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Co-pays proposed as part of $166M in Medicaid cuts

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Co-Pays and Not Changes to Eligibility Proposed

Gov. Gina Raimondo has proposed balancing next year’s $9.38-billion budget with nearly $166 million in cuts to Medicaid. None of the changes will affect eligibility or benefits, officials said. Co-Pays and other cost reducing strategies will be implemented.

A plan to “rebalance” long-term care and nursing home services would account for another $18.2 million in savings. That includes “modernizing” the eligibility process for long-term care. The budget also calls for a 1-percent increase to nursing home reimbursement rates. In recent years, those rates have seen as much as a 3-percent increase.

Asked if he expected backlash from the nursing homes, Beane said, “I think, frankly, the nursing homes will be pleased to see that some part of the COLA is going to be included here. That’s the first time the governor’s proposed budget has included an increase. She has said in her cover letter to this budget that if revenues are up, this is an area she’d like to see more investment.”

Source: Co-pays proposed as part of $166M in Medicaid cuts

As the long term care insurance market continues to struggle with its future, knowledge as to the rules of Medicaid eligibility that will pay for long term skilled nursing is critical. Individuals can only have $4,000 of countable resources to qualify for Medicaid. Your home, car and personal property is not a countable resource and is protected. Under the proposed budget, those rules appear to remain unchanged. However, what are you to do with savings, investment accounts, a second home or investment property? Will you be forced to liquidate those assets and spend them down on my long term nursing care below $4,000 before I qualify for Medicaid? Without  a plan and proper advice, the answer is likely yes for most. However, with a proper plan, these assets can be protected for yourself, your spouse and your heirs. Contact us to discuss how.

Healthcare Costs Consuming SSI Benefits

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Health Costs May Gobble Up Social Security Benefits

Healthcare for the average woman means they could spend an estimated 70 percent of her retirement check on health care costs, according to a recent study by the Nationwide Retirement Institute. The average man fares better, but still uses nearly half of his benefits to cover medical expenses.

Here’s how the Nationwide analysis reached its disturbing healthcare estimates: It assumed a woman with a life expectancy of 88 married a man who would live to 85 and they both claimed Social Security at 62, which is the earliest and most popular age to file for retirement benefits, regardless of gender. More than half of elderly married couples and nearly 75 percent single retirees depend on Social Security for the majority of their income in retirement. “Women disproportionately rely on Social Security in retirement,” said Nancy Altman, co-director of Social Security Works, which advocates for the expansion of the program. In fact, roughly two-thirds of Social Security beneficiaries age 85 and older are women. In the Nationwide’s bleak scenario, the man collects a monthly benefit of $1,543 and the woman collects $1,171 per month. (The average monthly benefit for a retired worker is $1,350, according to the Social Security Administration.)healthcare-costs

Nationwide projects hefty health costs for the hypothetical couple. The man would pay $214,278 in medical costs in retirement and the woman would pay more than $289,682, because of her longer lifespan. The forecast includes what the couple would have to spend on long-term care at a nursing home or in an assisted living center.

Source/more: CNBC.com

Want to protect your life savings from possible long term care costs?

We have advised hundreds of people on the steps they must take today to protect their assets from the possible catastrophic costs associated with long term care and nursing home care. Contact our office today for a no-cost consultation to discuss your estate planning options.

Matt Leonard

Research in war against Alzheimer’s

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Promising new research on Alzheimer’s at Butler Hospital and Brown University begins with a simple swab of the cheek

Cognitive impairment such as Alzheimer’s is a prevalent cause for needing long-term care. As the disease progresses, it undermines a persons ability to live independently in the community. Families who are faced with this disease, are a loss as to how to care for their loved ones. Estate Planning is a critical step in this process. Another, is learning and understanding more about the disease and what research is being done around it.

PROVIDENCE, R.I. — The weather one recent evening reflected the nature of the topic when a small crowd gathered at Butler Hospital to learn more about Alzheimer’s disease. It was cold and dark — in a word, gloomy.

Such is the illness, which erases memory and personality while burdening relatives and caregivers on its path to inevitable death. As yet, there is no cure.

But the man who drew these people from the comfort of home preaches hope, in the form of groundbreaking research he conducts with other scientists around the world.

On this evening, Dr. Stephen P. Salloway did more than preach.

Using the military metaphor he favors, he sought to enlist recruits in a new phase of a campaign he likens to the Second World War, when, against great odds, Allied forces defeated a mighty foe.

“I’m very excited that we are building an infrastructure worldwide to fight Alzheimer’s disease,” Salloway said as he began his presentation. “Many of our same allies in World War II are allies in this fight against Alzheimer’s.”

The scientist projected a slide describing research efforts around the planet, with Europe, Australia, North America and parts of Asia pinpointed as strategic centers.

“We are making progress, and there are other initiatives and consortiums, here and abroad, moving this forward,” Salloway said.

On he went, through slides of diseased brains, of German neuropathologist Alois Alzheimer’s first, historic patient, and of the APOE gene, which may indicate increased risk of the disease, depending on which of six possible variants an individual carries. Other factors, including age, diet, lifestyle and overall health, also influence risk.

With researchers elsewhere, Salloway and his team at Butler’s Memory and Aging Program are seeking volunteers to enlist in the so-called Generation Study, for men and women age 60 to 75 who are cognitively normal — but may be at risk, depending on their genetic makeup.

Screening begins with a swab of the cheek, which is analyzed for the APOE gene; eligible candidates may then decide to enroll in clinical studies of new medications, including a drug known as CNP520, which has just entered a trial sponsored by Novartis Pharmaceuticals in collaboration with Amgen and Banner Alzheimer’s Institute.

“Not only can you find out your genetic risk by having the APOE test,” Salloway said, “but then if you’re the right age group and meet the criteria and you’re interested, you could also participate in a prevention trial to try to lower the risk. We’re very excited about that.”

Many in the audience were as well. Eighteen would sign the necessary papers and have their cheeks swabbed. They would become the latest recruits in Salloway’s citizen army — which, when all studies and the Butler prevention registry are counted, now numbers more than 800.

Salloway’s aim is much higher.

Sandra Robinson Gandsman, a Pawtucket resident who spent most of her career in health-care marketing, was among those who enlisted with a swab and her signature. She was motivated, in part, by her knowledge of disease.

“Very honestly, this is more frightening than cancer,” Gandsman told The Journal. “If you get a diagnosis of cancer, there’s a possibility you can be cured. Certainly there are treatments that you can take. But Alzheimer’s — it’s kind of like, ‘Wow, there’s not much there.’”

The work of Salloway and others, she said, could put something there. Lives could be transformed for the better. New generations could escape the threat altogether if promising avenues prove true.

Sentiment also motivates Gandsman. She related the experience of a 73-year-old friend diagnosed with early-stage Alzheimer’s — that “mild” first of three phases of the disease characterized by “challenges performing tasks in social or work settings” and “forgetting material that one has just read,” among other symptoms, according to the Alzheimer’s Association.

“I noticed for a couple of years a lot of forgetfulness and repetition,” Gandsman said of her friend.

One day, she stepped on the tennis court with the woman, who had played the game for decades and was skilled at it.

“She didn’t know where she was,” Gandsman said. “She couldn’t keep score, but she didn’t know she couldn’t. She hit the ball and wasn’t sure where she was supposed to stand. I immediately called her husband. I thought she’d had a small stroke.”

She hadn’t.

“Her husband had been covering for her,” Gandsman said. “I didn’t realize it at the time.”

It was not hyperbole.

The prevalence of the disease doubles every five years after age 65, reaching as high as half of all people 85 and older. Lacking major advances, by 2050 an estimated 125 million people worldwide will have dementia, a broad category of brain afflictions that includes Alzheimer’s. Health-care costs for U.S. Alzheimer’s patients was estimated at $259 billion in 2017, a figure that does not include the billions of hours of free care, typically accompanied by significant emotional and other stresses, that family and friends provide.

Beyond the statistics is the reality of becoming one, as Salloway’s audience — mostly middle-age and older — acknowledged.

“If you ask older people what disease they fear most, what’s number one?” Salloway said.

“Alzheimer’s,” was the collective response.

“Why?”

But optimism co-exists with alarm, which is another theme Salloway strikes when he speaks to the public, as he does regularly. Building an army is more than a desk job.

“In order to make a difference, we need to find better treatment,” he said. “Congress is getting older and they’re worried about Alzheimer’s, too. That’s one of the few things that Democrats and Republicans agree on: that Alzheimer’s is bad. And so there is now a national plan to fight Alzheimer’s, with a major goal of developing breakthrough treatments by 2025. And we’re working hard to meet that goal.”

Congress has done more than pay lip service, Salloway said, and his slide confirmed it: National Institutes of Health funding for Alzheimer’s research rose from $448 million in 2011 to $991 million in 2016, surpassing the billion-dollar mark last year, when it reached $1.39 billion. This year, research funding is projected to reach $1.8 billion.

“Cancer is $6 billion, so we’re still well below that, but we’re making progress,” said Salloway, a professor at Warren Alpert Medical School of Brown University. “You might have heard that Bill Gates announced he was investing $100 million in Alzheimer’s research. That’s terrific. We’re so excited about that. I think that’s going to stimulate others to donate as well.”

Special-education teacher Donna de Chauny doesn’t have millions to invest; like Gandsman, she answered Salloway’s call out of noble purpose.

“If some of the research that we participate in helps further the information that helps find a cure, then I am happy to participate,” de Chauny said.

“When you watch somebody you love go through it, it’s just terrible,” de Chauny said.

Before moving from her home in North Carolina to Warren, Collene’s symptoms had become increasingly pronounced, even as she endeavored to hide them.

“She knew she couldn’t remember things,” her daughter said. “Every time you’d talk to her on the phone, the same things would repeat themselves because she was trying to have a conversation. And she couldn’t really gather the words to react to what you were saying in an appropriate way.”

But she kept trying to maintain a veneer of normalcy, even after relocating to Rhode Island.

“She would pour her coffee on her cereal in the morning and think nothing of it,” de Chauny said. “We’d say, ‘I don’t think that’s going to taste too good, Mom.’ And she’d say, ‘Oh, that’s always the way I have it.’”

Collene was not the only family member to suffer from Alzheimer’s, de Chauny said; all three of her mother’s siblings also died of the disease.

Salloway spoke to that during the swabbing event, the second held at Butler, saying that remaining mentally and physically active and socially engaged appear to reduce risk, as do “eating a balanced, Mediterranean-type diet,” sleeping well, quitting smoking, maintaining healthy weight and blood pressure, and other measures. All are encapsulated in the mantra: “What’s good for the heart is good for the brain.”

But more than lifestyle is involved in Alzheimer’s, which is characterized by buildups of two proteins in the brain: tau, which forms tangles inside neurons, and amyloid, which forms damaging plaque in connections between nerve cells. The precise mechanism of these protein buildups is not entirely understood, but research has brought advances.

One recent development has been a type of Positron Emission Tomography, or PET, technology that can reveal the presence of plaque years before symptoms of Alzheimer’s appear; previously, a diagnosis could be confirmed only at autopsy, with a microscopic examination of the brain.

Another has been clinical trials of Aducanumab, a drug made by Biogen that has demonstrated success in reducing amyloid plaque. The drug holds such promise that the paper describing the research behind it made the cover of the Sept. 1, 2016, edition of Nature, one of the world’s leading science publications. Salloway was one of the paper’s authors.

A third is a technique being developed by Salloway’s group and a team led by Peter J. Snyder, professor of neurology at the Alpert Medical School and Lifespan’s chief research officer, that could be used to diagnose Alzheimer’s by retinal imaging, a relatively simple and inexpensive procedure that an ophthalmologist could perform.

And there is more promising research elsewhere in the state, including that conducted by University of Rhode Island neuroscientist Paula Grammas, whose work focuses on the role the vascular system plays in Alzheimer’s. Grammas is the inaugural director of the George and Anne Ryan Institute for Neuroscience.

Salloway projected a slide, “Rhode Island as an incubator for innovation in AD research,” that included a photo of Grammas with Governor Gina Raimondo, URI president David M. Dooley, and former CVS Health Chairman and CEO Thomas M. Ryan, who established URI’s Ryan Institute.

“Rhode Island — because of our small size, everybody knows everybody,” Salloway said, to laughter.

But proximity and determination have more than comic value. With both, collaboration can flourish.

“We could really be an innovation center for Alzheimer’s research and prevention studies,” Salloway said.

Without volunteers, innovation would slow. And so, Salloway urged his latest recruits to encourage others to join the army.

“You’re already doing a lot to fight Alzheimer’s,” he said, “but I want you to take the Alzheimer’s challenge. I want you to tell five other people that you came here tonight to find out about Alzheimer’s research. We hope you will spread the word around.”

And also, host “swabbing parties” at homes or civic organizations, with the Butler team handling the logistics.

To learn more about Alzheimer’s research at Butler and how to enroll in a study, call (401) 455-6402 or visit butler.org/memory

Alzheimer’s disease research funding

$448M

National Institutes of Health spending in 2011

$1.39B

NIH spending in 2017

$1.8B

NIH projected spending in 2018

$6B

NIH spending on cancer research in fiscal 2017


Sources: NIH, U.S. Senate Committee on Appropriations

Source: Researchers build ‘citizens army’ in war against Alzheimer’s

Medicaid and Federal Funding

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How is Medicaid funded and what are the funding rules?

States are not required to accept federal funding for Medicaid; however, if they chose to participate in the Medicaid program, they are required to comply with federal statutory and regulatory requirements. Camacho v. Texas Workforce Com’n., [326 F.Supp. 2d 794 (W.D.Tx. 2008)].

States must submit their proposed Medicaid plans for approval from the Centers for Medicare and Medicaid Services (CMS). CMS does not automatically approve state Med

icaid plans and has the final say in approving or denying a proposed amendment to a state Medicaid plan. For instance, in Md. Dept. of Health and Mental Hygiene v. CMS, [592 F.3d 424, 427 (4th Cir. 2008)], the CMS rejected Maryland’s proposed amendments to its state Medicaid plan because those amendments would have unreasonably limited the deductibility of medical expenses incurred by Medicaid enrollees after being determined eligible for Medicaid in contravention of federal requirements.

The CMS may approve a state’s waiver application through a section 1115 waiver application. The 2017 National Academy Elder Law Attorneys Summit highlighted a current trend of CMS allowing a state to forgo the three months of retroactive Medicaid coverage. Recently, Arkansas and Maine have submitted 1115 demonstration waiver applications doing away with the three months of retroactivity and Iowa is also seeking to forgo this option. It is anticipated that CMS will continue to relax the three month retroactive coverage in future state demonstration waiver applications.

Understanding how the funding for the Medicaid program works is a step in understanding the rules to qualifying for Medicaid and where those rules originate. The State of Rhode Island has the Department of Human Services as overseeing the administration of the Medicaid program. Applications for Medicaid are submitted to DHS where they review and advise as to the applicants approval for the program.

Chasing millions in Medicaid dollars, hospitals buy up nursing homes

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A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

Westminster Village North, a nursing home and retirement community in Indianapolis, recently added 25 beds as well as two kitchens to speed food delivery to its residents. It redesigned patient rooms to ease wheelchair use and added WiFi and flat-screen televisions. This fall, it’s opening a new assisted-living unit.

The nursing home can afford these multimillion-dollar improvements partly because it has, for the past five years, been collecting significantly higher reimbursement rates from Medicaid, the state-federal health insurance program for the poor.

The changes began when Hancock Regional, a county-owned hospital 15 miles away, began leasing Westminster Village North. A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

About half of Westminster’s residents are on Medicaid, so the new funding was substantial.

“We have seen amazing changes and created a more homelike environment for our residents,” said Shelley Rauch, executive director of the home.

Nearly 90 percent of Indiana’s 554 nursing homes have been leased or sold to county hospitals in the past 14 years, state records show, bringing in hundreds of millions in extra federal payments to the state.

Even though Indiana’s nursing home population has remained steady at about 39,000 people over the past five years, Medicaid spending for the homes has increased by $900 million, to $2.2 billion in 2016, according to state data.

Today, more than two-thirds of Indiana’s Medicaid long-term care dollars go to nursing homes. The U.S. average is 47 percent.

The funding enhancements were pioneered in Indiana, but hospitals in Pennsylvania and Michigan also have used the process. Advocates say it has been a key factor in helping to keep Indiana’s city and county hospitals economically vital at a time when many rural hospitals nationwide are facing serious financial difficulties.

 

Critics contend that the money flow has not significantly improved nursing home quality. Furthermore, they say, it has provided incentives to steer patients to nursing homes rather than lower-cost options, such as home health care or community-based daycare centers.

Joe Moser, who until May was Indiana’s Medicaid director, acknowledged while in office that more people were moving to nursing homes rather than staying in their homes, and said it was due in part to the hospital-nursing home marriages. “It is a factor that has contributed to our imbalance” in care choices, he said.

Daniel Hatcher, a law professor at the University of Baltimore and author of “The Poverty Industry,” a book published last year, said this funding arrangement is a bad deal for the poor because it takes a large portion of Medicaid dollars targeted for services for low-income nursing home residents and sends it instead to hospitals to use as they please.

That undercuts the purpose of the Medicaid program, he said.

“The state is using an illusory practice and taking away money from low-income elderly individuals who are living in poor-performing nursing homes,” he said. He noted Indiana is ranked near the bottom of states for nursing-home quality by several government and private reports. Among them is a scorecard from Families for Better Care and the AARP scorecard.

But proponents of the practice say that even when hospitals get most of the money, it is well spent.

Marion County Hospital and Health Corp., the large safety-net hospital system in Indianapolis, owns or leases 78 nursing homes across the state, more than any other county hospital.

Sheila Guenin, vice president of long-term care there, said the hospital keeps 75 percent of the additional Medicaid dollars and the nursing homes get the rest. Still, the additional money has improved care. The transfer of the license to the hospital has kept several nursing homes from closing and increased staffing rates at many others, she said.

About 40 percent of the county hospital’s nursing homes have five-star ratings from the federal government, up substantially from 10 years ago, Guenin said. Among the improvements at the nursing homes were the addition of electronic health records and of high-capacity emergency generators to provide power in a natural disaster.

Still, some patient advocates said the extra funding is flowing to hospitals and nursing homes with little public accounting. Ron Flickinger, a regional long-term-care ombudsman in Indiana, said, “A lot of extra money is being spent here, but I’m not sure patients have seen it benefit them.”

Medicaid, which typically covers about two-thirds of nursing home residents, is jointly financed by the federal and state governments. States pay no more than half the costs, although the federal match varies based on a state’s wealth. In Indiana, the federal government pays about 65 percent of the costs.

The enhanced nursing home payments began in 2003 when a county-owned Indianapolis hospital decided to take advantage of Medicaid rules to bolster its bottom line. In this case, the hospital purchased a nursing home, then provided the money for the state to increase what it spent on the home to the federally allowed maximum.

That increase, in turn, drew down more federal matching funds. Since the federal remittance was larger than the hospital’s contribution, the hospital got back its initial investment and divided the extra money with the nursing home.

Other county-owned hospitals in Indiana slowly followed suit.

All the Medicaid funding for nursing homes should be going to those homes to care for the poor, not shared with hospitals to use as they choose, he said.

The strategy, promoted by consultants advising hospitals and nursing homes in Indiana, is used heavily there because of the plethora of county-owned hospitals. But the federal government is tightening the rules about such payments.

Texas has secured Medicaid approval for a similar strategy starting this month, but federal officials have made the extra funding dependent on nursing homes meeting quality measures, such as reducing falls. Oklahoma is seeking to get federal approval as well.

And in a rule released last year, the federal Centers for Medicare and Medicaid Services announced that it would gradually force states to shift to payment systems that tie such reimbursements to quality of care. Michael Grubbs, an Indiana health consultant, said that rule does not stop the Indiana hospital funding program, but it’s unclear that it will last.

Nursing-home operators in Indiana say the financing arrangement has helped them keep up with rising costs and improve care for residents.

Zach Cattell, president of the Indiana Health Care Association, a nursing-home trade group, noted the number of nursing homes in the state earning Medicare’s top, five-star rating has increased 9 percentage points since 2011. He said the percentage of high-risk residents with pressure ulcers and those who are physically restrained also dropped significantly.

“The money has meant a great deal to us,” said Gregg Malot, director of business development at Pulaski Memorial Hospital in northern Indiana. “I don’t see this as a loophole but see it as an opportunity for small, rural community hospitals to improve our quality and access to care.”

His hospital is the only one in Pulaski County. The extra Medicaid revenue from having acquired 10 nursing homes statewide — about $2 million a year — has helped finance the purchase of the hospital’s first MRI machine, so doctors don’t have to rely on a mobile unit that used to come twice a week, he said. The hospital also spent some of the money to add a computerized system to monitor patients’ vital signs.

Steve Long, chief executive of Hancock Regional Hospital in Greenfield, said his hospital recently built two fitness centers in the county with help from the extra Medicaid dollars that resulted from its acquisition of Westminster Village.

He rejects the notion that additional Medicaid money reduces the hospital’s incentive to add home- and community-based care in the community. He said new Medicare financing arrangements, such as accountable care organizations, give the hospital motivation to find the most efficient ways to care for patients after they leave the hospital.

But he acknowledged the hospital benefits from seeing more patients go to nursing homes licensed under its name.

“Welcome to health care — it’s a complex and confusing environment where we have all different competing incentives,” Long said.

 

Source: Chasing millions in Medicaid dollars, hospitals buy up nursing homes

Tips for choosing the Medicare plan that’s right for you

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Fall and winter don’t just bring cooler temperatures and the holidays — the final seasons of the year also mean open enrollment for Medicare. For most seniors in the United States, the period between Oct. 15 and Dec. 7 is the only time they can switch or make changes to their Medicare plan insurance.

“As people age, their health care needs evolve,” says Dawn Maroney, chief growth and strategy officer for Alignment Healthcare. “When that happens, they may find the Medicare plan they first chose when they became eligible no longer meets all their needs. This open enrollment period is their yearly opportunity to re-evaluate whether to continue with their plan or switch to another, with changes becoming effective the first of the new year.”

Medicare basics

Most Americans are aware that Medicare is a government program designed to ensure people older than 65 have access to affordable health insurance. The program can also cover people younger than 65 who have certain disabilities.

The Medicare program has four parts, according to Medicare.gov: A, B, C and D.

* Medicare Part A helps pay for in-patient hospital stays, care in a skilled nursing facility and hospice care.

Drawing of Medicare with Stick Men and Clipping Path

* Medicare Part B helps cover care by doctors or other health care providers, outpatient services, some medical equipment and some preventive services.

* Medicare Part C (also known as Medicare Advantage) covers everything included in parts A and B, and usually includes Medicare prescription drug coverage as part of the plan. Medicare Advantage plans may include extra benefits and services for an extra cost. Medicare-approved private insurance companies, such as Alignment Healthcare’s Alignment Health Plan, run Medicare Advantage plans.

* Medicare Part D helps cover the cost of prescription medications and is run by Medicare-approved private insurance companies.

Original Medicare versus Medicare Advantage

Most people think of Medicare parts A and B as Original Medicare, in which the government pays directly for the health care services received. People with Original Medicare can see any doctor and hospital that accepts Medicare in the country, without prior approval from Medicare or their primary care physician. Most people do not pay a monthly premium for Part A if they paid taxes while working; everyone pays a monthly premium for Part B, based on income. The standard premium for Part B in 2017 was $134 per month, which is deducted from the individual’s Social Security benefits.

Original Medicare pays for about 80 percent of the total costs of health care. The patient is responsible for the remaining 20 percent, which can mean high out-of-pocket costs in the event of a hospitalization or other events requiring significant medical attention. To offset the financial burden of that 20 percent, some people choose to purchase supplemental insurance, called Medigap.

Private insurance companies offer Medigap to cover things Medicare doesn’t, such as deductibles, co-pays and co-insurance — but, keep in mind, Medigap only supplements Original Medicare benefits. Further, if you do not apply for Medigap in the first six months of becoming eligible, there’s no guarantee that an insurance company will sell you a Medigap policy.

 

With Medicare Advantage, government-approved private companies administer health plans that cover everything Original Medicare does, but can do so with different rules, costs and restrictions that can change every year. For example, a private Medicare plan may require your physician to request permission before performing a procedure in order to be paid by the plan. Medicare Advantage plans, however, usually cover extras that Original Medicare does not, like dental care, vision services, hearing exams and gym memberships.

Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D), which is not included in Original Medicare, at no additional cost. If you elect to enroll in a Medicare Advantage plan, you still have Medicare — this means that you must still pay your monthly premiums for parts A and B, in addition to a monthly premium for Part C, if applicable. Many Medicare Advantage plans are available for no additional monthly premium.

When choosing between Original Medicare and Medicare Advantage, you should consider these questions:

* How likely is it your health needs will change down the road? Since health changes as you age, chances are your treatment needs will, too. If you don’t enroll in the additional insurance and drug coverage when you first sign up for Original Medicare, you may pay a monthly penalty for enrolling later and may not be eligible for additional Medigap coverage.

* Are you still working past age 65? If so, you will probably want to enroll in Part A, because there generally are no monthly premiums, and it may supplement your employer’s insurance plan. You might choose to delay enrolling in Part B, but it depends on your health coverage. Everyone has to pay a monthly premium for Part B.

* Is it more important to you to have lower or no premiums or lower out-of-pocket costs? With Original Medicare, you may pay more out of pocket without supplemental insurance and prescription drug coverage. Medicare Advantage includes supplemental insurance and sometimes prescription drug coverage, too.

* How important is it to keep your doctor? Original Medicare is accepted by any doctor or hospital that accepts Medicare, without referral. Medicare Advantage plans allow you to select a doctor from the plan network, which is usually very large; your current health care providers are likely to be in the network already.

* Do you regularly take prescription medication for chronic conditions? Prescription drug coverage is not included in Original Medicare, and if you fail to sign up for Part D at the time you enroll, you could pay a penalty for adding it later. Most Medicare Advantage plans do cover prescription drugs.

“Medicare Advantage allows patients to receive the care they need to stay well and keeps their budgets in check with set costs and annual maximums,” Maroney says. “It’s an ideal solution for patients who need frequent care or who struggle to meet medical expenses.”

To learn more about Medicare, visit www.Medicare.gov. For information about Alignment Healthcare and its affiliated Medicare Advantage plans, visit www.alignmenthealthcare.com.

 

Source: Tips for choosing the Medicare plan that’s right for you

FREE Seminar

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Join us for a FREE seminar to be conducted at Heritage Hills Nursing Center in Smithfield, Rhode Island where we will be discussing the legal issues that must be planned for with seniors.

Click the below link to lean more. To register, please call Jenny Coutre at 401-231-2700 x39.

HERITAGE HILLS v3

FREE Seminar
To Register Call
401-231-2700 x39

Higher health-insurance rates coming to R.I. for 2018

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Health-Insurance rate increases

A number of Rhode Island health-insurance companies have been granted permission for double-digit rate increases to their premiums for 2018.

The new rates released Thursday by the Office of the Health Insurance Commissioner range from increases of 5 percent to 12.1 percent. In six of 12 cases, the rates app

Insurance Policy

roved are less than the increases requested by the insurance companies. Collectively, the 2018 premium approvals are $16.7 million lower than what insurance companies requested.

The rate increases approved for the individual market, which covers roughly 47,000 people, are: Blue Cross Blue Shield of Rhode Island, 12.1 percent; Neighborhood Health Plan of Rhode Island, 5 percent.

The rate increases approved for small-group market, which covers roughly 60,000 people, are: Blue Cross Blue Shield of Rhode Island, 7.3 percent; Neighborhood Health Plan of Rhode Island, 6.3 percent; United HealthCare HMO, 8.1 percent; United HealthCare PPO, 8.1 percent; Tufts Health Plan HMO, 6 percent; Tufts Health Plan PPO, 6.5 percent.

The rate increases approved for the large-group market, which covers roughly 123,000 people, are: Blue Cross Blue Shield of Rhode Island, 10 percent; United HealthCare, 8 percent; Tufts Health Plan HMO, 9.8 percent; Tufts Health Plan PPO, 10.4 percent.

Having health insurance is the first step in the process of planning for medical issues and paying for your care to address those issues. However, health insurance is only one piece in the health care planning puzzle. People need to be aware that health insurance does not pay for every health related expense. One major expense it does not pay for is nursing home care, or skilled nursing care. These medical expenses are not covered by health insurance and should you or a loved one find yourself in a position to need to reside in a facility, many are overwhelmed with the financial burden it imposes. Thus planning your estate and planning for these expenses is critical. Call us to discuss how you can plan for these expenses.

Source: Higher health-insurance rates coming to R.I. for 2018