Tag Archives: medicare

Ways to Pay For Nursing Home Care




The easiest way to pay for nursing home care for an elderly or disabled family member is also the hardest. You write the monthly check. It hurts because the average yearly cost is now $70,128.

Before writing a check, it makes sense to talk with a knowledgeable attorney or accountant so that your family does not overlook tax deductions or available benefits. For example, if you pay more than 50% of the support for a relative who meets certain gross income guidelines, then you may claim the relative as a dependent on your own federal tax return. You might also qualify for the dependent care credit which is available for a dependent parent who needs full time attention.




The I.R.S. also permits a tax deduction for qualified long term care services. Many of the costs incurred in a nursing home can qualify for the medical expense deduction under a proper plan as long as it is set up by a licensed healthcare practitioner.

Medical expenses can be claimed as itemized deductions, so long as they exceed 7.5% of adjusted gross income. Qualified health insurance premiums, long term care service and other eligible medical expenses can be added together to meet this cutoff. If you pay nursing home costs for a parent or disabled family member, it is important to consider this deduction.

Many people turn to Medicaid to write the check for nursing home care. The program is jointly funded by the states and the U.S. government. The first hurdle is that your family member must have a medical reason to be in a nursing home. It is not a housing program. The next hurdles are the income and asset guidelines. The single person guidelines for Medicaid limit assets to $2,000 in the bank, possibly a car, some personal property and a prepaid funeral account. The rules are more generous for spouses. A spouse can keep approximately $100,000 in assets and the family home. If any assets were given away within five years prior to applying, those transfers may block your family member from eligibility. The guidelines do vary from state to state.

Considering that some government statistics predict that 50% of U.S. population will spend at least some time in a nursing home, it is a good idea to consider long term care insurance. The average stay is 11 months. Long term care insurance policies have many different features, including daily benefits, elimination period, inflation riders and benefit length limits. Two good starting points are to be sure that any policy you purchase is tax qualified and that the insurance company is sound. Since long term care insurance is a new product and the companies have had limited claims losses, it tends to be reasonably priced.

The United States Veterans Administration is another possible source of nursing home care. The U.S. Veterans Administration maintains about 115 nursing care facilities. That is a very small number to house all of our veterans. They have about 300 beds each and there is some availability for spouses of veterans, surviving spouses and certain eligible parents, such as Gold Star mothers.

Medicare is another checkbook but its funds are very limited. It doesn’t come out until a patient spends three days in a hospital and is prescribed to a nursing home by a doctor for “skilled nursing care.” After 21 days you have to write checks for a significant co-pay of $128 per day. A medi-gap policy can cover this but your own checkbook comes out again for full pay after 100 days.

It pays to plan and consult ahead and long term care insurance may be a bargain in the long run.

Joseph M. Hoffmann, Esq. is an attorney in Newton, who helps clients with trusts, estate planning, Wills and related transactions.

About the Author:

Joseph M. Hoffmann, Esq. is an attorney in Newton, who helps clients with trusts, estate planning, Wills and related transactions.

Article Source: http://EzineArticles.com/?expert=Joseph_M._Hoffmann,_Esq



Medigap Insurance: Do I need a Medicare Supplement?







Medigap insurance overview:

Medigap insurance is a Medicare supplement insurance provided by a private insurance company. Medigap insurance is separate from the original Medicare insurance plan, as well as being separate from federal programs. It fills in some but not all of the holes in the basic, original Medicare plan. Typically, this Medicare supplement insurance plan pays the cost of premiums, co-payments, deductibles and any physician’s fees that exceed the amount approved and paid by Medicare. It does not cover any charges not covered by Medicare. Also, long-term care is not paid for by Medigap insurance.

Medigap insurance covers people for ongoing medical expenses. It is frequently considered to be a good idea for many people, but is not for everyone. An example may be an individual enrolled in a Medicare advantage plan or other managed-care plans, or group health plan that provides adequate coverage. In many instances, it may even be illegal for a company to sell an individual Medigap insurance coverage when they have these types of plans.




Anyone nearing the level of financial eligibility for Medicaid does not need a Medigap insurance plan. Also, as mentioned above, it is illegal for a company to sell this type of Medicare supplemental insurance plan to someone on Medicaid. However, you should be aware, that Medicaid is run by the individual states that may have their own varying coverage arrangements.

If an individual wants additional coverage, they should consider changing to a Medicare Advantage plan, which may offer some additional benefits (but may also have some limits that you may be uncomfortable with).

If you’re interested in a Medigap insurance plan, you should probably buy it within six months of enrolling in Medicare Part A. During this window of opportunity, your parent or loved one cannot be denied coverage because of existing medical problems.

After this six-month enrollment period is over, insurance companies may be allowed to increase the price of the policy, refuse coverage or even attach an array of conditions to a policy. Your senior may be protected from these increases, denials, and conditions if their current employer, group, or Medicare Advantage health coverage ends for some reason.

Your senior may also switch from one Medigap insurance policy to a different one without penalty for pre-existing illnesses or disability, as long as they have had their current policy for at least six months. The company can however delay coverage beyond what the original policy covered, for six months.

The basic Medigap insurance plan includes the following benefits. All Medigap insurance plans cover certain holes in the original Medicare insurance plan. These include:

Co-insurance for hospitalization.

After Medicare’s hospitalization coverage is used up, 365 additional days (over a lifetime).

Co-payments required by their Part B Medicare insurance (20% Medicare approved fee for doctor services and 50% for mental health services).

The first 3 pints of blood each year (at which time Medicare will then pick up the payments).

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting







Medicare Supplement Insurance Plan Choices







Medicare supplement insurance plan overview:

Medicare supplement insurance plans are usually limited to 10 standard plans in most states, to make your shopping just a little easier. They usually run from plan A, which is the core plan that covers only the basic benefits and is available in all states, through plan J., which is the most comprehensive and expensive of the Medicare supplement insurance plans. By law, these insurance plans can not vary from state to state or from company to company. Also, to make it even a little easier, the language and terminology used in the policies are standardized in these Medicare supplement insurance plans.




There are always exceptions however in that not all states carry every one of the Medicare supplement insurance plans, and a few states (such as Massachusetts, Minnesota, and Wisconsin), have their own versions of these plans. Although there are many aspects of these programs that are standardized to make it easier to purchase these plans, your loved one in Minnesota may not be able to buy the same Medicare supplement insurance plan as another individual in Illinois.

Another thing to consider is that any of the standardized plans can be sold as “Medicare Select” policies which work like managed-care plans. According to these plans, individuals are required to use designated doctors, clinics and hospitals within a “network”, but usually pay less for the plan. Finally, insurers are also allowed to add benefits to a standard Medicare supplement insurance plan, making it just a little less standardized.

In spite of all these efforts at standardization, you or your loved one should read the policies carefully for any Medicare supplement insurance plan you are interested in. You should always make sure that you understand completely what is covered and what exclusions or restrictions may exist in your prospective program. Ask the company for a very simply worded summary, which companies are required to provide. You should make sure that your loved one is actually comparing apples and apples, so that they can decide with relative ease which Medicare supplement insurance plan is the best program for them. They should then shop around and find out who has the best price and best services, along with being the most stable and reliable companies providing these Medicare supplement insurance plans.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting







Medicare Advantage Plan: What is it exactly?







Medicare Advantage Plan overview:

The Medicare advantage plan is provided as an alternative to the original Medicare plan, depending upon where your loved one lives. Private insurance companies also provide coverage similar to the Medicare advantage plan. Frequently they offer broader coverage but limit which doctors, hospitals, and other health-care providers that your senior may visit for services.

If your parent or loved one decides to utilize a Medicare advantage plan, they will still be in the Medicare program, and will still get coverage included in Part A. and Part B of the original Medicare plan.

Medicare advantage plans usually fall under one of the following four categories.




Managed-care. Under managed-care plans, your senior can only go to doctors and other providers within the managed-care network. Also, in most cases referrals to specialists are made through primary care doctors. Doctors can leave the plan at any time and your senior needs to make sure that their current doctor is not thinking about leaving the plan in the future.

Some managed-care plans offer an option called “point of service” which means that your senior may go to doctors and hospitals outside of the network, but they may have to pay deductibles and coinsurance to do so.

Preferred provider organization. These organizations are similar to managed-care plans except that your senior can see specialists without referrals from primary care doctors. In some cases, your loved ones can see any doctor or other health care provider who accepts Medicare, although, they may have to pay an extra charge if the provider is not within the plans “network”.

Private fee-for-service. These plans operate much like the original Medicare plan except that are private company, rather than Medicare, determines the “approved fees”, premiums, deductibles, coinsurance, and co-payments. Your senior may go to any physician or hospital approved by Medicare who has decided to accept the plan’s fees as their payment.

Specialty plan. These plans are relatively new in that they provide normal Medicare coverage, plus they pay for any extra care that is needed because of a specific disorder or disease (such as renal disease, congestive heart failure, or diabetes).

In summary, Medicare Advantage Plans come in many forms with many being very similar to the original Medicare plan. You should continue to learn all that you can in order to make sure that your loved one gets the services that they need through either their original Medicare plan or through one of these Medicare Advantage Plans.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting







Medicare Assignment: What does it mean to me?







Medicare assignment overview:

Medicare assignment is a way to keep costs under control in the Medicare program. Medicare assignment is a way in which costs are determined in advance, with Medicare establishing a certain fee that it will pay for medical procedures and supplies before the procedures are even provided. When a physician, health care provider, or supplier of medical supplies accepts Medicare assignment, they are basically stating that they will take the assigned fee as full payment for a given service with your loved one only paying the deductible and a coinsurance (usually either 20% or 50% depending upon the service rendered) amount.




Current estimates are that more than 70% of doctors (excluding pediatricians and others who do not provide care under Medicare) are “participating physicians”, which means that they accept Medicare assignment on their patients.

If a physician does not accept assignment, they can establish the amount of their own charges and your loved one will be responsible for the difference beyond the part that Medicare would normally pay for that specific service and the actual charge. Also, your senior may have to pay the bill in full and then get a partial reimbursement from Medicare.

There are limits to how much doctors can charge for their services. In most cases, the physician cannot add more than 15% to the fees that have been approved by Medicare. For example, if the approved fee for a specific service is $100, the most a doctor can charge is $115. (Of course a doctor can charge whatever he/she wants for services that are not covered under Medicare).

If your parent or loved one is very happy with their doctor, they may be willing to pay whatever the physician chooses to charge, and they may be willing to pay the extra charge. Otherwise, your senior may find a participating physician either by calling doctor’s offices and asking if they accept Medicare assignment or by looking in the Participating Physician Directory, which can be found at www.medicare.gov , or at public libraries, Social Security offices and also at your local senior citizens center. Your senior may also call his/her Medicare carrier for a list of participating providers.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D Licensed Psychologist Clinical Director- Senior Care Psychological Consulting







Tell me about traditional Medicare.







Original Medicare insurance plan overview and requirements:

The original Medicare insurance plan is divided into two parts: Part A, which includes hospital insurance; and Part B, which is basically medical insurance for outpatient services.

Part A Medicare insurance covers most hospital bills, hospice care and a limited amount of nursing home and home care. Most people who meet the Medicare requirements do not have to pay anything to receive Part A, the hospital insurance, but they may be responsible for certain deductibles and co-payments once they actually receive services.




If for some reason your parent or loved one is not enrolled in Part A Medicare insurance, they should enroll right away; if they wait until they are hospitalized, they will face a mountain of paperwork and bureaucratic delays at an already very difficult time.

Part B Medicare insurance, is the medical insurance portion which covers most doctors fees (but not annual checkups), medical equipment, diagnostic tests, outpatient care, and some mental health and rehabilitative therapy. Most people pay a monthly premium of about $70 for this part of their Medicare insurance, which comes directly from their Social Security payments. Beginning in 2007, the premium will be linked to income, with higher rates for those making over $80,000 per year.

An annual deductible of about $100 must be met before payments begin. After the deductibles are covered, the enrollee pays a “coinsurance” or share the cost of any covered service (about 20% for most services) and Medicare will pay the rest.

Part B Medicare insurance is optional. If your elder receive Social Security payments, they are usually enrolled automatically. If for some reason they do not want Part B (possibly because they are adequately covered by another policy), they need to contact a local Social Security office to let them know immediately. But, there may be penalties if they decide to change their mind and sign up at a later time.

Medicare insurance requirements are as follows:

Services must be provided by a Medicare-approved hospital, agency, institution, or company, except in emergencies.

Services must be “medically necessary”, that is they must be ordered by a physician to diagnose or treat acute or chronic illness.

Services must be provided within the United States are in some emergency situations, Canada (some Medicare advantage plans have different rules regarding travel.)

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting







Medicare Insurance: What are the facts?







Medicare Insurance Overview:

Medicare insurance is a federal health insurance program for people over the age of 65 and some people with disability under the age of 65. The Medicare insurance program is operated by the Centers for Medicare and Medicaid Services (CMS), which used to be known as the Health Care Financing Administration.

A Medicare card is given to anyone who receives Social Security benefits or benefits from the Railroad Retirement Board when they turn 65 years old. If your loved one doesn’t receive Social Security benefits (because he/she is still working or because neither she nor her husband paid Medicare taxes while they were working or for many other reasons) they may still apply for Medicare. To do so they need to contact their local Social Security office or the Social Security Administration (800-722-1213 or www.ssa.gov ).

Medicare Choices:




Contrary to popular belief, Medicare insurance offers choices. Your senior may choose the original Medicare insurance plan, or choose from a variety of other plans referred to as Medicare Advantage. Individuals who choose the Medicare Advantage plan are still covered under Medicare and still get the coverage offered under the original Medicare plan in most cases, however, they get additional coverage for certain examinations, tests, and medical services that are not included in the basic plan. However, they may not be able to choose their own doctors and may have to stay within a “network” of doctors and other health-care providers.

One of the factors to determine which Medicare plan your senior should choose will have to do with how much they are willing to pay upfront, what their health care needs are, extra benefits necessary, which doctors they want to see or where the doctors are located. For the most part, your senior may switch from one Medicare insurance plan to another at any given time. Some plans however, limit the number of individuals they will take and accept as new members when they have reached their maximum. (The roles are different for individuals with end-stage renal disease. You may contact Medicare for more information on this issue.)

Medicare: Additional Information and Contacts

To oversee your parent’s Medicare insurance coverage, you should contact the local Social Security office and ask for authorization data to access their records, receive bills, checks and other correspondence. If your elder’s able, they can give you authorization to access the records by completing a form (form SSA 1696-U4), which is available through the Social Security Administration. You can call (800-772-1213) or you may download it on the Internet at www.ssa.gov .

Some information Inspired by How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic Ph.D. Licensed Psychologist