is already available.” Progress is being made in this telehealth services. Schatz also stated in a press release, “Almost every other part of our health system uses technology to save costs. It’s long past time for Medicare to catch up.” Providers, as well as beneficiaries, should take full advantage of the growing trend toward these services.

If you have any questions, please feel free to contact us.

Middle and Low Income Seniors Facing Affordable Housing Shortage

Middle and Low Income Seniors Facing Affordable Housing Shortage

There is a growing need for affordable senior housing that is only starting to be addressed by businesses that build for this market. If you have a lot of money you typically have a lot of options. At the other end of the spectrum if you have nothing you can qualify for government assistance though these programs, but most often include wait times, years of wait times, due to lack of available housing. The truth is many seniors, nearly 40%, have less than $50,000 in savings, not including the value of their homes, according to a study by the Joint Center for Housing Studies and Harvard University. That doesn’t make them poor but it doesn’t make them rich either. Middle income seniors are stuck in the middle and the statistics are indicative of a looming senior housing crisis. By 2035 one in three households will be headed by someone aged sixty-five or more years and the population aged eighty or more years will have doubled to 24 million.

The truth is that thoughtfully designed housing for senior adults is not being created on a scale that reflects the growing need and the need is palpable. Many aging adults don’t even want to project that one day they will no longer be able to live in their current home. When asked about their forward living plans it usually consists of some variant of “the plan is to die in my home.” Sadly, it is impossible to script your passing and while you might hope it happens gently in your home it is more likely that an adverse event, such as a fall, will change everything and you will require some level of care. The Social Security Administration estimates that if you turn 65 today, you will live to 84.3 if you are a man, and to 86.6 for women. Added SSA: “And those are just averages. About one out of every four 65-year-olds today will live past age 90, and one out of ten will live past age 95.” (https://www.thestreet.com/story/13640644/1/inside-the-nation-s-looming-senior-housing-crisis.html) Those numbers of longevity represent staggering costs when you consider the likelihood that those oldest years will require the most significant care.

That “significant care” costs serious money. According to “A Place for Mom,” the average national cost for a private assisted living facility is almost $4,000 per month. If you want private nursing home care that cost increases to more than $6,000 per month, depending on where you live. If you compare these costs with the fact that nearly 50% of adults aged sixty-five or older have just enough income to afford basic expenses you can intuit it is a recipe for disaster. The only thing left is to spend assets pay for care. That is not a good option for several reasons. First, you will likely run out of assets quickly due to the current costs of care. Second, you would be unable to leave a legacy to children or continue to provide for a spouse after you are gone. 

That is why the understanding of aging is facing a paradigm shift – many companies that design and build for retirement communities want the word “senior” dropped altogether. Innovative technology companies and non-profits are sounding the alarm and changing the discussion from challenge to opportunity, from health care to health, wellness, and lifestyle, and bringing entrepreneurial ideas to create a positive change. It is a step in the right direction but it does not change the current reality – there is a shortage of affordable senior housing and there is a continuing increase in need for senior residency. 

What is your housing reality and future? Do you have a plan in place to handle the changes that most likely will affect you and your living environment? It is important to have this discussion with your family, and with a professional elder law attorney. Proactive planning is in your best interest. Contact our office today and schedule an appointment to discuss how we can help you with your planning.

Do Not Plan or Save at Your Own Retirement Peril

A significant portion of Americans are saving nothing for retirement and very little in their day to day lives. While the unemployment rate is low and wages are seeing an increase the American worker is not saving enough of their income which will inevitably lead to short falls of operational cash during an unexpected crisis and in their retirement years further down the road. (https://www.cnbc.com/2018/03/15/bankrate-65-percent-of-americans-save-little-or-nothing.html

Bankrate maintains that half of all Americans will not be able to maintain their standard of living once they have stopped working. GoBankingRates corroborates these findings citing that over forty percent of Americans have less than $10,000 dollars saved for their retirement. These statistics point to a dismal retirement future for nearly half of all Americans. 

This doesn’t have to be your future. It doesn’t matter how little you currently save. You don’t have to become the horror story of retiring and meeting financial ruin like so many do. What matters is that you change the trajectory of your retirement life by proactively examining how you are spending and saving. The sooner you begin the better your chances of success. 

The first and most important strategy to implement is learning to live beneath your means. That translates into saving money: probably more than you currently do. Saving money is an underestimated survival skill. To save begin by tracking your spending habits for thirty days. Once you have the data create a realistic and doable budget. Fluid expenditures like groceries, eating out, clothing, gasoline and auto maintenance need to have a set monthly budget. Create a simple two columned sheet of paper with budgeted and actual expenditures to monitor your progress. Typical categories where you can reduce expenditures include; cable packages, phone plans, groceries, entertainment costs, gym memberships, clothing and dining out. Start asking yourself over and over “Is this a need or a want?” and if it is a need, how can you make the cost lower. The game is how much money you can save, not spend.

Consolidate your non essential debt and pay it off, completely. Make it a primary goal to get out of debt. Stop being a debt slave. In the credit card industry there is an insider term used for people who fully pay their credit cards off each month. Guess what it is? It is a deadbeat. Companies cannot make money off of you if you stop becoming a slave to debt. If you can’t afford it then find a way to live without it.

Double check your insurance rates on your car, homeowner, and health. Do not purchase flight insurance, extended warranties, and disease insurance. Check this site for fifteen insurance policies you don’t need. (https://www.investopedia.com/insurance/insurance-policies-you-dont-need/). Get rid of the policy all together or find wiggle room for reduced premiums or get a more competitive provider to save money. 

Get rid of automatic payments attached to your banking accounts. Most people can eliminate expenditures they forgot they are even locked into. This also forces you to take control of your bill/payment cycles. Being involved in the day to day of bill payment keeps you far more aware of your financial situation and keeps your mind active.

Consider downsizing your home. If you are in a two story house it is inevitable that one day you will not be able to climb those stairs. A one story home or a first floor condo or apartment can help you purge your life of ‘stuff’ you no longer need. Some of those things can be sold and the proceeds can be saved. Any profit left over from downsizing immediately goes into savings or a financial investment vehicle to provide and protect your senior years. 

These are some but not all of the ways it is possible to change your savings habits. Guidance from a trusted professional is key to the pathway of success because there will always be roadblocks and setbacks that you must make adjustments for. Structuring a legal plan in connection with a retirement plan can provide added protection and allow you to enjoy retirement more thoroughly.

Contact our office today and schedule an appointment to discuss how we can help you with your planning.

Creative Financial Approaches to Long Term Care Services

Creative Financial Approaches to Long Term Care Services

Long term care insurance was sold aggressively in the 1980s, 90s and thereafter to offset the costs of seniors needing to live in a nursing home, assisted living or needing at home health care. Now, however, the business of long term care insurance has dramatically changed. What was once over 100 insurers providing LTC policy for sale has shrunk to a pool of less than twenty insurers who continue to sell the health care product. The big financial problem was that the majority of insurers had badly underestimated the longevity of these long term care policy holders and how many claims would be filed during their lifetime. The model became unsustainable from a business perspective. 

As reported by the Wall Street Journal (https://www.wsj.com/articles/millions-bought-insurance-to-cover-retirement-health-costs-now-they-face-an-awful-choice-1516206708) the industry is now in financial turmoil and has turned to the old adage of privatize the gains and socialize the losses; the translation being that millions of people age sixty-five or older with long term care policies are facing steep rate increases. It is not uncommon for a policy holder to face a fifty percent increase in their premium while some of the worst cases are upwards of ninety percent. Because the industry itself used such poor benchmarks and miscalculated projections, policy holders are seemingly left with two choices: Pay the money or leave your coverage after paying into it for years, and sometimes decades.

What if you want a different choice? Everyone would agree that being priced gouged for premiums as you age is inherently unconscionable but if the policy is discontinued what then will happen to the peace of mind long term care brings? What was once the safety net of senior aging care (without becoming a burden to family members) is rapidly disappearing.

CNBC has recently reported about this very issue and suggests getting financially creative for long term care. (https://www.cnbc.com/2018/02/27/heres-a-surprise-source-you-can-tap-for-long-term-care-services.html) There is a surprising source that you can tap in order to maintain protection for yourself but it requires planning, professional help and time. Do not delay. 

The financially creative premise is to become asset poor, impoverished, and qualify for Medicaid which pays for nursing home care and services. This does not mean the legacy you built during your lifetime will not go to your selected inheritors. On the contrary the assets you own must move out of your name to qualify for Medicaid. The assets will then shift to your designated beneficiary since to qualify you as an individual cannot have over $2,000 in assets.

To begin you will need to retain the services of a qualified elder law attorney, who may also bring in an accountant and a financial advisor. Ideally, you will be able to wait five years before needing long term care and the help of Medicaid. If there are assets transferred during the “five year lookback” it may be subject to penalties or make the applicant ineligible for some period of time requiring them to pay out of pocket.

Now with time on your side it becomes critical to select the right vehicle for transfer. These can be annuities but more often tend to be irrevocable trusts. The assets in the irrevocable trust are no longer under the control of the older person and can provide protection from certain creditors. The vehicle chosen for transfer of assets is very important not only for the older individual but the recipient as well. In the case of an outright gift of appreciated assets (i.e. stocks or real property) there would be no stepped up cost basis which could lead to crushing capital gains taxes when it is time to sell. An elder law attorney with input from your accountant and financial planner can help you choose the right transfer of wealth plan.

Elder law attorneys are closely watching changes in Medicaid,, as Congress is often proposing legislation to change the program.. Be certain your elder law attorney is up to speed on the current requirements, as the eligibility requirements can change very quickly in each state, and sometimes each county.

Though you may never have thought you would find yourself creatively trying to qualify for Medicaid while protecting assets, the current long term care premium prices preclude a large portion of seniors from being able to pay the cost of the policy. Genworth Financial reports the national median cost of a private nursing home room to be $97,455 a year. It doesn’t take long to be wiped out at that cost without long term care. Medicaid may be your solution and time is of the essence for planning. 

Contact our office today and schedule an appointment to discuss how we can help you with your planning.

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Covert | Law

Your Plan. Your Family. Their Future.

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NEIL R. COVERT, Attorney at Law

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1.800.660.7564

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