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Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



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Thursday, June 22, 2017

How Safe is My Mother from Financial Exploitation?


 

Jennifer’s 80-year-old mother seemed to be running low on funds every month.  By the end of the month, she had no money for groceries.  Jennifer had helped her mother with a budget, so she thought her mother had plenty of money to make it through each month.  When she asked her mother to allow her to look at her bank statements, though, Jennifer discovered a series of automatic debits to several companies she did not recognize.  It turns out, her mother had signed up for monthly book delivery clubs, as well as recurring magazine subscriptions for magazines Jennifer knew her mother did not read.
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Thursday, June 1, 2017

Important Things You Should Know Before Deciding to Seek Guardianship or Conservatorship of an Adult


What exactly is a guardian, what is a conservator and when should you become the guardian or conservator of an adult?

Aunt Mary is 86 years old and has always been a little eccentric, but lately she’s been giving money to John, a much younger man that she calls her special friend.  Aunt Mary says that she knows her family doesn’t approve of her giving him money and gifts, but she has plenty of money, John has been her friend for many years, he has always helped her with her home and yard, and she doesn’t have anyone else she would rather spend her money on.  Does she need a guardian or conservator?

What is a guardian and conservator?

A guardian is a person who is legally responsible for someone who is not able to manage his or her own affairs. Guardians and conservators are appointed by the judge of the probate court in the county in which the person in need of a guardian/conservator, called a ward, resides or can be found.

In Georgia, a guardian is the term that is used for the person responsible for managing affairs related to the health and safety of the ward, while a conservator is responsible for the financial affairs of the ward.


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Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
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Thursday, December 3, 2015

Important Things You Need to Know About Medicare Part D

 

This year, a relative of mine had two issues that affected her prescription plan.  First, she was diagnosed with an illness and prescribed new drugs.  Second, she forgot to pay her Medicare Part D premiums and lost her prescription coverage.  How do you choose a Medicare Part D plan?  How do changes in medication affect the Part D insurance plan a participant might choose?  

Medicare Part D is the health insurance that covers prescription medication for outpatient drugs.  Part D is a fairly recent addition to the Medicare Alphabet, having been added in 2006.  This plan seems incredibly confusing, and it can require some research to determine the best plan for each individual.

Medicare Part D is a federally subsidized drug benefit.  The participants will pay a monthly premium to an insurance company that has contracted with the government.  In 2015, the average premium is around $33.15 per month.  After a participant has paid the deductible $320.00, the participant will pay 25% of the cost of the drugs until the total cost of the prescription drugs has reached $2960.  The federal government pays $2,220 of this amount and the participant will pay $760.  

But how to choose a Medicare Part D plan?  Medicare has a pretty powerful program online that can help you make the decision.  Go to www.medicare.gov/find-a-plan.  It will ask you to enter the zip code of the participant, and then will ask for all of the medications the participant is taking, the dosage of the medications, and the number of pills purchased each time.  It will also ask for the pharmacy where the participant usually purchases the drugs.  Once all of that information is entered into the find-a-plan site, the site will spit out a list of plans with comparative information including the cost of premiums, the annual drug deductible, the estimated annual drug costs, and the rating of the plan based on 3 out of 5 stars assigned by Medicare. Medicare sometimes assigns a 5-star rating for a Part D insurance plan that will be indicated by a yellow star with a 5 in the middle next to the Medicare Part D plan.   Once you have entered all of the information, you can compare the costs of the various plans.  Of course, the information is only valid if all of the drugs in the correct dosages are entered into the system.  Be sure to check to see whether the cost of the drugs will go up during the year.  Usually, the cost of the prescription drugs goes down once the deductible is met, and goes up again when the participant hits the donut hole at $2960.

The participant will have to go to a pharmacy in the plan’s network in order to get the lower price you expect to pay. 

Not everyone needs a Medicare Part D plan.  Some retirees may have coverage under their retirement plans, veterans who qualify for free or reduced price medications may not need the coverage. That is called “creditable coverage.”  If you do need it, though, and don’t sign up for it when eligible, you will be charged a penalty when you do finally sign up.  The penalty is at least 1% for every month you delay enrolling past the Initial Enrollment Period.

 

 

 

 


Thursday, November 19, 2015

What You Should Know About Medicare Part B

 

Medicare Part B pays for doctor’s services, whether in their offices, the hospital, your home or other settings, and lab tests, screenings, medical equipment and other supplies. 

You will pay a monthly premium, which may be deducted from your Social Security, Railroad Retirement or Civil Service check.  If the premiums are not deducted from your retirement or disability check, you will be required to pay premiums quarterly.  In 2015, the monthly premium for most recipients was $104.90, though the premiums are higher if your annual income on your individual tax return is over $85,001 or on your joint return it was over $170,001.  The highest premiums in 2015 are $335.70 per month.

Once you pay the premium, there is a deductible and a coinsurance amount that you will pay.  The yearly deductible is $147, and the coinsurance amount is 20% of the Medicare-approved amount that is charged by the providers. 

For example, if you visit a doctor and the doctor accepts assignment from Medicare, the doctor agrees to accept the amount that Medicare has approved for the service.  Medicare pays 80% of the cost and you will pay 20%.  If the doctor accepts Medicare patients, but not an assignment, the doctor can charge you up to 15% more than the Medicare approved amount and you will have to pay the extra amount unless you have a Medigap policy.  If the doctor does not accept Medicare, Medicare will not pay for the service and you will be responsible for the entire amount of the service provided.  Medigap insurance won’t pay for the cost of a doctor who has opted out of Medicare.

Do I have to have Medicare Part B?  You are not required to sign up for Medicare Part B, but you will be responsible for paying privately for the services covered by Part B (unless you have a Medicare Advantage Plan) if you have chosen not to sign up.  If you don’t enroll in Part B when you turn 65 and enroll in Part A, when you do sign up for Part B you may be have to pay a higher premium for Part B.  The premium can go up 10% for each 12-month period that you could have been enrolled in Part B.  If you have insurance through an employer or have a union group health insurance plan that is your own, a spouse’s or a family member’s (if you are disabled), you do not need to sign up for Part B if that insurance will be the primary insurer.  If the plan is not the primary insurer, and Medicare is the primary, you will need to sign up for Part B.

Note that Cobra coverage does not count as employer coverage.

 

 

 

 

 


Thursday, November 12, 2015

UNDERSTANDING THE BASICS OF MEDICARE PART A

 

Medicare Part A is known as hospital insurance.  That term may be misleading, however, because services provided in the hospital by doctors, anesthetists, and surgeons are covered by Medicare Part B.  Part A covers nursing care, such as care provided by professional nurses, a semi-private room, meals, lab tests, prescription drugs, medical appliances and supplies, rehabilitation therapy.  Services provided for home health care, when you qualify, or hospice care are also covered under Part A.

Generally, the Part A premiums are paid for by the Medicare taxes withheld from your paycheck if you or your spouse has worked enough to qualify for 40 or more work credits.  If you have not worked long enough to earn the 40 credits, you may pay up to $407/month based on the number of credits earned during your employment.

You can qualify for Medicare Part A if you are age 65 or if you are disabled and qualified for Social Security Disability Insurance for 24 months. 

Most people assume that Medicare will cover the cost of all health care once you reach 65.  That is not truly accurate.  Although the premiums for Part A may be “free” because you or your spouse paid through the payroll deductions from your paycheck while you were working, in most circumstances you will be required to pay a co-pay or co-insurance.  In addition, you will be required to meet a deductible of $1,260 for each hospital benefit period in 2015.  What is a hospital benefit period?  That is the period from when you are admitted to a hospital and ends when you have been out of the hospital for 60 days in a row.  After the deductible is met, Medicare will pay for the full cost of the hospital care for 60 days.  If you go home from the hospital before the 60 days are up, but are readmitted during that 60 days, the costs of the stay will be covered.  After 60 days and before day 90, you will pay $315 for each day of the benefit period.  After 91 days, you will pay $630 per day.  (These are the 2015 costs.  The 2016 rates will most likely be higher.)

What about admission to a Skilled Nursing Facility (SNF)?  Medicare will pay the full cost of Days 1 through 20 in a SNF.  From Day 21 through 100, you must pay a daily co-pay of  $157.00 (These are 2015 costs.)  and from Days 101 on you must pay all of the costs. Before Medicare will pay for your stay in the SNF, however, you must be admitted to the hospital for a 3-day inpatient stay.

You can buy a Medigap policy to cover some of the Part A deductibles and co-pays.  If you are admitted to a SNF, long-term care insurance may cover some of the costs of your care.

Open enrollment for Medicare plans is October 15 through December 7th, 2015.  At that time, you can compare Medicare Advantage (Part C)  plans to regular Medicare plans to determine which option is the best one for you.

 

 

 

 


Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


Thursday, July 23, 2015

Four Ways to Pay for Long-Term Care

Concerned about how your parents will pay for their long-term care?  Here are the four basic ways to pay for care.


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Thursday, July 16, 2015

The Zen of a Family Meeting: The Five Things You Must Cover When Planning for Your Aging Parents’ Care

 

 

July is Sandwich Generation Awareness Month.  The Sandwich Generation refers to those people, mostly in their mid-40’s to late 50’s, who are caring for aging parents as well as caring for young children or dependent young adult children.  If you are the meat or peanut butter in that sandwich, you might be looking for help from your siblings or other family members.  One of the best ways to plan the care for an aging or disabled family member is by holding a family meeting.  The meeting is designed to do many things:  get information from the aging or disabled person about their needs, figure out what kind of care is needed and brainstorm about ways to find that care, gauge the financial resources available for care, and assign duties to various family members so that one caregiver does not get burned out.

Who should attend the meeting?  I recommend that all of the parents and siblings attend a meeting, preferably where they can meet face to face to talk about the issues facing the aging parent now, and those issues that may come up in the future.  If grandchildren, aunts and uncles or friends will be responsible for some of the care, invite them along.    The parent or person with a disability should be in attendance so long as they are physically able to be there. 

It is usually best to hold the meeting in a neutral place, such as a meeting room in a hotel or community center.  I also recommend there be a fairly impartial facilitator to keep the meeting on track, if possible.  And, there should be plenty of snacks and drinks so people won’t want to leave before you’ve discussed all the important points.

With so many families spread out over the world, it can be difficult to get everyone together.  If the family has a regular family reunion, perhaps the reunion time can be extended to allow the family to get together for this meeting.  If there is no regularly scheduled reunion, you can use scheduling programs such as www.doodle.com to find out when the most attendees will be available. If some family members absolutely cannot meet in person, you can use tools such as Skype www.skype.com or Google Hangouts www.google.com/hangouts‎ to bring those other family members in by video.

Once you have set the time and place, have everyone agree to an agenda.  Appoint someone to come up with a proposed agenda in advance of the meeting, and then circulate that proposed agenda for comments, additions and changes.

Here are the five basic items that should be covered in the meeting:

 

  1. The Health and Safety of the aging parent or person with a disability

     

    How do they feel about their own healthcare and safety and what are they concerned about?

    Are there any disease or illness diagnoses?

    Are they paying attention to personal hygiene?

    Have there been any instances where the safety of the parent has been compromised, such as falling, leaving the stove on, wandering, etc.?

    Who are their physicians, dentists, therapists, professional and volunteer caregivers?

    What medications are they taking and are they remembering to take them regularly? 

     

    What health insurance do they have?  If they are on Medicare, is there supplemental insurance or prescription medication coverage?

    How are the premiums paid and is there someone who will be informed if the premiums are not paid?

     

    How are their finances? 

    What financial resources do they have? 

    What are their regular bills and how do those bills get paid?  How will you know if they forget to pay the bills?

     

  2. The current living and care arrangements, whether those arrangements are working, and a plan for future living arrangements

 

 If the parent’s condition is changing, what living and care arrangements will be necessary in the future?

How will you find appropriate housing and care?

 

  1. The legal documents do they have and the legal documents they need

     

    Who is their lawyer and when was the last time they saw a lawyer?  Where are the legal documents stored?

    Who is named as Agent, Personal Representative, etc. in those documents?

    Who are their beneficiaries on their IRA’s, 401(k)’s, life insurance policies and annuities?

     

  2. A plan to pay for long-term care

    Is there long-term insurance available?  If so, what are the terms?  Where is the policy and how are the premiums paid for? 

    If there is no long-term care insurance, can the parent or person with disability afford to pay for care by him or herself?  Are there any government programs, such as Veterans benefits or Medicaid, that can help pay for long-term care?

     

  3. The family caregivers – who will do what and when

Sometimes family members volunteer to perform the tasks for which they have talent.  The brother who is a nurse may be the natural fit for the person to oversee the parent’s healthcare and the sister who is the CPA will take over the finances.  What if it isn’t so clear or if no one wants to take on the tasks?  Can people be hired to perform some of the tasks such as paying the bills? 

Can the family agree that it may not be fair to one of the children to take on all of the responsibility for care?

If one family member is taking on the bulk of the care, can the others agree to take a turn to provide relief to the primary caregiver? 

 

The topics may vary from family to family, and for those families who may find it especially hard to discuss these items you might consider having a professional or a mediator to assist in these discussions.

 

 

 

 


Tuesday, July 1, 2014

VA Improved Pension and Medicaid

 

 

Joe, an 89-year-old veteran served in WWII.  He and his wife, Mary, have been living in an assisted living facility for three years and Joe has been receiving VA Pension with Special Monthly Pension for Aid and Attendance.  Joe recently fell, and his physician has decided Joe cannot return to the assisted living facility.  Joe is now in a Nursing Home and needs to apply for Medicaid to cover the cost of his care.   

 

VA Pension Benefits can be a lifesaver for veterans or their surviving spouses who need home care or assisted living facility care.  The added money the VA awards eligible veterans or their surviving spouses when added to social security income is often just enough to help a veteran or spouse afford to stay at home with companion care or be able to move to a good assisted living facility (ALF). 

 

When a veteran, his or her spouse or surviving spouse needs skilled nursing care in a skilled nursing facility or nursing home, though, the VA Pension is often not enough to cover the cost of that level of care.  The average cost of a semi-private room in a nursing home in Georgia is about $181.00/day or about $5430.00 for a 30-day month, according to the MetLife Survey of Long-Term Care Costs published in November of 2012.    For 2014, the maximum VA Pension award for a married couple is $2085.00. *(This maximum amount includes Basic Improved Pension plus Special Monthly Pension for Aid and Attendance).  Currently, the Social Security Administration estimates that the average Social Security benefit for an aged couple when both are receiving benefits is $2,111., while the average for a single aged widow or widower is $1243 per month.   Since the combined VA Pension and Social Security rarely exceed the $5000 monthly price tag for a nursing home stay, the veteran or spouse may need to qualify for Medicaid in order to afford to live in the nursing home. 

 

Medicaid is a federal/state program available to people with low assets and income who meet the physical requirements for admission to a nursing home.  Generally, that means that the person is deficient in some of the activities of daily living.  While circumstances vary, usually a Medicaid recipient pays his or her monthly income to the nursing home, and then Medicaid pays the difference up to the amount Medicaid has contractually agreed to pay the nursing home. 

 

A single veteran who qualifies for Medicaid will have his entire VA pension benefit reduced to $90.00.  If a veteran is married and qualifies for Medicaid, whether or not he can continue to receive Improved Pension will depend on whether his spouse’s income is sufficiently reduced by unreimbursed medical expenses to make them eligible for the Improved Pension award. 

 

A married veteran can still receive the VA pension benefit and the additional part considered to be aid and attendance, so long as he would be otherwise eligible for the benefit.  If the income of the couple is less than the pension amount, the award can be apportioned to the spouse who is not in the Nursing Home and receiving Medicaid.

 

If Joe goes into the Nursing Home and begins receiving Medicaid, his Pension with Aid & Attendance can be apportioned for Mary to spend on her Assisted Living Care. 

 

 

 

 


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The Elrod-Hill Law Firm,LLC assists clients with Estate Planning, Veterans Benefits, Medicaid, Elder Care Law, Probate, Special Needs Planning and Pet Trusts in the North Atlanta area including the counties of Dekalb, Gwinnett and Fulton.



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