Kansas & Missouri Estate Planning

Medicare and Medicaid Dodge The Budget Bullet (For Now)

Have you heard the news? It seems the grand experiment failed. The Congressional Super Committee, charged with doing what the Congress at large could not do, has run out of time.

And, by running out of time, failed in its mission to come up with budget cuts.

So, what does that mean for Medicare and Medicaid beneficiaries?

As Reuters reports, in the event the Super Committee should fail, as it has, then automatic and sweeping cuts go into effect. For Medicare, that means a two percent cut across the board, or about $123 billion over the next decade.

Not exactly chump-change.

However, it might have been $500 billion to $700 billion in cuts, if various supercommittee arguments had prevailed.

Nevertheless, as it stands, there definitely will be a little pain, but not quite as much for individual beneficiaries. No, likely it will hit hospitals and doctors the hardest. Why? In the aggregate, that's where the money tends to end up.

Of course, we're not yet out of the woods just yet. As it became clear last summer that we'd have to wait until the winter for some kind of budget solution from Congress, it now seems that we'll have to wait for the upcoming election season. In turn, expect things to intensify even further and for budget discussions to become all the more drastic.

Ah, isn't it good to live in interesting times?

Reference: Reuters (November 22, 2011) "U.S. healthcare cuts minimal, more pain looms"

Medicare Enrollment Window Opens Earlier

Are you (or someone your love) Medicare eligible? If yes, then did you know the Medicare enrollment period is earlier this year?

It's Medicare season once again, but it’s early this time. Unfortunately, many seniors just haven’t gotten the message. According to a recent survey in Florida and reported through the Kaiser Health News, nearly two-thirds of seniors are unaware that Medicare enrollment is earlier this year.

The open enrollment period is now from October 15 to December 7. And that's a whole month earlier than in the past.

So, why the change? The Affordable Care Act (read "Obamacare").

Along with the accelerated enrollment period, it is hoped that beneficiaries will have their Medicare cards by the start of the New Year. Customarily, late enrollees find themselves in a bit of a pickle (i.e., without their Medicare cards) come January 1. While the start date this year is non-memorable (October 15), the deadline isn't for most Americans of Medicare eligibility age (December 7).

Of course, the enrollment period isn't the only change afoot with Medicare. Like last Medicare season, the sheer number of plans has been pared down in an effort to make selection easier.

Planning pointer: Review your anticipated medical needs (or those of your senior loved ones) to determine whether a change in plan is warranted. As a result, you could stand to save hundreds – or even thousands – of dollars. Many seniors don’t make plan changes out of habit. Accordingly, some diligent (and gentle) prodding may be in order.

Reference: The Kaiser Health News (October 4, 2011) "Changes Take Seniors By Surprise"

Government Medical Care (And Senior “Double-Dippers”)

Like old Mother Hubbard and her empty cupboards, the U.S. Government coffers are bare. So what does that mean for Medicare and Medicaid, especially for folks who dip into both programs? Government health benefits for some 9 million of the sickest and poorest U.S. citizens will come under scrutiny from the congressional "super committee" seeking to cut the nation's debt.

Are you or an elderly loved one receiving benefits from Medicare or Medicaid? If yes, then likely you already appreciate the funding problems facing Congress and its appointed "super committee" regarding the future of these programs. However, for many of today's elderly, certain changes to these programs may be both real and immediate. Consequently, careful attention must be paid to the associated political developments. One area of specific focus is "dual-eligibles."

Seniors receiving aid from both Medicare and Medicaid are so-called "dual-eligibles" (read: "double-dippers") and, as such, their benefits are under scrutiny from the super committee. In fact, changes may be in the wings, according to Reuters.

Medicare and Medicaid spend about $300 billion a year for "dual-eligibles," making them a prime target. Here's what that means in real terms: Roughly 39 percent of the Medicaid program costs and 27 percent of Medicare costs are going to 15% and 16% of program enrollees respectively - and at the same time. Of course, these patients also tend to be the ones in the greatest need, with half of them under treatment for five or more chronic conditions.

What's going to happen? As usual, that's far from clear. Many states and insurers are pushing for managed care options to handle all aspects of care. This would help reduce the present bureaucratic overlap and, hopefully, cut costs. On the other hand, there are the detractors.

The reality of dual-eligibles is likely to continue to rise in budget and debt discussions, along with a host of other little issues. What can you do? Keep a close eye (and open ear) on the decision-making process (and the decision-makers), especially if those changes may impact your health care. It probably wouldn't hurt to contact your representatives in Congress.

Reference: Reuters (September 28, 2011) "Debt panel eyes dual Medicare/Medicaid patients"

Alzheimer's: Be Prepared Now!

Living with Alzheimer’s disease is very difficult for the individuals affected, as well as their loved ones. Nevertheless, by dedicating some time to prepare personally, financially and legally early on in the diagnosis a family can know they have done everything to support their loved one to live a full life and protect their legacy.

You may not have known but September is World Alzheimer's Month. As the month comes to a close tomorrow, it's important not to forget about Alzheimer's all year long. Medical research and advocacy are vital causes to uphold. And, it is a disease that you and your loved ones might have to face directly, if you have not already. The reality of Alzheimer's or dementia striking close to home (along with some understanding and prior planning) can help you come to terms with the extensive economic toll and the unique legal ramifications.

According to a recent Forbes article, Alzheimer's is as widespread as it is demanding. Consider this: Another American citizen will develop Alzheimer's every 69 seconds. Oftentimes, the symptoms are subtle, at least initially. Some estimate that more than 13 million Americans will have the disease by 2050 and run up as much as $1 trillion in costs. Because of the progressive nature of the disease, most of the costs and problems won't develop until later on. Nevertheless, significant planning must take place at the time of diagnosis, if not anticipated beforehand.

So, what is the scope of this "significant planning"? First, you will need to secure medical care, both for now and down the road. That means fundamental financial planning needs to be addressed, to include securing government benefits like Medicare and Social Security Disability Insurance. Second, because of Alzheimer's progressive cognitive degeneration, estate planning must occur early in the process to secure and protect family assets.

Fundamentally, it's important to understand that Alzheimer's is not the same as other diseases. Through it all, competent counsel will be necessary to properly assess the needs and possibilities, as well as to ensure that everything is in place when needed most.

Reference: Forbes (September 21, 2011) "September Marks World Alzheimer's Month as Advocates Push for Early Diagnosis and Health Care Planning"

For-Profit Hospice Concerns

I have had the privilege of volunteering with a local nonprofit hospice for more than a decade. I am constantly amazed at the quality of care and the compassion of the care providers. Not all hospice providers are nonprofit, however. In fact, concerns about putting profit into hospice was explored in a recent article.

Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home.  As a result, hospice care can provide a great benefit to many families and their dying loved ones. Generally speaking, Medicare has been praised for its support through reimbursements to providers over the past 28 years. Nevertheless, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers.

As hospice has moved into the mainstream, concerns about excessive costs and misuse have mounted. A primary concern is that Medicare's flat-fee payment system encourages hospice providers to seek out patients likely to live much longer than the six month time period for which hospice was originally intended. Why? Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not.

For-profit hospices in particular tend to have longer-staying patients. "The financial incentives do in fact dictate behavior," said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. "It's a lucrative business, at least under the current reimbursement system."

In response, Medicare has adopted a restriction: It won't pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash from hospice providers contending that sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive.

Yet, given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled.

When evaluating hospice care for yourself or a loved one, be sure to thoroughly investigate the care provider before making a commitment. Perhaps the most chilling aspect of these findings is not that people are using a hospice benefit for too long – but that they may be enrolling too soon, perhaps before giving other, more aggressive medical procedures a chance to work.

Reference: The Kaiser Health News (June 27, 2011) "Growing Hospice Care Costs Bring Concerns About Misuse"

How To Haggle Over Long-Term Care

There are some things you just don't haggle about but, perhaps contrary to what you would guess, it turns out that long-term care isn't one of those things. Long-term care is expensive, to say the least, but as explained in a recent article in SmartMoney, there are some expenses that may be negotiable.

Typically, nursing homes will not negotiate fees. Nevertheless, you may be able to negotiate with assisted-living facilities and home health care agencies. Really? How?

Start by arming yourself with information. You can look up local costs at Genworth.com/costofcare on a map prepared by Genworth Financial, one of the country's largest long-term care insurers. This map can help you compare costs for various types of care in your area. In addtion, MetLife offers another source of area-specific information at MatureMarketInstitute.com (click on "Research" then "2010 Market Survey of Long-Term Care Costs.")

Other resources include “Medicare and Home Health Care” which describes the home health benefits that Medicare covers (available at Medicare.gov) and the United Hospital fund's "Next Step in Care" website for family caregivers.

Other bargaining strategies to keep in mind:

• Ask if there is a waiting list at the facility. If not, you may have more room to negotiate.
• While nursing homes generally do not discount rates, you may be able to negotiate for extra amenities.
• If a home-care agency has rates at the higher end of your local market, you may be able to get a lower rate. How? Let them know you are interviewing several agencies and taking cost into consideration.
• If you hire a home-care agency for a significant number of weekday hours, that agency may be willing to discount any extra fees they charge for weekend work.

You can learn more long-term care options on the Long-Term Care Practice Center at our website. While you're there, be sure to subscribe to our free monthly e-newsletter.

 

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Surprise: Seniors NOT Flocking To Get "Free" Colonoscopies!

Question: If you had the option of getting a free colonoscopy, or doing, well, anything else... which would you choose? I thought so. There a just some benefits even the government can't seem to give away for free. [Question: If you opted for the "free" government colonoscopy, only to get a hefty bill for the service later, how would you feel? I don't know, but I think this could be good material for a Saturday Night Live sketch.]

Medicare enrollees, want to take advantage of some of the free preventive care screenings now available? Starting this year, seniors enrolled in Medicare no longer have to pay for more than a dozen tests and other preventive health care services. These benefits, which also include an annual wellness exam, are part of the new federal health-care law.

But big crowds are not lining up for the free mammograms or colonoscopies. Why not? Well, honestly, some of the tests are unpleasant and most people would prefer not to undergo a colonoscopy – even if it is free. However, according to a recent Kaiser Health News article, it also could be that most Medicare enrollees don't know about the free services. And, Medicare's information about these benefits isn't easily accessible, and can be confusing.

In addition, some of those who have taken advantage of the "free services," have been unpleasantly surprised to receive hefty bills. According to a separate Kaiser Health News article, although screening colonoscopies are free, you can get an unexpected bill afterward. This is because the colonoscopy is free only as long as it is preventative.

So, what does preventative mean?

“If a patient with no symptoms goes in for a screening colonoscopy and the gastroenterologist finds no pre-cancerous or cancerous polyps, everyone agrees that Medicare and commercial insurers are required to cover the expensive test 100 percent. But when the doctor removes a polyp, some insurers apply charges– meaning the insurer pays less of the bill.”

To find out more about the free services, you can consult the Medicare website and their (48-page) handbook.

Not all insurers are imposing the charges. According to the Kaiser Health article, Aetna, Cigna, Group Health Cooperative, Humana, United Healthcare and Wellpoint/Anthem all said members pay no cost-sharing when a polyp is found. However, before scheduling any "free tests," you might want to check with your insurance provider about how they treat the procedure should anything be found.

Hiring A "Guide" To Navigate The Health Care Jungle

Remember watching those old black & white movie matinees on the family black & white television? Remember the ones with the safari hunting storylines set against the backdrop of a dangerous, far-away jungle? Leading the adventuring "gentleman," and his wife (always fetching, aristocratic.. and wildly out-of-place!) and the crew of local hired on to carry stuff (usually the wife's crates of freshly-pressed khaki clothing) - was the always tanned and buff guide. The guide had been there and done that many times before. That's why he was leading the safari hunting adventurers on their adventure.

When you or a member of your family are in midst of a health care crisis, then you may feel like you are alone in a dangerous, far-way jungle - without a guide. And even the best of us can't always keep our wits about us in the health care jungle. How do you safely navigate the jungle and deftly deal with its bureaucratic inhabitants? What do you do about legal snares and other issues that can arise in the event of a medical-billings problem or an insurance coverage denial?

A private health care advocate (read: "jungle guide") might be an option worth exploring, according to a recent article in the Wall Street Journal's MarketWatch.  

Health care advocates cannot offer medical advice or address legal issues (like malpractice lawsuits) but they can help resolve medical billing problems, fight insurance-coverage denials, aid in complex medical decision-making and find the right specialist or hospital for a particular condition. Some even accompany patients to doctors' offices and other care settings. Many are or were nurses or social workers – and can help push through a problem when you really need assistance or guidance. Most hospitals employ similar representatives that can help during your stay, but private advocates are often small businesses that can be called upon in far more circumstances. Plus, unlike those employed by the hospitals, private advocates work for you only.

So. what does this cost? Advocates typically charge $50 to $200 an hour, says Joanna Smith, president of the National Association of Healthcare Advocacy Consultants (NAHAC), a professional group in Berkeley, CA. If you are looking to hire a health-care advocate, you should expect a written estimate of costs and services, and feel comfortable with the advocate’s style, experience and expertise before signing on. The NAHAC has designed a code of ethics, which you can find on their website. Be sure to ask about those when interviewing an advocate. Also, don't be bashful about asking for references from satisfied patients who have offered to provide testimonials.

Now, back to my matinee.