What is the PACE Program in Virginia?

PACE stands for the Program of All Inclusive Care for the Elderly. And this movement has gained a lot of momentum in recent months, particularly as it relates to concerns about care for the elderly and protecting them well into their later years in life. At its simplest definition, PACE is an alternative to nursing homes.

This is a Medicaid and Medicare program that helps to keep people in their own communities. In many cases, the programs are run with the support of in-home care providers at a nexus of community-based centers. This helps to complete an interdisciplinary care team for total comprehensive wellness. According to the national PACE Association, approximately 95% of people enrolled in the program live in the community and only 5% live in nursing homes.

Given that it is required to be eligible for nursing home care before enrolling in PACE, this is a substantial thing to take note of if you have a loved one who is in the process of figuring out the best care solution for them.

Most PACE participants are eligible for Medicaid and Medicare. The operators of these programs will receive specific monthly payments for each participant, meaning that some of it is paid by the payer and some is paid by the provider. COVID-19 played a significant role in increasing attention towards the PACE program. The general death rate in nursing homes across most of the pandemic was 11.8%, where it was only 3.8% in PACE locations.

If you have questions about qualifying for PACE in Virginia or discussing alternative care arrangements, schedule a consultation with an estate planning lawyer in your area to learn more.



Discharges, Medicare, and Long Term Care Basics for Seniors

A new study identified that Medicare could save approximately $4.6 billion with no negative impact by disallowing discharges to long term care hospitals. The study analyzed different outcomes for patients between 1998 and 2014 for those patients who were discharged to long term hospitals.  
Do you have long term care insurance to help you plan ahead for your future? If not, do you have a Medicaid plan in place to ensure that you’ll be ready to tap into government benefits when you need them?
Markets with LTCHs tended to be bigger than those without and that made up nearly 35% of Medicare enrollees by the conclusion of the 16-year period. When compared with rates for time spent in a skilled nursing home, per day rates averaged $1400 in 2014 in comparison with $450 for a skilled nursing home. Don’t make the mistake of assuming that Medicare will pay for all of your advanced care needs- this misconception and the related lack of Medicaid planning costs families.
The skilled nursing home would have been the alternative for nearly all of the LTCH patients and the choice to use LTCH facilities, instead, represented a 33,000 increase in overall Medicare spending. Since many different policymakers are looking for ways to reign in the spending on health care, it is important for anyone who is planning for their own financial future to consider how best to protect their individual interests.
You need the support of a knowledgeable estate planning attorney to help you understand how Medicaid and Medicare may work together and may not work together in your future years as you plan for the possibility of long term care events that could disrupt your savings and your retirement. The support of a lawyer is instrumental in finding loopholes in your plan and helping you to articulate new strategies that consider the future.

Medicare And Veterans Administration Benefits Don’t Work Together

Veterans trying to decide between using their VA benefits or Medicare can use both, but only to a limited extent, according to the website Medicareinteractive.org.
“You can have both Medicare and Veterans Affairs benefits,” the site states. “However, Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility. In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
“In order for your VA coverage to cover your care, you must generally receive health care services at a VA facility.”
A lot of veterans, according to the site, use their service-related benefits for things like over-the-counter medications, annual physical exams and hearing aids.
“However, you may want to consider enrolling into Medicare Part B, medical insurance, even if you have VA coverage,” the story states. “Part B may cover services you receive from Medicare-certified providers and provide you with medical coverage outside the VA health system. In addition, if you do not enroll into Part B when you are first eligible to do so, you will most likely incur a Part B premium penalty for each 12-month period you were without Medicare Part B coverage.
“Some veterans only use their VA drug coverage to get their medications, since VA drug coverage may offer more generous prescription drug coverage than Medicare Part D, the Medicare prescription drug benefit. Since VA drug coverage is considered creditable, meaning it is as good as or better than the Medicare prescription drug benefit, you can delay enrolling into Medicare Part D without penalty. If you do lose VA drug coverage, make sure you enroll into a Part D plan within 63 days of losing your VA benefits.”

Half of seniors eligible for drug benefit don’t apply

A little Extra Help could do senior citizens a world of good, literally and figuratively.
That’s the name for a Medicare benefit that can greatly help low-income elderly people pay for their prescriptions, but one that far too many of those eligible for it don’t know exists.
“More than 2 million people on Medicare could be getting their prescription drugs nearly for free, but don’t,” according to a recent story by Mark Miller of Reuters news service. “That’s because they have not signed up for Extra Help, an important Medicare benefit that subsidizes drug costs for low-income senior citizens.
“Extra Help can pay nearly all of the prescription drug costs a senior incurs in a Part D drug plan. It is provided automatically to seniors receiving Medicaid or Supplemental Security Income benefits. In some states, Extra Help also is automatic for people receiving benefits through the Medicare Savings Program, which helps subsidize Medicare Part A (hospitalization) and Part B (outpatient) premiums.”
However, for those who qualify but just not automatically, less than half are enrolled in Extra Help, Jack Hoadley, a research professor at the Health Policy Institute of Georgetown University who tracks the program, told Reuters.
“The government reaches out with information on this from time to time,” Hoadley was quoted as saying. “What’s harder is to figure out how to reach out specifically to people who are eligible.”
“The benefit is substantial – annual savings can easily total $800 on premiums and deductibles, and can be much higher for seniors with high drug spending,” Miller wrote. “Two factors determine your eligibility for Extra Help: income and assets. Your income cannot exceed the federal poverty level guidelines. For seniors with incomes of 135 percent of the federal poverty level or lower, Medicare pays the entire annual premium, expected to average $480 next year, according to the Kaiser Family Foundation. Extra Help also covers deductibles, which typically run $310 for the year.”
Seniors who wish to learn more about Extra Help may do apply online at secure.ssa.gov/i1020/start or call 1-800-772-1213 to get the process started.

Long-term care insurance faces troublesome future

While many people approaching or in their Golden Years want to take the wise precaution of acquiring long-term care insurance, increasingly they may discover they cannot afford to do so.
“With nearly 70 percent of Americans aged 65 or older expected to need long-term medical care at some point, millions of Americans have turned to long-term-care insurance to help them cover its high costs,” he wrote. “But rate hikes on long-term-care premiums are coming, meaning many of those who prudently planned for their long-term-care needs may not be able to afford to keep their coverage.
“Insurance companies have faced a triple-whammy that has hit them especially hard in recent years. Low interest rates and weak investment returns have hampered their ability to build up the loss reserves they need in order to pay out claims. And with long-term-care insurance often extending for decades, the assumptions that insurance companies make about what returns they’ll be able to earn are even more important than on other types of policies, such as homeowners’ insurance. At the same time, health-care costs have continued to rise. The same factors that are making it problematic for the federal government to ensure Medicare’s continued stability are hitting long-term-care insurance providers. Private insurers face the added handicap of having a smaller pool of available revenue and financial reserves to draw from.”
Sadly, according to Caplinger, a Motley Fool contributor, these factors will probably remain in play for quite some time to come, forcing older Americans looking for long-term care insurance to settle for less than they might have wanted and still more than they cared to pay.
“Some people will be able to accept less inclusive policies and still get by,” Caplinger wrote. “But given the financial realities of being retired on a limited income, a substantial portion of the people who currently have long-term-care insurance coverage may be so soured on the experience that they’ll stop paying their premiums and let their long-term-care policies go away entirely.
“That will represent a sad end for those who paid tens of thousands of dollars over the years for coverage that they may now never have any opportunity to use.”

Affordable Care Act Likely to Improve Situations of People with Disabilities

The Affordable Care Act (ACA) is a hot topic lately, and of great concern to people of all walks of life; but people with disabilities, or who rely on government benefits to help them pay for health care and living expenses, have even more at stake in the game and more reason to be concerned. It is this population of elderly or disabled individuals who, according to this recent article in Forbes, have had to (in some states) limit their income in order to continue receiving affordable health insurance through federally funded programs. But hopefully, the ACA is about to change all that.

“The most obvious and most significant health industry reform important to [elderly or disabled individuals] is the elimination of pre?existing conditions as a bar to purchasing private health insurance. However, ACA also eliminates annual or lifetime caps, rescission of insurance policies, non?renewability, and higher premium costs for persons with pre?existing conditions.”

Before the passage of the ACA many disabled persons couldn’t qualify for health insurance from private insurers, leaving public programs such as Medicaid as their only option. The problem with relying on Medicaid is that once your income reaches a certain amount you no longer qualify. For disabled persons with “pre-existing conditions,” losing Medicaid benefits while still unable to qualify for private insurance was equal to disaster, and resulted in many people self-limiting their income.

Now, however, private insurance companies will no longer be able to bar individuals with pre-existing conditions. Thankfully, this should “open the door to many more people to confidently join the workforce, knowing they will not do so at the cost of having medical needs met.”

If you or a loved one has a special needs trust, or would like to know how the ACA may affect your government provided health insurance or benefits, please contact our office.

How the Supreme Court Ruling on Health Care Reform May Affect Seniors

The recent Supreme Court ruling of the constitutionality of the new health care reforms has many seniors breathing a sigh of relief. The ruling has ensured that, at least for the time being, senior citizens will continue to receive their currently existing benefits from programs such as Medicaid and Medicare; but the ruling also paves the way for changes—some good and some not so good—in the way various home-based and long term care services are paid for and provided.

This article in Forbes explains some of the ways that the ruling on the Affordable Care Act will impact senior citizens or adults with disabilities:

According to the article, Medicaid “currently funds nearly half of all paid long-term care services.” This current coverage will continue under the 2010 health law, but states can refuse to provide new coverage to individuals if they choose.

The Medicare program is currently under some considerable financial strain, and the Affordable Care Act “includes a small increase in the payroll tax that is aimed at increasing revenues for Medicare.” This should be a great help to the program, and a relief to seniors who receive benefits from Medicare.

For seniors and adults who require long-term care services and have been frustrated by numerous roadblocks to getting that care at home instead of in a nursing facility, good news is on the horizon; the ACA “includes important new incentives for states to expand Medicaid long-term care services for people living at home.”

And finally, the law is giving more attention to seniors and adults with chronic and long-term illnesses. The ACA “creates a new office to coordinate the health and long-term care of people who receive both Medicare and Medicaid. . . It also includes important incentives to encourage hospitals, nursing homes, doctors, and other providers to work together to improve care for people with chronic disease.”

Will Medicare Provide for You in Your Golden Years?

Many retirees (or soon-to-be-retirees) have been living and saving under the assumption that Medicare would pay for a bulk of their medical costs during retirement, but a recent article in the Wall Street Journal reveals that counting on Medicare may not be the safest bet anymore. According to the article, one of the most important facts that retirees need to understand about Medicare is that “Medicare pays for very little long-term care, and you’ll still need significant savings to cover the rest of your medical expenses.”

This statement may come as a shock to those who fall in the soon-to-be-retired category simply because they likely haven’t had to give much thought to post-retirement medical costs yet; but they may be in for a rude awakening when the time comes to rely on Medicare. “Two-thirds of those on Medicare also said they pay the same, or more, for healthcare now than when they were working. They have been unpleasantly surprised by the cost of Medicare Part B premiums, what you pay for doctor and outpatient coverage, with 44% paying more than they had expected.”

Fortunately, our readers can become aware of this need to be more proactive about their own healthcare, and can start planning now. How you should plan will depend greatly on your age, your current rate of saving, and many other factors. Please contact our office (or your own trusted attorney or financial planner) today.

A Woman’s Work Is Never Done

Do you know who will take care of you when you are unable to take care of yourself? Studies show that most caregivers for aging seniors are likely to be women, and most likely to be your daughter or daughter-in-law. What this means is that unless parents have a plan for their future long term care, the financial burden of caring for these aging parents will fall to daughters and their families.

Serving as a caregiver for elderly parents includes more than just driving to doctor appointments or helping with the shopping, it often includes paying for food and medical costs, as well as taking time away from careers to care for family members. In fact, it’s not unusual for female caregivers to experience a significant loss of income over a lifetime in reduced salary and retirement benefits.

Many seniors think that they will have government programs such as Medicare and Medicaid to fall back on, but these programs don’t always provide as much as expected or hoped. Relying on government programs can leave your children or family members footing just as much of the bill as they would without the programs. Instead, seniors may want to consider investing in long-term-care insurance, which can provide more flexible and comprehensive coverage than government programs, and save seniors and their families much time and money.

If you are a daughter of aging parents, now is the time to talk to your parents about the future. Studies show that you are the one who is likely to shoulder the responsibility of caring for parents as they age. Doing so will affect your family, your career, your finances, and even your health.

The subject of aging and elder care is a difficult one, but not one to be left to the last minute. Talk to your family about your wishes and plans for the future, then bring your estate planning attorney into the discussion. Once you have an idea of your wishes, an expert can help you feel better about your options, and put you on the right path for keeping your family healthy, happy, and financially secure in the years to come.

Veteran Journalist Shares Her Personal Experiences Entering the Medicare System

Trudy Lieberman has had plenty of experience with Medicare—of course up until now most of it was from the outside looking in. As a journalist for more than 40 years specializing in insurance, health care, health care financing and long-term care, one would think that when the time came this year for her to enter the Medicare system herself she’d be an old pro. Unfortunately, as Ms. Lieberman discovered—and shared with the readers of her exceptional five part article series in Time Magazine’s Moneyland—entering the Medicare system as a patient can be confusing for even the most knowledgeable of inside reporters.

While her experience as a reporter may not have made signing up for Medicare any easier for Ms. Lieberman, her willingness to share her entrance into Medicare with readers may make the process easier for the rest of us. Here are just a few of the issues Lieberman has written about thus far:

Sorting through Medicare information and choosing a plan: “Brochures and ‘lead cards’ for Medicare Advantage plans and Medigap policies began flooding my mailbox in January. This stuff can be a real burden, but some of it’s worthwhile – some even important – so you can’t just throw it all away…Hopefully, my sorting system (partly informed by decades of reporting on Medicare, partly by common sense) will make the task easier for you.

Choosing a Medigap Plan to fill in the gaps of Medicare coverage: “It quickly became clear that the push to give consumers more choices and more information has actually made the job of picking a Medigap plan much harder. I ended up having to check out multiple websites, brochures, handouts and make several toll-free calls for assistance.”

Finding a plan to cover the cost of prescription drugs: “I decided to ask my pharmacy about the retail cost of the drugs I currently take. I’ve always had great drug coverage, so it was shocking to learn that my prescriptions would cost $3,131 a year if I had to pay out-of-pocket. (Of course, from interviewing seniors over the years, I know some folks actually pay four or five times that amount.)”

Part five comes out next week, and we look forward to reading the conclusion of this helpful series. We know how confusing and time consuming dealing with Medicare can be, so it’s helpful to know that many elder law attorneys specialize in helping seniors with this very process—we can help you too.