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Medicare

What is an elder law attorney?

By Elder Law, Estate Planning, Guardianship, Medicaid Planning, Medicare, Probate, Tax Law

An elder law attorney, also known as an elder care attorney, is familiar with the state and federal laws that impact seniors and their well-being.

These attorneys are well-versed and specialize in a range of areas:

  • Estate planning
  • Powers of attorney
  • Medicaid
  • Medicare
  • Veterans benefits
  • Probate and trust administration
  • Nursing homes
  • Elder abuse and fraud

Elder law attorneys allow you to plan ahead. By meeting with an elder law attorney and setting up documents, you can protect your assets, properly pass your estate to heirs, and name individuals to make health care and financial decisions for you when you are unable.

If you have further questions or wish to set up documents, contact our office at (941) 906-1231 to schedule an appointment with one of our attorneys.

September 30, 2016
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How do recent changes in Medicare rules affect access to Speech Generating Devices for patients?

By Medicare

Medicare has changed their coverage of Speech Generating Devices which affects many people’s access to devices they rely on to communicate.  In April of 2014, Medicare changed their categorization of Speech Generating Devices (SGDs) which electronically generate voices for patients who are unable to speak due to ALS or spinal cord injuries.  The policy change by Medicare had three major results:

  • SGDs were no longer purchased for patients by Medicare.  Instead, they became “capped rental” items meaning Medicare would pay for their rental for 13 months, after which they became the property of the patient.
  • SGDs would no longer be covered when a patient was in a hospital, nursing home, or home hospice program.
  • SGDs which had been provided previous to September of 2014 would no longer be covered because they were considered to have extra communication features. These features include the ability to access the internet and communicate with people long-distance.  Previously, patients had been able to pay extra to access these features from their devices but under the new Medicare rules, no device could have these features.  Devices owned by patients after the rental period also could not be upgraded at the cost of the patient.

Many patients also need eye-gaze technology to use SGDs and, although Medicare had covered these costs to allow patients the ability to communicate in the past, after these rule changes they began routinely denying coverage of eye-gaze devices.

Advocates for patients in need of SGDs have been trying to enact change and in late April, 2015, succeeded in getting the Steve Gleason Act passed through the Senate.  This act would return the ability to upgrade devices to be able to use the internet and long-distance communications on SGDs to patients.  It would also allow patients to retain their devices and coverage when entering hospitals or care programs.  This legislation is awaiting approval in the House.  Also in late April, Medicare changed their definition of what technologies SGDs could access to allow again for patients to access the internet and other services through their SGDs.  Although this policy has not yet gone into effect and SGDs are still being rented by Medicare instead of purchased, advocates are hopeful that changes will take place soon to ensure patients are given the technologies they need to communicate.

December 15, 2015
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New law signed by President Obama will require hospitals to provide Observation Status notice to patients:

By Elder Law, Medicare

When an individual goes to the hospital, they may not be admitted right away.  If one is not “admitted” to the hospital, Medicare will not pay for hospitalization and a patient may have a large medical bill as a result.  There may be a period in which an individual is being “assessed”.  This is called “Observation Status”.   Observation status ends once a patient is admitted or discharged.

After a three (3) night hospital stay, Medicare will cover rehabilitation.  Previously, patients are not aware of the difference between observation status and being admitted.  The new law known as Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act signed by President Obama will take effect one year from August 6, 2015, the date it was signed.  Hospitals have to develop a notification system within this year.

The new law will require the hospitals to give notice to the patients who have been under observation status for more than 24 hours of their outpatient status within 36 hours or upon discharge, whichever happens sooner.  The notice must advise the patient of their outpatient status and advise that their stay does not qualify for rehabilitation services covered by Medicare because they did not meet the three (3) night requirement.

This is one step closer to ensuring hospital patients are properly being informed.

October 7, 2015
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What To Do When Your Child Turns 26 While On Your Health Insurance Plan

By Medicare

Q.  My adult daughter and I are covered through my husband’s employer. Our daughter turns 26 this summer, but I thought we couldn’t sign up under the Obamacare Health Insurance Marketplace until open enrollment later this year. What is she supposed to do between her summer birthday and the Obamacare open enrollment in November?

A.   Now that your daughter is turning 26, she will eventually need to get her own plan.  The Affordable Care Act allows her to stay on her parents’ plan only until she is 26.   Here are a few things to do and/or consider:

1. Check with your husband’s employer to find out exactly when your daughter will lose her coverage.  It may be on her birthday this summer or it may be at the end of the plan year.

2. If your daughter wants to stay on your husband’s plan as long as possible, she may be able to extend it for up to 18 months under the federal law known as COBRA. Just know that she would be responsible for paying the entire cost of her premium, which could be expensive.

3  If her own job does not provide health insurance coverage, your daughter can apply for an individual plan using the federal health insurance marketplace.  Because Florida refused to enact its own state insurance marketplace, citizens of Florida have to use the federal site at healthcare.gov.  It doesn’t matter that she’s applying prior to the November “open enrollment period”.  Because she’s losing her coverage under your plan, she’ll be eligible for a special enrollment period.   Note that she may be eligible for premium tax credits to make coverage more affordable if her income is between 100 and 400 percent of the federal poverty level (as of July 2014 the range is $11,490 and $45,960 for a single individual).

If you are an employer or a family looking to apply for health insurance coverage under the Affordable Care Act and have questions about the tax incentives available, call Bach & Jacobs and make an appointment with Board Certified Tax Lawyer Fred Jacobs by calling (941) 906-1231.

July 29, 2014
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What Happens If An Employer Discontinues Retiree’s Health Insurance Plan?

By Elder Law, Health, Medicare

Kaiser Health News recently answered readers’ questions about the Affordable Care Act and the federal Marketplace exchange, which has caused a lot of confusion for folks.  Here’s an excerpt From: http://www.kaiserhealthnews.org/Stories/2014/May/20/Andrews-IYH.aspx?p=1
Q:   I will be retiring this year from my company, before age 65. My company is dropping retiree health care in January, stating that retirees younger than 65 can elect coverage through the exchanges. Will the company be required to offer COBRA starting in January? I fear that coverage will be expensive through the exchanges since we will not be eligible for any subsidies due to my husband’s $200,000 income. He’s self-employed and covered under my company’s health plan.
A:  In general, if an employer discontinues its retiree plan, it’s not required to offer retirees the opportunity to extend their coverage for up to 18 months under the federal law known as COBRA, according to a Treasury Department official. The cancellation of your retiree plan will create a special enrollment opportunity for you to sign up for a plan on the health insurance exchanges. You won’t need the special sign-up period; however, since January is midway through the annual open enrollment period that runs from Nov. 15 through Feb. 15 when people can change plans anyway.
As you note, you won’t be eligible for subsidized coverage on the exchange because your husband’s income exceeds 400 percent of the federal poverty level ($62,920 for a couple next year). But it’s worth checking out plans on the marketplace anyway, says Laurel Lucia, a policy analyst at the Center for Labor Research and Education at the University of California, Berkeley. Depending on your health needs, a marketplace plan might be a better fit. “The typical job-based plan resembles a gold or platinum marketplace plan, but on the marketplace they’d have the option of buying silver and bronze level plans as well,” she says. Many individuals find the costs of Marketplace plans are much more affordable than COBRA plan rates.

July 23, 2014
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Do You Automatically Receive Medicare Part D If Approved for Medicaid in Florida?

By Medicaid Planning, Medicare

Q:  Do I automatically receive Medicare Part D if I am approved for Medicaid in Florida?

A:  Medicare Part D now pays for prescription drug coverage for all Medicaid recipients.  However, it is not immediate or automatic even if you are notified of Medicaid approval.  Upon approval of Medicaid, you must apply for a Medicare D plan, which will be paid for by Medicaid.  If you are moving into a facility, such as assisted living or nursing home, you should contact the facility to find out which Medicare D prescription drug plan they recommend.  For additional information and assistance, you can contact the Department of Elder Affairs SHINE program, which provides free unbiased insurance counseling to Florida seniors, caregivers, and family members regarding Medicare, Medicaid, and other health care issues.  The Elder Helpline is 1-800-96-ELDER (1-800-963-5337).

April 17, 2014
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What if I have PCIP coverage?

By Health, Medicaid Planning, Medicare

Coverage through the federal Pre-Existing Condition Insurance Plan (PCIP) ends December 31, 2013. PCIP will not pay for any medical services after December 31, 2013. You must enroll for new coverage between October 1at and December 15, 2013. If you enroll after December 15, your coverage can start no earlier than February 1, 2014.

When the health care law was signed in 2010, it created PCIP as a temporary program. PCIP made health coverage available to uninsured people with pre-existing conditions until key parts of the law took effect.

Starting in 2014, health insurance companies can no longer deny you coverage or charge you more because of your health condition. On October 1st the new choices for health coverage will be available. You can get coverage in the individual market, through your employer, or from public programs like Medicaid and the Children’s Health Insurance Program (CHIP).

PCIP enrollees have new options.

Every state has a Health Insurance Marketplace, where you can learn whether you qualify for lower costs based on your household size and income. All Marketplace insurance plans offer the same essential health benefits and cover treatment for pre-existing health conditions. For Florida you can enroll by going to www.healthcare.gov.

You have other options for buying new health coverage. You can buy a plan on your own from a licensed health insurance company, or enroll in a job-based plan. But in order to get lower costs based on your income, you must buy your plan through the Marketplace.

You must take action to get new coverage. PCIP coverage does not automatically convert to a Marketplace plan.

If you need legal advice for estate planning, probate and trust administration, Medicaid planning, or VA benefits, please contact our office at (941) 906-1231 for an initial consultation.

October 31, 2013
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Estimate Costs of Health Plans for Florida

By Health, Medicaid Planning, Medicare

The Tampa Bay Times has published an article on September 25, 2013 providing a preview to the rates expected to be published on October 1, 2013 for health insurance under the affordable care act.

A single 27 year old earning $25,000.00 per year can buy a bronze poilicy (the least expensive) for $167.00 per month.  He/she will receive a tax credit due to their low income of $54.00 per month reducing their premium to $113.00 per month.  This tax credit will be paid directly to the insurance provider.

A family of 4 living in Tampa Bay earning $50,000.00 per year can get a silver policy (the second lowest cost plan) for $282.00 per month, after receiving the tax credit.

Coverage offered by these plans are expected to include preventative care and maternity care.

Everyone will be able to research plans in their communities beginning October 1, 2013 at www.healthcare.gov.

For more information on estate planning, Medicaid planning or tax planning, please contact our office at (941) 906-1231 for an initial consultation.

September 30, 2013
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