An Opportunity You Don’t Want to Pass Up
October 31, 2011
This is a special time of year. No, I’m not talking about Halloween or the traditional holiday season from Thanksgiving through New Year’s. It is Medicare’s open enrollment period, a once a year special event.
Medicare is one of the many government programs that can be maddeningly confusing. There are so many different options to choose from. There is Part A which is mandatory but then Parts B, C and D are not. There is a smorgasbord of plans to select from. But, what if you opt for a plan and later change your mind?
Well, that’s where the seven week period of open enrollment comes in. The government allows current Medicare enrollees to get into and out of any plan one time a year. This year it’s between October 15 and December 7. (There are other times of the year that allow some changes but they are much more limited.)
So, for example, you can switch from traditional Medicare to Medicare Advantage (Medicare’s HMO) or from Advantage back to traditional. You can switch between Medicare Advantage plans. You can also add drug plans (Part D), change drug plans or drop one entirely.
Of course, having the ability to do this doesn’t mean it’s easy to make the right choice. There are so many plans to pick from. Specialty plans are available, for example, which are designed to work well for people who are receiving Medicare and Medicaid or Medicare and certain VA benefits.
The bad part about having so much variety is that making the right decision is that much harder. Like anything else, however, getting the right guidance from a qualified and knowledgeable specialist can make all the difference. It is just impossible to make such an important decision without getting the answers to all your questions first. Those Medicare insurance specialist are out there. You just have to seek them out, but don’t delay, because if you miss the window you’ll likely have to wait an entire year. For more information contact us at info@hauptmanlaw.com.
End of the World? Fat Chance
October 24, 2011
I was talking to Warren the other day about long term care and he said – jokingly, I think – that he didn’t need to plan because the end of the world was coming, October 21 to be specific. Usually, I hear people say that the government will bail them out. This was a slightly different version of a common theme. Don’t deal with the problem because, somehow, it will take care of itself.
Warren was referring to the latest prediction by Harold Camping, an American Christian radio broadcaster. Camping claimed the world would end on October 21, 2011 after incorrectly predicting disaster would occur on May 21, 2011. It always amazes me that so much media attention attaches to apocalyptic predictions. Camping claimed he had examined the Bible and using numerology, a form of mathematics of sorts, was able to calculate the exact date.
So, October 21 came and went. The world as we know it is still here, and we’re still wrestling with the same problems we had on October 20. While Warren was being facetious, his comment expresses the sentiment of many. They just don’t want to deal with the unpleasant subject of aging and dying. I am not sure why talk of the end of the world is any easier or more comforting to think about, but I’ll have to ask him when I see him next.
It really just allows us to push the topic into the back of our minds, but time marches on and we all get older. We can ignore it for a while but eventually the subject will rear its ugly head. If Harold Camping wants to increase his batting average as far as predictions go, he might want to focus on the future of the long term care system in this country. Because it doesn’t look pretty. We are headed towards a real catastrophe and our government doesn’t seem to have a clue how to solve it (See my post last week about the death of CLASS). As always, those who are ill prepared will suffer most. The message is clear. If you were “hoping” the end of the world would bail you out, sorry to disappoint you. Maybe it’s time to buckle down and put your long term care plan in place.
The Death of CLASS
October 17, 2011
I’m not talking about a loss of manners or style or discretion in a world in which technology has helped push the doors open wide to reveal everything that used to be private or personal. That’s a whole other subject. I’m referring to CLASS, President Obama’s attempt to establish a national long term care insurance plan.
CLASS, which stands for Community Living Assistance Services and Support was the part of President Obama’s 2010 health care reform bill that addressed long term care. There weren’t many specifics in the bill, just a general outline. The plan was to be a voluntary government program under which participants pay a monthly premium, which would then guarantee them a small benefit to cover their long term care needs. However, they would be required to pay into the program for at least 5 years before claiming the benefit.
Participants would pay a monthly premium through payroll deduction. The program was not intended to be another government funded one. How much of a benefit would be paid and for what types of care weren’t clearly defined in the bill which became law. The plan called for a committee to be formed to develop all the details over the next 2 years with the goal of beginning enrollment in 2012 and payouts in 2017. Now, you may notice that I keep referring to the plan in the past tense. That’s because only 19 months after the law was passed the President scrapped the CLASS program.
Last April, in this blog, I pointed out the many flaws in the plan. It didn’t take an actuary to look at the numbers and figure out very quickly that there would be serious problems collecting enough premium dollars from a shrinking workforce to be able to pay out the mountain of claims that are sure to come as our population continues to age. There was also the matter of the benefit amount which, although never finalized, was rumored to be in the $50 to $75 range. The whole plan just didn’t seem to be well thought out, and perhaps that’s why the Obama Administration chose to announce its death on Friday. (If you have bad or embarrassing news to release the PR trick is to release it on Fridays so it hits the papers Saturday when readership is at its lowest.)
So, where does that leave us? I said last year that I wasn’t expecting much from CLASS and that proved correct. But, I am also sure that this isn’t the last we will hear from this president or the next administration on the subject. We can’t continue to ignore the problem of long term care in this country and we can’t hope and pray that the government will come to our rescue. Each of us needs to ask some hard questions. “Do I have a plan and is it adequate to meet my needs?” If you don’t or it isn’t, then you’ve got to talk to the right people, such as your financial advisor, accountant, insurance agent and elder law attorney and get help now. The clock is ticking and time is most definitely not on our side.
Be Nice to Me – I Pick Your Nursing Home!
October 10, 2011
For several years now, many regular readers of this blog have offered me kind words and feedback on my weekly stories and interesting posts, suggesting that I write a book. Well, I have finally taken their advice and am pleased to announce the publication of my first book, titled “Be Nice to Me – I Pick Your Nursing Home”. Some might be puzzled, others amused, by the title. It was intended to be humorous and head turning. The book is a compilation of many of my posts over the years, updated in some cases. My goal is not simply to be thought provoking, but for the reader to take action to address what is a growing problem in this country, the cost of long term care and how best to administer it.
For more information and to purchase your copy go to www.elderlawtodaypodcast.com/services/
A Medicaid Millionaire
October 3, 2011
Much has been written about how much long term care is costing this country and specifically how much tax payer dollars are spent on government benefit programs, with those numbers continuing to rise. All true. But, government waste, ineptitude and an inability to eliminate fraud certainly play a role. An article in the local newspaper last week caught my eye. It described the largest settlement of a home healthcare fraud case ever but what was most interesting was the person who was the catalyst for the investigation.
Richard West, a Medicaid recipient afflicted with muscular dystrophy, who needs nursing assistance and uses a ventilator, learned that certain of his vital services were being cut back because he had “maxed out” his benefits. Although severely disabled, he still has mental capacity – and determination. He checked his medical records and discovered that the home health care company that provided him with nursing care was overbilling Medicaid. He tried reporting what he found to several government hotlines, but got nowhere so he hired an attorney.
The healthcare company, Maxim Healthcare, has several hundred offices around the country. The case involved 4 federal agencies and the Medicaid fraud units of at least 3 states. The investigation reached through almost every state in the country. For at least 6 years, Maxim billed Medicaid for services it never provided, using what is known as “no show” billing. Nurses were paid for jobs they never had. After being nabbed, Maxim agreed to return improper payments it received and pay criminal fines, totaling $150 million. For his part in bringing the fraud to light, Richard West received $15.4 million.
West described his frustration in reporting what he found, first to his county social worker, then to the state Medicaid office and then to a Medicaid fraud hotline number and waiting for action. As anyone who has ever dealt with government bureaucracy knows, you can wait a long time. West then took matters into his own hands. Unfortunately, most Medicaid recipients are too sick, physically and mentally, to take on the fight that West did.
West was literally fighting for his life. Take away the vital services that Medicaid provides and he feared that he would die. Now he has too much money to qualify for Medicaid. Not exactly the “Medicaid Millionaire” who proponents of Medicaid reform claim are collecting benefits that shouldn’t be. But it just goes to show you that you can’t rely on the government to take care of you. It took a wheelchair bound 63 year old man on a ventilator to get the government to pay attention to someone stealing hundreds of millions of dollars right from under its nose.
