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 Elder
Law Update
Georgia Edition |
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If you have an idea or comment that will help me
make this a better newsletter please send
it to me. Just
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Yep, that is a bowtie. Not a clip-on. Tied
it
myself.
October was an incredibly busy month. North
Carolina announced plans to begin
enforcement of tough new federally-mandated
transfer of assets rules with respect to
applicants for nursing home assistance. The
enforcement began November 1. Georgia got
onboard with that almost a year ago, but in
North Carolina, it made for an unsettling
October. October is also the month the feds
come out with new Medicare and Medicaid
numbers. More on those below.
The Centers for Medicare and Medicaid
Services (CMS), the federal agency that
regulates the Medicaid program, announced
"spousal impoverishment" numbers for 2008.
Those numbers will dictate how many assets
and how much income the spouse of a nursing
home resident will be able to retain and
still qualify the other spouse for Medicaid.
You can see those numbers by clicking
HERE.
Last month I promised we'd begin looking at
specific areas of Medicaid. We've put that
promise on hold for a month. This is the
Medicare "Swap Season" . . . that magical
time when seniors are inundated with
persuasive advertising to drop their
existing coverage, change from this plan to
that, or move from traditional Medicare to
an Advantage Plan. I have received many
questions from clients, and from the looks
of the columns submitted below others are
concerned. So, we've had a slight change in
plans.
First, we have added a great deal to the
Mason Law website relating to Medicare.
You'll see links to that part of the website
below. Second, you may think of this issue
of the
Elder Law Update as the "Medicare
issue". I hope you'll find some usual
information.
I have prepared a brief summary of the
enrollment and disenrollment rules for
Medicare, Medigap Plans and Medicare
Advantage Plans. That article appears
immediately below.
Warren Coble raises his concerns regarding
plan changes below as well.
Also, we have a new columnist. Dr. Patricia
Shevlin and I serve together on a nonprofit
board of directors. She has weighed in with
a brief column on Medicare Part D plans. Dr.
Shevlin is a principal in Asheboro Family
Physicians. Her partner Dr. Bob Dough and I
have discussed Medicare Part D before, and
with Dr. Shevlin's article, I know it is an
area of concern to them.
Speaking of doctors . . . as of October 24,
Dr. Beth Hodges has a new tax exemption.
Specifically, Elena Rose Hodges . . . all 7
pounds, 2 ounces of her. Congratulations to
both Dr. Hodges' . . . Dr. Beth and her
practice partner/husband Dr. Cisco! Dr.
Shevlin and Dr. Hodges will be swapping off
from month to month in
Elder Law
Update.
Unfortunately, the last few months I have
had a number of matters pertaining to
financial exploitation of an elder. Savannah
banker Rose DeVries shows us how to avoid a
problem that can effect all of us: Identity
theft. Her article appears below as well.
Finally, my column this month in
Coastal
Senior should be important for
people who have old wills that might contain
rude awakenings due to changes in tax laws.
The November issue is on the stands in the
South Carolina low country and coastal
Georgia, but you can read it by clicking
HERE.
Have a great Thanksgiving. We have much for
which to be grateful.
Bob Mason
Certified Elder Law Attorney
Certified by the
National Elder Law Foundation,
recognized by the American Bar Association
as the certifying entity for specialization
in Elder Law. |
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THE MEDICARE SWAP SEASON
Bob Mason
With the approach of November 15, newspapers and
magazines are packed full of confusing
advertisements urging seniors to look at new
Medigap (supplemental) insurance policies and
Medicare Advantage plans. Companies are urging
seniors to jump from one type of plan to
another. The advertisements will only add to
the bewildering array of options available to
seniors.
The purpose of this brief column is to lay out a
summary of important (and, alas, complex) rules
relating to when someone can purchase a Medigap
policy or change to another Medigap policy. And,
of course, any purchase or swap has potential
financial ramifications.
After that brief discussion, we will take a look
at switching in to and out of Medicare Advantage
plans. For more on Medicare Advantage plans,
see my two part article written for the
Coastal Senior
(a Savannah publication) by clicking
HERE (for Part 1)
and
HERE (for Part 2).
As you will see, I'm not particularly enamored
with Medicare Advantage plans.
Medicare Generally
If you are really new to Medicare, it may be
helpful for you to look at my article "Medicare
101". Go there by clicking
HERE.
Remember, I never promised this would be easy!
Medigap Policies
For more background on Medigap plans, you may
wish to read myarticle on Medigap policies
posted on my website by clicking
HERE.
In any event, traditional Medicare
does not pay for everything. As with any other
health insurance, you are expected to meet
deductibles and co-pays. They quickly add up.
That's where Medicare supplemental plans (or
"Medigap" plans) come in. If you plan on using
traditional Medicare (as opposed to enrolling in
a Medicare Advantage plan) do not leave home
without a Medigap policy. You can take a look at
the 2008 Medicare deductibles and co-pays by
clicking
HERE.
There are twelve standardized plan types
(labeled Plans A-L). Each plan provides the same
package of services regardless of the company.
It makes shopping easier. It is important to
note that you must select a Plan C or higher in
order to insure that your Medigap policy will
pay expensive nursing home co-pay amounts ($128
per day beginning in 2008).
Medigap policies are extremely important, but it
is also extremely important to select and enroll
in a Medigap policy during a "guaranteed
enrollment period". Attempting to enroll in a
Medigap policy at other times (perhaps after
several years in Medicare you decide you should
have done it in the first place) can be
expensive . . . even if you locate a Medigap
plan willing to enroll you.
So what is a "guaranteed enrollment period"?
There are certain times when individuals are
guaranteed the issuance of a Medigap policy at
prices that have been reviewed and approved in
each state. You are guaranteed such admission
if:
·
You first become eligible for Medicare Part B.
·
Upon first becoming eligible for Medicare Part
B, you enrolled in a Medicare Advantage plan and
you disenrolled from that plan within the first
twelve months.
·
If you dropped a Medigap policy for a Medicare
Advantage plan and you disenrolled within twelve
months, you are also guaranteed the same
Medigap policy that you first dropped if this is
the first time you have dropped a Medigap policy
for a Medicare Advantage plan. If your old
Medigap policy is no longer available in your
area, you are guaranteed the purchase of either
an A, B, C or F policy.
·
If you move out of the service area of your
Medigap policy, you are guaranteed admission in
to a new Medigap policy of types A, B, C or F.
Medicare Advantage Plans
Medicare Advantage plans are alternatives to
traditional Medicare, and are meant to give
consumers a broad array of service packages and
pricing. Traditional Medicare is maintained by
the federal government and is standardized
throughout the country. Medicare Advantage plans
are offered by approved insurance companies.
It is in this area that confusion will really
begin. Because Medicare Advantage plans are
offered by private companies (with big
advertising and marketing budgets) you will see
a lot of advertising "noise" on television,
radio and in print media.
There are a number of "election periods"
relevant to Medicare Advantage plans.
First there is an initial election period that
consists of the three months immediately
preceding your initial eligibility for Part A
and enrollment in Part B of Medicare. If you do
not elect in during this period, you will be
automatically enrolled in traditional Medicare.
Thereafter there is an annual "coordinated
election period" that runs from November 15
through December 31. During this period you may
enroll in a Medicare Advantage plan, change to a
different Medicare Advantage plan, or return to
traditional Medicare. Please see the rules I
discussed above to see if you qualify for a
guaranteed Medigap policy. You very well may
not, which means you will return to traditional
Medicare with out any "gap" protection.
Not to be confused with the "coordinated
election period" that runs from November 15
through December 31, there is an open
enrollment/disenrollment period that covers the
first three months of the calendar year. Under
this period an individual who has not otherwise
made a contradictory election under the
coordinated election period may opt in to a
Medicare Advantage plan.
Finally, there is a special election period
during which an individual may transfer from a
Medicare Advantage plan back to traditional
Medicare or from a Medicare Advantage plan to
another Medicare Advantage plan. A special
election period applies in a number of "serious"
events: plan termination in the geographical
area, a move out of the service area by an
enrollee, a substantial violation of a material
provision of the plan or there has been a
material representation by marketing
representatives. Under this provision an
enrollee must convince the Centers for Medicare
and Medicaid Services (CMS) of the material
misrepresentation. I am told that it is not the
easiest task in the world.
Happy shopping. I have good news and bad news:
There is plenty of information out there!
Bob Mason
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MEDICARE PART D AND THE DONUT HOLE
-Patricia Shevlin, MD
Medicare D- like it or not - is the only way
most retirees have to pay for medications.
To be fair, the plan has allowed many
retirees access to medications they might
have done without because of cost. The
flipside is that a new anxiety- provoking
situation has been added to their lives: the
donut hole. Every day in my practice I am
told how close a patient is to the donut
hole or how they're trying to manage being
in the donut hole. As this year's Medicare D
re-enrollment time is here, I thought I'd
share my tips for managing expenses under
Medicare D.
-
Switch to generic alternatives or lower
tier drugs in January to stretch those
dollars. Do this in conjunction with
your physician so that the best choices
are made for the patient.
-
Think about using Wal-Mart or Kmart for
the cheaper generics and plan to pay for
them without using Medicare D. This is
especially helpful if the retiree is
going to these stores regularly anyway.
-
To keep prescriptions at one drugstore,
tell the pharmacist not to process the
generic prescriptions through Medicare D
and have the retiree pay for them out of
pocket. The Medicare dollars can be
spent on the more expensive
prescriptions
-
As family members, we can assist the
retirees by offering to pay for the
generic prescriptions or some portion of
them. With the holidays fast
approaching, what better gift can we
give our older relatives than keeping
the donut hole a little farther away.
Patricia A. Shevlin, MD
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WORRIED
ABOUT IDENTITY THEFT?
-Rose deVries,
Darby
Bank & Trust Co.
Identity theft is a serious and growing
problem. Millions of identities -names,
Social Security numbers and credit card data
- are being stolen. In 2005 the Federal
Trade Commission (FTC) ranked Georgia 9th in
the country for identity theft victims.
Nationwide the FTC's online database, the
Consumer Sentinel, received 253,450
complaints (nearly 8,000 from North Carolina
alone).
Because the Consumer Sentinel relies on
voluntary consumer reporting, the FTC
estimates the problem is much bigger,
perhaps as many as nine million per year.
In response, Congress amended the Fair
Credit Reporting Act to allow consumer
protections on credit reports. As a result,
consumers can now place one of three types
of fraud alerts on their credit reports: 1)
initial fraud alert, 2) extended fraud alert
or 3) active military duty alert.
Anyone suspecting that they are or may
become a victim of fraud can request an
initial
fraud alert. Once activated, the
initial fraud alert remains on a credit
report for 90 days. The consumer reporting
agency must include the alert in the file
and provide the alert with any credit score
generated. Under this protection, the
reporting agency is not required to call you
for authorization on new loans or activity
related to your credit.
For actual identity theft victims, the
extended
fraud alert is available. This
more serious alert lasts for seven years and
also requires the alert to be provided with
any credit score generated during that
period. Also, creditors are required to call
or contact the consumer prior to authorizing
new credit accounts. Finally, the consumer
must file an identity theft report with the
police.
Any active member of the service is eligible
for the third type of protection -
active
military duty alert. This
protection is good for 12 months and can be
renewed as necessary. It requires the
reporting agency to include the alert with
any credit score generated. Potential
creditors must then take reasonable steps
toward verifying a consumer's identity.
Thirty-nine states have taken action into
their own hands, allowing consumers to
"freeze" credit reports.
A credit freeze bars lenders and others from
reviewing an individual's credit history.
Because few lenders will issue credit
without first seeing a credit report, fewer
thieves are able to open fraudulent
accounts. A thief may still have access to
your name, birthday and Social Security
number - he just will not be able to access
your credit.
During a freeze, credit bureaus assign a
personal identification number to a
consumer. The PIN allows the consumer to
lift the freeze when necessary. Depending on
the state, reporting agencies may charge a
nominal fee - ranging from $3 to $20 - for
locking down or lifting your credit file
freeze.
Georgia may be ranked ninth in identity
theft, but it has no legislation in place
allowing consumers to freeze their credit
reports. Many feel this measure would give
consumers control over their personal
information thus preventing a majority of
new account fraud.
The last three sessions of the Georgia
General Assembly rejected freeze laws.
In the meantime, Atlanta-based Equifax is
planning to offer consumers a nationwide
file freeze option. Further details have yet
to be disclosed.
While credit freezes may not be available,
the following steps will significantly
reduce your chances of becoming a credit
theft victim.
-
Be cautious when giving out personal
information
-
Protect your incoming and outgoing mail
-
Pay attention to billing cycles
-
Be smart about passwords and PINs
-
Protect your computer
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Check your credit reports
-
Shred documents with personal
information
-
Cancel unused credit card accounts
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Do not carry your Social Security card
with you
-
Don't leave a paper trail of receipts
Every 79 seconds, a thief steals someone's
identity and goes on a buying spree. On
average, a single theft ends up costing the
victim $1,000 in out-of-pocket expenses and
can cost businesses more than $10,000.
Protect yourself. Save your time and money -
and keep your good name intact.
Rose de Vries, JD, is Vice President of
Private Banking Services for Darby Bank &
Trust Co. (offices in Vidalia, Lyons, Pooler
and Savannah, Georgia). Rose is based in
Darby's main Savannah office. You may email
comments and questions to Rose by clicking
HERE
or by giving her a call at 912-944-2612.
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 MORE
ON CHANGES AND GAPS
-Warren Coble
The Centers for Medicare and Medicaid Services
has announced the 2008 Medicare changes, and
once again confusion will reign with Part D and
Advantage plans that CMS has dropped, added, or
changed.
Unfortunately, there are still NO Part D plans
that provide effective gap coverage except for
generics. Costs on some plans have escalated
greatly. You owe it to yourself (or your loved
one) to check out your plan to see if it is
still effective for you. It may not be.
Past issues of this newsletter have pointed to
the pitfalls of Medicare Advantage Plans. (you
can reach the Elder Law Update archives by
clicking
HERE). With those plans you must understand
WHAT you are buying. Advantage plans, while
considered a part of Medicare (Part C), operate
differently from the rest of Medicare. Many of
these plans are being marketed as "the same
benefits as Medicare" without the premium
required for supplements. While technically true
in the sense these plans provide hospital,
doctor, and nursing home coverage, the manner in
which the payments are made varies greatly from
both Original Medicare and between individual
Advantage plans. Confusion remains rampant
regarding coverage issues.
Generally, enrollment in Part D plans and
Advantage plans are for an entire calendar year.
Another limitation of Advantage plans is that
the plan cannot be used to obtain medical
services in a county where that particular plan
is not offered.
Another important note: With Private Fee for
Service plans (PFFS) the patient is responsible
for determining at each visit if their provider
is still accepting their particular plan.
Providers are allowed to "pick and choose" who
they will accept, and when they will accept a
particular plan. Because of this, many consumers
are at risk of having to change doctors, or
having non-covered services.
Before enrolling or changing plans, understand
the benefits and limitations. Counseling is
available through the State Health Insurance
Information Program in each State. In North
Carolina, call 1-800-443-9354. In Georgia, call
1-800-669-8387. Information is also available on
the SHIIP websites as well as the Official
Medicare Website, WWW.MEDICARE.GOV. I am
available for private consultation, if desired
and can help individuals by phone and email as
well as personal contact. Just send me an email!
Social Security expert Warren Coble welcomes
your questions regarding Medicare, Social
Security and Senior Life in general! Email
Warren by clicking
HERE. |
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The Usual Disclaimer:
This newsletter is for general information only.
Please do not rely on anything you read in this
email as definitive legal advice applicable to
you. All situations are different, including
yours. Nothing you read in this newsletter is a
suitable substitute for professional advice you
may receive from your attorney, your accountant,
or your tax advisor.
All contents copyrighted 2007 by Mason Law, PC.
Contents may be republished with written
permission of Mason Law, PC (which permission
will usually be given!). |
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