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Medicare

Wednesday, November 27, 2013

Nursing Home Care for Veterans

Nursing Home Care for Veterans

The VA provides “Community Living Centers”, or what used to be called Nursing Homes.  These are operated by the VA, and are usually in a Veterans Administration Hospital.  These Community Living Centers (CLC’s) provide rehabilitation for veterans recovering from injury and illness in the short-term, but also provide long-term skilled nursing care for veterans who need care for long periods of time for a service-connected injury.

For veterans rated at 70% service-connected or higher, or for those who need nursing home care for their service-connected injuries, the VA pays for their nursing home placement as part of their package of healthcare benefits.

The CLC’s are available for non-service connected veterans who are enrolled in VHA healthcare, and need short term services such as rehabilitation, hospice, respite, and for those waiting for placement in the community.

VA provides care to veterans based on a priority system.  There are currently 8 categories of veterans based on service- connection and financial need.  For example, a veteran who is 50% service-connected or higher is in category 1.  A non-service connected veteran with significant assets and income is most likely going to be enrolled in category 8.

Veterans in category 1 will be eligible for placement in a CLC, and will not have a co-pay, but those in category 8 will be placed in a CLC only if there is availability and no one in a higher category needs the bed.  The veteran in category 8 will pay a daily co-pay for services in the CLC.

In Atlanta, the CLC is located in the VA hospital on Clairmont Road, and is almost always full to capacity with a waiting list.  For those veterans for whom nursing home care is not part of the package of medical benefits, they may be able to find placement in one of the two Georgia War Veterans Homes.

The two Georgia War Veterans Homes in Georgia are not run by the national VA, but are available to veterans.  The Georgia Department of Veterans Services and the Georgia Health Sciences University operate the Georgia War Veterans Nursing Home in Augusta.   The Georgia War Veterans Home in Milledgeville is operated by United Veteran Services of Georgia, Inc., which operates the home for the Georgia Department of Veterans Services. 

In order to be eligible for admission to a Georgia War Veterans Home, the person must be domiciled in Georgia, and must have resided in Georgia for the five years immediately preceding admission.  He or she must have been a “war veteran”, defined as any veteran who served on active duty in the Armed Forces of the U.S. during wartime or during the period between January 31, 1955 and May 7, 1975.  In addition, the U.S. Department of Veterans Affairs must approve them as “eligible for care and treatment”.  Veterans accepted into the Georgia War Veterans Homes will be required to pay some expenses such as Medicare or health-care insurance deductibles and co-pays.  The forms to apply for admission to the Georgia War Veterans Homes are found at veterans.georgia.gov/gwvh-forms.


Friday, November 15, 2013

Veterans Eligible for Both VA Healthcare and Medicare? Who Pays What?

Eligible for both VA and Medicare? 

Who pays what?  Do I need insurance if I’m eligible for VA healthcare?

You’ve been approved for VA Pension or Compensation, and you will be receiving healthcare and prescription drugs at the VA facility.  You also have Medicare part B and Medicare part D.  Do you need both? 

Medicare Part A pays for inpatient hospital care for up to 90 days per benefit period, skilled nursing care partial pay for up to 100 days each benefit period, home healthcare for up to 100 days, and hospice care.

Medicare Part B pays for doctor’s visits, ambulance services, preventive care services, and durable medical equipment, as well as many other services.

Medicare Part D pays for outpatient prescription drugs.

For veterans that qualify, the VA provides care in VA healthcare facilities, as well as contract care in other facilities when the VA cannot provide the required care.  The VA authorizes care at non-VA facilities when necessary medical services are not routinely available at a VA facility, or the VA determines that the services can be obtained more economically outside the VA.  The non-VA care must be authorized by the VA in advance.

Unless the veteran has other healthcare, or his or her healthcare is being provided by the spouse’s employer, once he or she turns 65 she must enroll in Medicare Part B and D.  If she does not enroll at age 65, when and if she finally enrolls, she will have to pay a Part B and/or a Part D premium penalty which increases for every year she does not enroll in the programs.

The veteran may want to enroll in Part B in order to receive healthcare services from Medicare approved providers that provide services he may not be able to receive in a VA facility.  In that case, it is important to enroll at age 65. 

If the veteran is eligible for prescription medications from the VA, he may choose not to enroll in Medicare Part D.  VA prescription coverage is considered “creditable”, meaning it is as good, or better, than Medicare Part D coverage.  What that means for the veteran is that he can delay enrolling in Part D and not suffer a penalty.  However, if the veteran loses his prescription coverage, he has 63 days to enroll in a Part D plan or he will be penalized. 

When deciding whether or not to enroll in Part D, the veteran should consider if he will get all of his prescriptions from the VA.  The VA will only provide coverage of the drugs the veteran receives from the VA.  A veteran is eligible for the prescription benefit if he or she is enrolled in and receiving health care from the VA.  The prescriptions must be written by a VA health care provider, or a VA-authorized provider.   A VA health care provider will review prescriptions written by a private health care provider to determine whether the VA can rewrite the prescription and dispense it from a VA pharmacy.  Most prescriptions can be mailed to the home, or can be picked up at the VA pharmacy.  Depending on what priority category the veteran is in, he or she may have a co-pay for each prescription received.  Co-pays for prescriptions are between $8.00 and $9.00 per prescription.


Monday, March 18, 2013

Come hear Patti speak Tuesday, March 26th!

Come join us at the Tapestry House of Alpharetta Tuesday, March 26th at 6:30pm.

Patti will be speaking about the difference between being housebound with a  caregiver vs moving into an Assisted Living Facility. 

All are welcome!

 

 

 

 

 


Monday, January 21, 2013

Can A Special Needs Trust Pay for things such as Credit Card Bills or Security Deposits?

   Administering a "special needs" trust can be a challenge. The rules often seem vague, and they occasionally shift. What may seem like a simple question might actually involve layers of complexity. Sometimes expenditures might be permissible under the rules of, say, the Social Security Administration, but not acceptable to AHCCCS, the Arizona Medicaid agency -- or vice versa. Trustees work in an environment of many constantly-moving parts.

Take these two examples:

Example 1:  Being the trustee of a Self-Settled Special Needs Trust for a sister. Can you pay her credit card bills?

Maybe (don't you just love lawyers' answers?). Let's break the question down a little bit.

    First, identify the trust as "self-settled." That means the money once belonged to your sister (it might have been an inheritance, or a personal injury settlement, or her accumulated wealth before she became disabled). That also means the rules are somewhat more restrictive.

We will assume that the bills are for a credit card in her name alone. If the card belongs to someone else, the rules may be different. Not many special needs trust beneficiaries can qualify for a credit card; when they can, it can be a very useful way to get things paid for (as you will soon see).

The next question requires a look at the trust document itself. It might be that it prohibits payments like the one you would like to make. That would be uncommon, but not unheard of. We will assume that the trust does not expressly prohibit paying her credit card bills.

What benefits does your sister receive? Social Security Disability and Medicare: Not a problem.But if it is Supplemental Security Income (SSI) and AHCCCS (Medicaid) there could be a problem.

    Next, we need to know what was charged to the credit card. Was it food or shelter? If it was used for meals at restaurants, or grocery shopping, or for utility bills, you probably do not want to pay the credit card bill from the trust. If you do (and assuming the trust permits it) then you will face a reduction of any SSI she receives, and possible loss of AHCCCS benefits.

Were the credit card bills for clothes, medical supplies, gasoline for her vehicle, even car repairs? There is probably no problem with paying the credit card statement. Even home repairs should be OK in most cases (just not rent, mortgage, utilities, etc. -- and the rules might be different if anyone else lives with your sister).

As you can see, what started out as a simple question turns out to have a lot of complexity. You might want to talk with a lawyer about your sister could use the credit card. When it works, though, it can be quite beneficial.

Example 2: Can a special needs trust pay the security deposit on a new apartment?

What an interesting question. We think the answer is probably "yes."

Once again we need to look at the trust document itself. Was it funded with your own money (like a personal injury settlement), or was the trust set up by a relative or friend with their own money? Is there language prohibiting payment for anything related to your apartment?

Assuming no trust language prohibits the payment, we can turn to the effect such a payment would have on your benefits. Social Security Disability and Medicare? Once again, no problem. SSI and AHCCCS/Medicaid? Your benefits might be reduced, but the payment can probably be made.

The key question is whether a "security deposit" is "rent." Arguably, it is not, rather it is an advance payment for cleaning. A special needs trust, even a self-settled special needs trust ,can pay for cleaning. Social Security's rules treat payment of "rent" as what's called "In-Kind Support and Maintenance (ISM)." This payment, we think, should not be characterized as ISM.

If it is not ISM, then it should have no effect on your SSI or your AHCCCS benefits. If it does, it might simply reduce your SSI payment (by the amount of the deposit, but capped at about $250). So long as you still get SSI it should not have any effect on your AHCCCS benefits.

Are these rules unnecessarily complicated? Yes. Does it sometimes end up costing more in legal fees to figure out what to do than it would to just pay the bills? Yes. Welcome to the complex world of Special Needs Trust Administration. Would it be possible to write simplified rules that allowed limited use of special needs trust funds while saving a bundle on administrative expenses? Yes, but please don't hold your breath while waiting for them.

 


Wednesday, January 2, 2013

The start to a new life for the Mentally Disabled

   It is a new strategy for Georgia, one of several states responding to mounting pressure from the Justice Department, which in recent years has threatened legal action against states accused of violating the civil rights of thousands of developmentally disabled people by needlessly segregating them in public hospitals, nursing homes and day programs.

   For a family with a loved one who is mentally disabled, one of the hardest decisions they will have to face is determining the proper care for their loved one. Until recently, many mentally disabled persons have been placed in hospitals to live for the rest of their lie. While they are under constant care, there are social elements that are missing when living in a hospitals. These social elements, such as sense of community, friendships, and acitivies like dancing, are essential for personal growth.

  The link below is a story that exemplifies the importance of providing better living options for those who need it most.

 

 

 

http://www.nytimes.com/2012/09/30/us/ending-segregation-of-the-mentally-disabled.html?pagewanted=all&_r=0


Monday, November 26, 2012

IRS Issues Long-Term Care Premium Deductibility Limits for 2013

IRS Issues Long-Term Care Premium Deductibility Limits for 2013

The Internal Revenue Service (IRS) is increasing the amount taxpayers can deduct from their 2013 taxes as a result of buying long-term care insurance.

Premiums for “qualified” long-term care insurance policies (see explanation below) are tax deductible to the extent that they, along with other unreimbursed medical expenses (including Medicare premiums), exceed 7.5 percent of the insured’s adjusted gross income. This threshold is rising to 10 percent on January 1, 2013, although it will remain at 7.5 percent for taxpayers 65 and older through 2016.

These premiums — what the policyholder pays the insurance company to keep the policy in force — are deductible for the taxpayer, his or her spouse and other dependents. (If you are self-employed, the tax-deductibility rules are a little different: You can take the amount of the premium as a deduction as long as you made a net profit; your medical expenses do not have to exceed a certain percentage of your income.)

However, there is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for 2013. Any premium amounts for the year above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year Maximum deduction for year
40 or less $360
More than 40 but not more than 50 $680
More than 50 but not more than 60 $1,360
More than 60 but not more than 70 $3,640
More than 70 $4,550

Another change announced by the IRS involves benefits from per diem or indemnity policies, which pay a predetermined amount each day.  These benefits are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $320 per day (for 2013), whichever is greater. (The 2012 limit was $310.)

What Is a “Qualified” Policy?

To be “qualified,” policies issued on or after January 1, 1997, must adhere to certain requirements, among them that the policy must offer the consumer the options of “inflation” and “nonforfeiture” protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as “qualified” as long as they have been approved by the insurance commissioner of the state in which they are sold.

The Georgetown University Long-Term Care Financing Project has a two-page fact sheet, “Tax Code Treatment of Long-Term Care and Long-Term Care Insurance.” To download it in PDF format, go to: http://ltc.georgetown.edu/pdfs/taxcode.pdf


Monday, November 12, 2012

Seniors Beware: How Much Salt are you Eating?

      Just like with most things in life, salt is best in moderation. Salt has been around for thousands of years and has served multiple purposes from being a means to preserve meats to adding flavor to a dish. But did you know that too much salt can create health problems including high blood pressure and heart disease? It is not just the french fries or the potato chips that we have to watch out for, but items that are packadged and heavy card-based.  On National Eating Healthy Day, the American Heart Association developed a list of six items that we should be mindful of consuming because of their above average levels of sodium. Please click the link to find out what are the 'Salty Six'.

 

http://seniorjournal.com/NEWS/Nutrition-Vitamins/2012/20121107-Seniors_Take_Heed.htm


Sunday, December 4, 2011

Medicare: Treat it as Part of Your Financial Plan

 


Medicare changed things up a bit this year by scheduling open enrollment early.  Because Medicare is in the news, I’ve been getting a lot of calls from clients to ask me about Medicare. While most people understand that they can become eligible for Medicare when they turn 65, they wonder about the types of Medicare plans available, and what plan they should choose.  Today, we’ll talk a little bit about the basics of Medicare, and about how to choose a Medicare Part D prescription drug plan.

Here is the basic Medicare alphabet:

Medicare Part A covers hospital insurance that can help pay for inpatient care at hospitals, skilled nursing facilities, hospice, and home health care.

Medicare Part B covers medically-necessary service such as doctor’s services, outpatient care, home health services, and some other services.  You will pay a premium to be covered by Part B.

Medicare Part C is a Medicare Advantage Plan.

Medicare Part D is the prescription drug coverage.

In order to become eligible for Medicare, you must be age 65, or you must have been receiving Social Security Disability benefits for 24 months.  Most people who are on Social Security or Railroad Retirement benefits will automatically get Medicare Part A and B starting on the first day they turn 65, or when they have completed the full 24 months after beginning to receive Social Security Disability.  One exception is that if you have ALS – Lou Gehrig’s disease- you are eligible for Part A and B in the month your disability begins.

Every year, for those who are qualified for Medicare, there is an open enrollment time when you have the ability to sign up for a new Medicare Part C or Part D plan. 

Normally, the open enrollment period begins in January.  However, this year the open enrollment period began on October 15 and ends on December 7.  If you want to know when to enroll in Social Security Part A and Part B, and when to enroll in Part C and Part D here is a handy chart:  http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf

Medicare Part D is probably the most confusing of the Medicare Alphabet Programs.  Medicare Part D is the program that offers prescription drug coverage to those who are qualified for Medicare.  In order to get the drug coverage, an eligible person must join a plan.  The plans are run by private insurers or other private companies approved by Medicare.

Medicare Part D is available if you are otherwise-eligible for Medicare A & B.  If you don’t enroll in Part D when you become eligible, you might have to pay a slight penalty when you do join at a later date.  You can enroll in two basic types of plans:  Medicare Prescription Plans or Medicare Advantage Plans.  The Medicare Advantage Plans are usually HMO’s or PPO’s that give you all of your Part A and B coverage, and in addition may give you drug coverage.  If you choose another Part D plan while already enrolled in a Medicare Advantage Plan that offers a drug plan, you may become disenrolled from your HMO or PPO plan and returned to regular Medicare.

How can you choose the right Medicare Part D plan?  The plans are run by private insurance plans, or private companies, and the cost of the plan is generally based on the prescriptions you use, the “formulary” of the plan, and whether you go to a pharmacy that is within your plan’s network.  The formulary is the list of drugs that a Medicare plan covers.

The Medicare.gov website is full of information about the plans that are available, and is also full of advice on how to choose a plan.  To choose a plan, you can enter your zip code and your prescriptions in the formulary finder on Medicare’s website.  http://plancompare.medicare.gov/pfdn/PlanFinder/DrugSearch.  The plan finder will then give you a list of providers and will tell you the cost of the plan and the cost of the drugs.  You can then call the providers with any questions you might have.

Erica Dumpel, with Czajkowski Dumpel & Associates, Inc. http://cdainc.net/ an experienced healthcare plan advisor, emphasizes that you should research the plans on a yearly basis.  If you have a number of prescriptions, hunting down the right plan can take a lot of time – but can also save you a significant amount of money each year. 

If you miss this year’s open enrollment period, or if you decide not to change plans, be sure to put a reminder on your calendar to review your plan again next year.  In fact, I recommend that you schedule a yearly financial and legal checkup, which should include a thorough review of all of your insurance premiums, co-pays and prescription costs.

Will you start treating your Medicare Plan as part of your Financial Plan?

 

 

 

 

 

 

 

 


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