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Medicare

What should I do if my doctor is no longer in my healthcare insurance network?

By Asset Protection Planning, Elder Law, Health, Medicaid Planning, Medicare

It is a common problem, but nonetheless an incredibly stressful one: the doctor with whom you have established a good relationship over many years is no longer included in your health insurance network. Whether this is because the doctor has retired, has moved, or is dissatisfied with your network and has chosen to switch, your question is the same: What can I do?

The first thing to do is to check whether you have continuity of care protection. This coverage entitles you to continue receiving the same services from your doctor at the same price, with the same copays and fees. If you are a senior and you have the Medicare Advantage plan, you also have the right to switch networks, given that the network change is “considered significant based on the [effect] or potential to affect current plan enrollees” (Centers for Medicare and Medicaid Services).

If these options are unavailable to you, it is recommended that you talk to your doctor about any alternate payment plans he/she might provide. Or, you can ask for referrals to another doctor in your area.

For expertise in Medicaid planning, Medicare, and elder law, please feel free to reach out to the attorneys at Bach, Jacobs & Byrne, P.A. at (941) 906-1231.

May 28, 2019
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What is an “incontestability provision” in an insurance policy?

By Asset Protection Planning, Elder Law, Estate Planning, Medicaid Planning, Medicare

Florida Statute §627.455 states:

Every insurance contract shall provide that the policy shall be incontestable after it has been in force during the lifetime of the insured for a period of 2 years from its date of issue except for nonpayment of premiums and except, at the option of the insurer, as to provisions relative to benefits in event of disability and as to provisions which grant additional insurance specifically against death by accident or accidental means.

The incontestability provision is thus the clause included in Florida life insurance policies which limits the time during which the insurer can challenge the validity of the policy to 2 years. Whether the challenge to the policy is based on alleged application fraud or an inability to enforce the policy, all claims must be filed within the 2-year period – or else, the claim is barred.

This provision has its origins in the mid-19th century, when insurance companies began including incontestability provisions to combat the perception that insurance companies would refuse to honor their policies over minor mistakes in a person’s life insurance application. Florida required the inclusion of incontestability provisions by law in 1955.

There is a possible exception to incontestability provisions: imposter fraud. Imposter fraud refers to the impersonation of a life insurance application by someone else during the medical examination of the application process – this type of fraud can be exempt from the incontestability provision.

To review your end-of-life and estate plan documents with experienced and dedicated estate and elder law attorneys, schedule an appointment with Bach, Jacobs & Byrne, P.A. at (941) 906-1231 today.

 

April 18, 2019
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Can nursing homes keep you from seeing your loved one?

By Elder Law, Long-Term Care, Medicare

No, it is against the law for nursing homes to ban visitors from seeing their loved ones, unless the visitor is deemed dangerous to the other residents of the nursing home. According to the Centers for Medicare and Medicaid Services, nursing home residents have the following rights when it comes to visitors:

  • To spend private time with visitors
  • To have visitors at any time, as long as you wish to see them, as long as the visit does not interfere with the provision of care and privacy rights of other residents
  • To see any person who gives you help with your health, social, legal, or other services at any time. This includes your doctor, a representative from the health department, and your Long-Term Care Ombudsman, among others.

If you feel that a loved one is being deprived of his/her rights as a nursing home resident, you have the right to register a complaint with the nursing home as a resident advocate. If the facility’s management does not resolve the issue, one can also report the problem to the Florida Agency for Health Care Administration at 1-888-419-3456 or to the Long Term Care Ombudsman of Florida at 1-888-831-0404.

January 28, 2019
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Risk Adjustment Payments Suspended

By Medicaid Planning, Medicare

Risk adjustment payments to insurance companies had been funded by the federal government as part of the Affordable Care Act since 2014 as part of the ACA’s prohibition against insurance companies discriminating against individuals with chronic illnesses or pre-existing conditions. However, the federal government in early 2018 suspended the risk adjustment payment program, citing a recent Federal District Court opinion regarding the formula used to determine the size of the payments.

Some have expressed fears that insurance premiums could increase as a result of the suspension, while others argue that the risk adjustment payment program has already done more harm than good, through a bias against small insurance companies. The Centers for Medicare and Medicaid Services have asked the Federal District Court to reconsider its decision, and, in the meantime, the insurance market hangs tensely in the balance.

November 1, 2018
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Medicare vs. Medicaid: What are you eligible for?

By Medicaid Planning, Medicare

Medicare is a federally funded program for which most U.S. citizens and permanent legal residents over the age of 65 who have lived in the country for over five years are eligible for. Medicaid, among other things, supports individuals and families by covering costs associated with both medical and long-term custodial care for those who qualify. Eligibility for Medicaid is means-based, and the program has strict asset and income eligibility requirements that vary from state to state. For more information on current qualification requirements, individuals should visit Medicaid.gov. Additionally, Babette Bach is a Board Certified Elder Lawyer and can assist you with your questions about public benefits and qualifications for Medicaid.

August 4, 2017
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Understanding the Parts of Medicare: Medicare Part D

By Medicare

Medicare part D provides outpatient prescription drug coverage. This part of Medicare is optional and is offered through private companies, which are certified by centers for Medicare/Medicaid services each year. If you want Medicare Part D coverage, you can either apply for a stand-alone plan or, if you have Medicare Part C coverage, you can get your Part D coverage through a Medicare Advantage Plan. Medicare.gov has an excellent program to assist you in choosing the best plan given your geographic location and your current prescriptions.

 

August 1, 2017
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Understanding the Parts of Medicare: Medicare Part C

By Medicare

Medicare part C, also known as Medicare advantage, is the alternative to Traditional Medicare Part B Benefits. It is an HMO model of care that is offered by private insurance companies that Medicare has approved. These private insurance companies typically offer enhanced benefits in addition to those that are traditionally available. These plans have networks to provide services, meaning only specific doctors and hospitals are covered. Each company has its own rules as to which facilities and doctors are covered. These plans are more affordable than Traditional Medicare but they are much more regulated and restrictive.

July 28, 2017
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Understanding the Parts of Medicare: Medicare Part B

By Medicare

Medicare Part B is your Medical Insurance, and it covers two types of services: medically necessary services and preventative services. Medically necessary services include services or supplies that are needed to diagnose or treat your medical condition, such as doctor’s office visits, lab work, outpatient surgeries and x-rays. Preventative services are designed to keep you healthy, and include things such as cancer screenings or flu shots. Medicare Part B also covers medically necessary durable equipment, such as wheelchairs or walkers. Most individuals are required to pay a premium for this type of coverage. This is “Traditional” Medicare and you get to choose any provider you wish who accepts Medicare.

July 25, 2017
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Understanding the Parts of Medicare: Medicare Part A

By Medicare

There are four Main components of Medicare: Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D. Medicare Part A is your hospital insurance and it covers medically necessary hospital care, limited nursing facility care, hospice, and limited home health services. Medicare Part A is free if you have worked and paid Social Security taxes for at least 10 years (40 Calendar quarters). If you have worked and paid taxes for less time, you have to pay a monthly premium. It does not cover long-term care, most dental care, acupuncture, routine foot care, or eye examinations to prescribe glasses.

July 21, 2017
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How does Medicare cover chiropractic care?

By Medicare

Medicare covers chiropractic care, but the coverage differs from that of ordinary medical care from your doctor. Medicare only covers the chiropractic adjustment. This restriction is due to the wording of the Social Security Act, and for more services to be covered by Medicare, new legislation would have to be passed.

In order to qualify for the coverage, the doctor is required to produce information and evidence that proves the adjustments are medically necessary. To meet the Medicare requirements, the doctor must use forms and questionnaires, and may be required to take x-rays if necessary. X-rays and other examinations are not covered by Medicare.

Medicare requires that you have “functional improvement” or you will be denied coverage. Functional improvement shows that your care is medically necessary and is not simply “maintenance care.” If you no longer have functional improvement, your doctor is required by law to inform Medicare.

May 12, 2017
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