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Special Needs Community News
The new year is a time to take hold of the past year and make positive changes for the months ahead.
Here are several resolutions that families of people with special needs will want to keep, in 2012 and beyond.
Read more... |
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Veteran's Corner
The VA has released the 2012 veteran benefit figures. Click here to open a PDF.
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Florida Assisted Living Coalition presents
Pompano Beach & Palm-Aire Health Fair for Seniors and People with Disabilities
Friday, January 20, 2012
1:00 PM - 4:30 PM
Herb Skolnick Senior Center 800 SW 36th Street
Pompano Beach
Complimentary Lunch
Reservations Required -
To make reservation,
call 1-800.939.2650.
Proceeds benefit
SAGE (Seniors Alliance
of Gay Elders) and
FALC 2012 Charities. |
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Wishing you a healthy and happy Holiday Season
from all of us at Elder Law Associates PA.
Ellen S. Morris, Esq. attended the Executive Board meeting of AFELA (Academy of Florida Elder Law Attorneys) and participated in the Advanced Practitioners Day of the AFELA UnProgram on December 2-3, 2011 in Orlando.
Howard S. Krooks, J.D., CELA, CAP presented "The New Durable Power of Attorney Act" at the 14th Annual Elder Law Update presented by The Elder Law Affairs Committee of the Palm Beach County Bar Association on December 16, 2011. We provide The Elder Law Update to our clients and our colleagues who make up a wide range of service providers for seniors and people with disabilities to facilitate the dissemination of helpful and accurate information. We thank you for letting us share our knowledge with you. We welcome your comments and questions. You may send them to Info@ElderLawAssociates.com. |
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Legal Advice for GRANDparents - New Marriages and Long Term Care
By: Howard S. Krooks, JD, CELA, CAP
 Q: I am 78 and my girlfriend of 10 years is 72. We enjoy a wonderful relationship and are contemplating getting married, but are concerned about what would happen if one of us became ill and required long-term care services. What do you advise?
A: Getting married at any age can be a wonderful event, but in later years long-term care planning should be considered before you take the plunge.
Click here to read the article on GRANDMagazine.com |
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2012 Medicare Premium Hike Lower Than Predicted, and Some Will See a Savings
 On the heels of the announcement of a 3.6 percent increase in Social Security benefits in 2012 comes news that Medicare's monthly premium will be much lower than expected next year -- and will actually drop for millions of beneficiaries. Administration officials said the new health reform law was partially responsible for keeping costs down.
The basic premium for Medicare Part B will be $99.90 a month, only a $3.50 increase over the $96.40 a month that most beneficiaries have been paying since 2008. This increase is $7 a month less than what was being projected as recently as last May and means that most seniors will be able to keep the lion's share of their Social Security benefit increase. In addition, higher-income earners and others who have not benefited from the recent premium freeze will see a significant drop in their premiums.
Most Medicare recipients have not experienced a rise in their Medicare Part B premium -- which pays for doctor visits and other outpatient costs -- because of a provision in the Medicare law prohibiting premiums from climbing more than that year's cost-of-living increase in Social Security benefits. Since there has been no Social Security increase in the last couple of years, most beneficiaries - nearly three-quarters - have continued to pay Part B premiums of $96.40 per month.
But this protection has not applied to the other one-quarter of beneficiaries who either:
- do not have their Part B premiums withheld from their Social Security checks, or
- pay a higher Part B premium surcharge based on high income (see below), or
- are newly enrolled in Part B.
These beneficiaries who did not benefit from the premium freeze will see their premiums reduced from $115.40 a month to the new $99.90 premium. In addition, the Part B deductible will fall $22 to $140.
Donald Berwick, MD, administrator of the federal Centers for Medicare and Medicaid Services, said one big reason for the lower-than-expected premium hike was historically low rates of health care utilization, which he attributed in part to the health reform law's focus on preventive services. In addition, the unexpected Social Security benefit increase meant that rising Medicare costs could be spread among many more beneficiaries, with each one paying a smaller share.
"Between reduced Part B premiums and increased Social Security payments, the average Social Security recipient will have a net cost-of-living increase of $40 per month in 2012," said the Center Medicare Advocacy.
Some might believe that politics played a role in keeping Medicare's premiums down during an election year, but that's not so, said Tricia Neuman of the non-partisan Kaiser Family Foundation. "Changes in premiums are obviously important to seniors but the numbers are based on what the law requires, and determined by independent actuaries, rather than politics," Neuman said.
Following are all the new Medicare figures for 2012:
- Basic Part B premium: $99.90/month
- Part B deductible: $140 (was $162)
- Part A deductible: $1,156 (was $1,132)
- Co-payment for hospital stay days 61-90: $289/day (was $283)
- Co-payment for hospital stay days 91 and beyond: $578/day (was $566)
- Skilled nursing facility co-payment, days 21-100: $144.50/day (was $141.50)
As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums. Following are those amounts for 2012:
- Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $139.90 (was $161.50).
- Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 will pay a monthly premium of $199.80 (was $230.70).
- Individuals with annual incomes between $160,000 and $214,000 and married couples with annual incomes between $320,000 and $428,000 will pay a monthly premium of $259.70 (was $299.90).
- Individuals with annual incomes of $214,000 or more and married couples with annual incomes of $428,000 or more will pay a monthly premium of $319.70 (was $369.10).
Rates differ for beneficiaries who are married but file a separate tax return from their spouse:
- Those with incomes between $85,000 and $129,000 will pay a monthly premium of $259.70 (was $299.90).
- Those with incomes greater than $129,000 will pay a monthly premium of $319.70 (was $369.10).
The Social Security Administration uses the income reported two years ago to determine a Part B beneficiary's premiums. So the income reported on a beneficiary's 2010 tax return is used to determine whether the beneficiary must pay a higher monthly Part B premium in 2012. Income is calculated by taking a beneficiary's adjusted gross income and adding back in some normally excluded income, such as tax-exempt interest,U.S.savings bond interest used to pay tuition, and certain income from foreign sources. This is called modified adjusted gross income (MAGI). If a beneficiary's MAGI decreased significantly in the past two years, she may request that information from more recent years be used to calculate the premium.
Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. On average Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011.
For Medicare's Fact Sheet on the new numbers, which includes the new Medicare Part D premium adjustments for high earners, click here.
For more about Medicare coverage, click here. |
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The Five Components of a Good Estate Plan
 Many people believe that if they have a will, their estate planning is complete, but there is much more to a solid estate plan. A good plan should be designed to avoid probate, save on estate taxes, protect assets if you need to move into a nursing home, and appoint someone to act for you if you become disabled.
All estate plans should include, at minimum, two important estate planning instruments: a durable power of attorney and a will. A trust can also be useful to avoid probate and to manage your estate both during your life and after you are gone. In addition, medical directives allow you to appoint someone to make medical decisions on your behalf.
Will
A will is a legally-binding statement directing who will receive your property at your death. If you do not have a will, the state will determine how your property is distributed. A will also appoints a legal representative (called an executor or a personal representative) to carry out your wishes. A will is especially important if you have minor children because it allows you to name a guardian for the children. However, a will covers only probate property. Many types of property or forms of ownership pass outside of probate. Jointly-owned property, property in trust, life insurance proceeds and property with a named beneficiary, such as IRAs or 401(k) plans, all pass outside of probate and aren't covered under a will. For more information about wills, click here.
Trust
A trust is a legal arrangement through which one person (or an institution, such as a bank or law firm), called a "trustee," holds legal title to property for another person, called a "beneficiary." Trusts have one set of beneficiaries during those beneficiaries' lives and another set -- often their children -- who begin to benefit only after the first group has died. There are several different reasons for setting up a trust. The most common reason is to avoid probate. If you establish a revocable living trust that terminates when you die, any property in the trust passes immediately to the beneficiaries. This can save time and money for the beneficiaries.
Certain trusts can also result in tax advantages both for the donor and the beneficiary. These could be "credit shelter" or "life insurance" trusts. Other trusts may be used to protect property from creditors or to help the donor qualify for Medicaid. Unlike wills, trusts are private documents and only those individuals with a direct interest in the trust need know of trust assets and distribution. Provided they are well-drafted, another advantage of trusts is their continuing effectiveness even if the donor dies or becomes incapacitated. For more information on trusts, click here.
Power of Attorney
A power of attorney allows a person you appoint -- your "attorney-in-fact" -- to act in your place for financial purposes when and if you ever become incapacitated. In that case, the person you choose will be able to step in and take care of your financial affairs. Without a durable power of attorney, no one can represent you unless a court appoints a conservator or guardian. That court process takes time, costs money, and the judge may not choose the person you would prefer. In addition, under a guardianship or conservatorship, your representative may have to seek court permission to take planning steps that she could implement immediately under a simple durable power of attorney. For more information on powers of attorney, click here.
Medical Directives
A medical directive may encompass a number of different documents, including a health care proxy, a durable power of attorney for health care, a living will, and medical instructions. The exact document or documents will depend on your state's laws and the choices you make.
Both a health care proxy and a durable power of attorney for health care designate someone you choose to make health care decisions for you if you are unable to do so yourself. A living will instructs your health care provider to withdraw life support if you are terminally ill or in a vegetative state. A broader medical directive may include the terms of a living will, but will also provide instructions if you are in a less serious state of health, but are still unable to direct your health care yourself. For more information on health care decisions, click here.
Beneficiary Designations
Although not necessarily a part of your estate plan, at the same time you create an estate plan, you should make sure your retirement plan beneficiary designations are up to date. If you don't name a beneficiary, the distribution of benefits may be controlled by state or federal law or according to your particular retirement plan. Some plans automatically distribute money to a spouse or children. Although others may leave it to the retirement plan holder's estate, this could have negative tax consequences. The only way to control where the money goes is to name a beneficiary. For more information, click here.
Please contact us if you would like to make sure your estate plan is complete. |
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Suit Contests Hospitals' Practice of Not Admitting Patients Prior to Nursing Home Transfer
 Seven Medicare patients have filed a class action lawsuit challenging a Medicare policy that allows hospitals to place patients under observation for days on end rather than actually admitting them. If these patients then move to a nursing home, they are not eligible for Medicare coverage of the first part of their nursing home stay, costing them or their families thousands of dollars.
Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. In part due to pressure from Medicare to reduce costly inpatient stays, hospitals are increasingly not admitting patients but rather placing them on "observation status" to determine whether they should be admitted.
Although according to Medicare guidelines it should take no more than 24 to 48 hours to make this determination, in reality hospitals sometimes keep patients under observation for up to a week. If the patient moves to a nursing home after being "released," the patient must pick up the tab for the nursing home stay -- Medicare will pay none of it. The bills can run between $200 and $500 a day.
There is little that patients who know they have been placed in observation status can do because they haven't been refused benefits. Medicare is still paying for their hospital stay, although on an outpatient basis.
"There's no official appeal," says Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. "Medicare has not denied coverage. You're in no man's land."
As ElderLawAnswers reported last year, more and more elderly are finding themselves temporary residents of this no man's land. Medicare claims for observation care rose from 828,000 in 2006 to more than 1.1 million in 2009, and claims for observation care that lasted more than 48 hours tripled to 83,183.
Bipartisan bills in Congress that would allow for the time patients spend in the hospital under observation status to count toward Medicare's three-day hospital stay requirement have gone nowhere. Believing they had no other options, and with harm to beneficiaries and their families continuing, and The Center for Medicare Advocacy and the National Senior Citizens Law Center filed the lawsuit.
The case, Bagnall v. Sebelius (No. 3:11-cv-01703, D. Conn), filed November 3, 2011, on behalf of seven individual Medicare beneficiaries who represent a nationwide class, argues that the use of observation status violates the Medicare Act, the Freedom of Information Act, the Administrative Procedure Act, and the Due Process Clause of the Fifth Amendment to the Constitution.
"The complaint specifically requests that beneficiaries not be put on observation status, but an alternative remedy would be to treat observation status as covered under Part A," the Center's Director of Litigation, Gill Deford, told ElderLawAnswers. "A secondary goal is to ensure notice and hearing rights as long as they continue to put people on observation status and cover it under Part B. The immediate remedy would be to require notice and the right to challenge the placement on observation status."
In a press release announcing the lawsuit, one of the plaintiffs, Lee Barrows, described her husband's stay in a Connecticut hospital.
"After five days of treatment in the hospital, my husband's neurologist, physician and social worker ushered me into the hallway to tell me that my husband was never admitted. I was stunned with disbelief and tearfully blurted out that I would fight this," said Mrs. Barrows. "His doctors then indicated that this happens once or twice a week."
For more information about the lawsuit from the Center for Medicare Advocacy, click here. |
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What You Pay Your Doctor Under Medicare Depends
 If you have original Medicare, the doctor you visit can make a difference in how much you have to pay. While you can go to any doctor who accepts Medicare payments, if the doctor does not "accept assignment," you can end up paying a lot more. (This does not apply to beneficiaries who are in Medicare Advantage, or managed care, plans.)
Medicare Part B recipients must satisfy an annual deductible. Once the deductible has been met, Medicare pays 80 percent of what Medicare considers a "reasonable charge" for the item or service. The beneficiary is responsible for the other 20 percent.
However, in most cases what Medicare calls a "reasonable charge" is less than what a doctor or other medical provider normally charges for a service. Whether a Medicare beneficiary must pay part of the difference between the Medicare-approved charge and the provider's normal charge depends on whether or not the provider has agreed to participate in the Medicare program.
If your doctor participates in Medicare it means that the doctor "accepts assignment." In other words, the doctor agrees that the total charge for the covered service will be the amount approved by Medicare. Medicare then pays the provider 80 percent of its approved amount, after subtracting any part of your annual deductible that has not already been met. The provider then charges you the remaining 20 percent of the approved "reasonable" charge, plus any part of the deductible that has not been satisfied.
If your doctor does not participate in Medicare and does not accept assignment, the rules are different. Non-participating doctors can charge 20 percent of the approved amount plus up to an additional 15 percent more than the Medicare-approved amount. Non-participating doctors can also charge you for the care upfront and request that you bill Medicare, while doctors who accept assignment cannot.
For more information about Medicare, click here. |
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 We always appreciate referrals from our satisfied clients, friends, business partners, and family members. We welcome the opportunity to serve the people you care about. Click on the blue Forward Email at the bottom of the page to send this newsletter to someone who will benefit from our insights. |
Elder Law Associates PA is a boutique elder law firm that practices exclusively in Medicaid and long term care planning including long term care insurance, Medicaid applications, home and community-based Medicaid waiver services, diversion program benefits, nursing home benefits, spousal refusal applications, and Medicaid fair hearings and appeals; nursing home and assisted living facility residents' rights litigation; asset preservation planning with a special focus on planning in light of the Deficit Reduction Act of 2005, including personal service agreements, the purchase of life estates, income producing real estate and spenddown planning; disability planning, including special needs trusts and guardianship; estate planning, including wills and trusts and advance directives; and probate, which encompasses estate and trust administration as well as litigation.
We assist clients in planning for the possibility of disability, incapacity, home health care, assisted living and/or nursing home placement. Our firm enables clients to avoid impoverishment caused by the escalating cost of long term care, to maintain their right to make health care decisions and to avoid unnecessary medical treatment.
We hope you have enjoyed The Elder Law Update. If you have questions about something you read, elder law matters or issues concerning persons with disabilities, we would be delighted to hear from you. We serve as an elder law resource to many professionals and organizations and want to become your elder law resource as well. You can reach us at Info@ElderLawAssociates.com.
Warm regards, |
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Ellen S. Morris, Esq. & Howard S. Krooks, Esq., CELA, CAP
Elder Law Associates PA
phone: (561) 750-3850 / (800) 353-3752
fax: (561) 750-4069
This publication is intended for general information purposes only. It is not intended to constitute individual legal advice to any specific client. |
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