Most people should sign up for Medicare when they reach 65; if they wait until later, they have to pay a significant penalty when they do sign up. There’s an exception, though, for people who are still employed at age 65 and are covered by a group health plan. These people can delay signing up for Medicare without a penalty. [Read more…]
In a major change, the federal government has agreed to provide seniors who have chronic illnesses and disabilities with Medicare coverage for many services … even if those services will simply maintain the person’s present health status and aren’t likely to improve their condition.
This is very important news for people who have diabetes, heart disease, Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, arthritis, or the effects of a stroke, among other medical conditions.
Soon, these seniors may be able to obtain Medicare coverage for care in a skilled nursing facility, as well as home health care and outpatient therapy.
For decades, Medicare had a “rule of thumb” that coverage for these services was available only if they were likely to lead to an improvement in the patient’s condition. This resulted in many people with chronic illnesses being unable to obtain coverage for treatments that were critical to maintaining their health, but that didn’t promise a cure or improvement.
According to the government, treatments that weren’t likely to lead to improvement were considered “custodial care,” which Medicare doesn’t cover.
But in January 2011, a group of seniors and some elder advocacy groups brought a nationwide class action lawsuit against the government. They argued that this policy violated their rights, because the “rule of thumb” against covering such services never actually appeared anywhere in the Medicare laws.
The government tried to have the case thrown out, but recently a federal judge rejected that request and allowed it to proceed. Shortly afterward, the government agreed to settle the case by expanding Medicare coverage.
The settlement is being reviewed by the court, and it’s still unclear exactly when the policy change will go into effect. It’s also unclear whether the change will apply just to future claims or to claims going all the way back to January 2011.
Under the terms of the settlement, patients who have “plateaued” in their treatment but still need the assistance of a skilled professional such as a nurse or therapist will be eligible for all of Medicare’s standard benefits. Seniors who are enrolled in Part A, which covers hospitalizations, will be eligible for up to 100 days in a skilled nursing facility (as long as it follows a three-day hospitalization), as well as up to 100 home visits following a hospitalization. Seniors who are enrolled in Part B, which covers doctor visits and other outpatient services, are eligible for potentially unlimited home visits.
It’s not completely clear to what extent the new policy will increase Medicare coverage for dementia. Many seniors with dementia simply need custodial care – unskilled help with routine activities of daily living such as eating, dressing, and bathing – and this kind of unskilled care wouldn’t be covered under the settlement.
However, if the services of a skilled professional might delay the progress of dementia, then those services might be covered. For example, Medicare might now cover occupational therapists who specialize in helping dementia sufferers.
In addition, Medicare might also begin covering speech therapists who teach stroke and Parkinson’s patients how to regain their communications skills. If you’d like to discuss all the ways Medicare is available to cover your or a loved one’s health issues, contact Attorney Kristina Vickstrom today at 508-757-3800.
[photo credit: Wikimedia.org]
As the number of family members providing care for aging parents increases, the solutions to find help with loss of income because of time off from employment for caregiving has become a major concern for many. The demands on both the time and energy needed to provide the needed care can make it impossible to maintain both a full time job with full time caregiving. [Read more…]
An irrevocable trust is an excellent tool when preplanning for Medicaid benefits. Anything that is put into the irrevocable trust is protected from a Medicaid spend-down if five years pass from the date of the transfer. [Read more…]
Medicaid, or MassHealth as it is referred to in Massachusetts, is an avenue available for funding long-term nursing home care. To qualify, you must meet asset thresholds that many elders exceed. Additionally there are income requirements for MassHealth/Mediciad. Adequate understanding of MassHealth/Medicaid law and proper strategizing is a critical component of any plan for the future. With the proper planning of an elder-law attorney, you can protect your property, spouse, and assets. [Read more…]
A three-day hospitalization often serves as a gateway for a senior citizen’s transition into a skilled care facility. When the patient is discharged to a skilled care facility for occupational, physical, or speech therapy, the patient’s health insurance (Medicare) will continue to finance treatment for up to 100 days per stay (as long as the person continues to benefit from rehab). Medicare coverage ultimately ends, and when it does, the patient must pay from income, savings, long-term care insurance, Medicaid, or a combination of these resources. [Read more…]
Hardly a day goes by when I don’t have a client who tells me that they can give away a certain amount of money free and clear, avoiding look-back periods for long-term care planning. They inform me that their neighbor, friend, or cousin told them that this is allowable. I then have the unfortunate task of telling them that they are wrong and that most states that have enacted the Deficit Reduction Act. After February 8, 2006, the rules relative to gifts changed.
Regardless of the amount, any gift that is made is a transfer and is subject to a look-back period of five-years for MassHealth (Medicaid) purposes. This doesn’t mean that the State will take that money, but rather, that the State will not pay for the donor’s long-term care costs until the five-year look-back is exhausted, or in the alternative, until all the gifts that have been transferred are used to pay for the institutionalized person’s care. [Read more…]
How often do you feel like you know what your state legislators are doing? The whole process can be mysterious and confusing. This week I would like to shed some light on the subject and tell you about a potentially helpful piece of legislation currently pending in the Massachusetts state legislature.
The proposed law would change the way assets are counted when determining whether a spouse in a nursing home, or certain other institutions and community based programs, is eligible for medical assistance through MassHealth (Medicaid). For MassHealth purposes, the spouse in the nursing home is called the “institutionalized spouse” and the spouse still living at home is referred to as the “community spouse.” Currently, under Massachusetts General Laws, chapter 118E, subsection 21A, many different types of income and asset types of both spouses are considered countable for purposes of determining eligibility. The total amount of countable income and assets are major factors the Division of Medical Assistance takes into account when determining if the institutionalized spouse is eligible for medical assistance from the Commonwealth (MassHealth/Medicaid). [Read more…]
The Executive Office of Health and Human Services, Division of Medical Assistance, commonly known as MassHealth is making a much overdue amendment to their existing regulations. Finally same-sex marriages, which have been recognized in the Commonwealth since late 2003, will be officially recognized by MassHealth. Governor Deval Patrick also signed the MassHealth Equality Bill nearly one year ago.
So what does this mean to spouses in same-sex marriages? They can now receive the same benefits as heterosexual marriages when applying for MassHealth for longterm care, meaning their assets can be considered jointly for eligibility purposes and MassHealth will also not penalize transfers between spouses in same-sex situations, as they currently do for traditional marriages. The definition of “family member” is also slated to be amended under the change. [Read more…]