Medicaid Planning

7 Limitations to Medicare

Published on: April 7, 2022 | by Ettinger Law Firm

With more people approaching the age of 65, a growing number of people are considering the potential benefits available from Medicare as well as other insurance options. Medicare A plays the critical role of paying for hospital stays as well as other services like skilled nursing facilities and hospice care. Meanwhile, Part B assists with physician visits and outpatient care.

If you’re close to enrolling in Medicare, you should consider what Medicare covers. By learning what Medicare covers now as well as what it doesn’t, you can begin thinking of alternate strategies to make sure that you receive all of the appropriate care that you need.

Prescriptions

Dobson Highlights Challenges with Medicare Part D Medication Coverage

Published on: March 24, 2022 | by Ettinger Law Firm

On February 11, 2022, the appellate court for the 11th circuit reversed a decision by a lower court. The appellate court in Dobson v. Secretary of Health and Human Services held that Medicare must provide coverage for a beneficiary’s off-label use of a medication.

How the Case Arose

The case concerns a Florida man who communicated with the Center for Medicare Advocacy because the man’s Part D Medicare coverage declined dronabinol coverage. Dronabinol is a man-made type of cannabis that is known under the trade names of Marinol, Reduvo, and Syndros. The medication is used to stimulate appetite as well as to treat nausea and sleep apnea. The medication is approved by the FDA for the treatment of HIV/AIDS-related anorexia and nausea and vomiting caused by chemotherapy.

Commonly Asked Questions about Over-the-Counter Tests and Medicare

Published on: March 10, 2022 | by Ettinger Law Firm

It’s almost an understatement to say that the Covid-19 pandemic has changed our lives and how we live in a range of ways. While Medicare did not pay for Covid-19 tests that were available over the counter, the Center for Medicaid Services is in the process of executing an effort in the spring of 2022 that will offer payment directly to qualifying pharmacies as well as other business entities that participate in this program to help Medicare recipients receive up to eight Covid-19 tests free each month.

Currently, Medicare Advantage Plans sometimes cover and pay for over-the-counter (OTC) Covid-19 tests as a supplement in combination with providing Medicare Part A and Part B coverage. If you’re enrolled in a Medicare Advantage Plan, you should review the terms of the plan to check whether the plan will cover and pay for Covid-19 tests.

All Medicare beneficiaries with Part B qualify to receive eight free OTC Covid-19 tests, despite whether a person is enrolled in a Medicare advantage plan.

How Medicare and Medicaid Are Addressing Long-Term Care Issues

Published on: March 10, 2022 | by Ettinger Law Firm

Deciding how to receive the medical care that a person needs is a critical part of the elder law process. Unfortunately, the unpredictable nature of aging and medical issues can make it challenging to determine what lies ahead. Various states have also begun to attempt to resolve financing challenges associated with elder care that a growing number of Americans will face in the next couple of decades as a growing portion of the baby boomer generation requires medical care.

The Growing Need for Assistance

Any person can end up needing assistance as they age. This is true regardless of whether a person ends up facing dementia, a significant drop in eyesight, or mobility issues. The degree of assistance and how long a person faces these issues can vary substantially. A person might end up needing assistance with meals, other daily living activities, or total care for the months or years before they pass away. Other times, people end up needing total care for years. The unpredictable nature of a person’s future makes it challenging to plan ahead.

Answers to Commonly Asked Medicare Home Health Questions

Published on: March 1, 2022 | by Ettinger Law Firm

The Center for Medicare Advocacy recently published a document answering various questions about Medicare’s home health benefits. In addition to a document answering frequently asked questions, the Center also published recordings of two webinars, “Medicare Coverage of Home Health Services”, which reviews the eligibility basics for Medicare coverage of home health services.

What Do Home Health Agencies Do?

Medicare’s home health benefits are known as the Mediacertified home health agencies. These benefits have been approved by Medicare to provide the home health services that Medicare covers. The agency has agreed to receive payment from Medicare. Additionally, Medicare only pays for home health services administered by home health agencies that are Medicare-certified.

Considering Medicare Advantage Plan Alternative

Published on: February 1, 2022 | by Ettinger Law Firm

Approximately, 26.9 million Americans are enrolled in Medicare Advantage Plans as of January 2022. While many people are content with their plans, not everyone is. Individuals have between January 1, 2022, to the end of March 2022 to make revisions to their Advantage Plan. During this period, a person can also drop a Medicare Advantage Plan and opt for a basic Medicare plan, which includes Part A and B.

Individuals should be aware of some important details before switching Medicare plans, though. For one, people can change plans early in the year. For example, a person might discover that their Medicare plan no longer covers important medication.

The Narrow Window to Change Plans

Protecting Assets With Caregiver Agreements

Published on: November 15, 2020 | by Ettinger Law Firm

Family members as caregivers overwhelmingly provide for elderly and disabled loved ones at home. Although a labor of love, taking care of ailing loved ones also has a market value, meaning that caretakers may be paid as a way to protect assets.

Through the use of a Caregiver Agreement, also known as a Personal Services Contract, the disabled or elderly person may transfer money to family members as compensation rather than as a gift. Gifts to family members made in the last five years before applying for Medicaid to pay for nursing home costs disqualify the applicant from receiving Medicaid for a certain period of time, known as a “penalty period.”

For example, mom depends on daughter Janice for her care. If mom gifts $100,000 to Janice, then goes into a nursing home in the next five years and applies for Medicaid, the gift to Janice will result in about a ten month penalty period. Janice will have to give the $100,000 back to mom to pay nursing home costs during the penalty period, or mom will have to use other resources to pay.

Preserving Income with Medicaid Pooled Trusts

Published on: November 8, 2017 | by Ettinger Law Firm

Medicaid is a safety net for millions of senior citizens across the country, providing funding to pay for home care, adult day care, or prescription drugs. However, the program is designed for low income individuals and can leave many on the fence financially over whether to choose to spend down assets or pay for these necessary services themselves.

Currently, the threshold to receive Medicaid services is only a few hundred dollars for individuals and just over $1,000 for married couples, which leaves these individuals with little income to pay rent, utilities, or buy groceries. Even financially secure seniors can find themselves needing vital Medicaid services like in-home or nursing home care in the event of a catastrophic health event, making planning for the future and keeping options open all the more vital.

One option that may be viable for certain individuals is joining a Pooled Supplemental Needs Trusts, also known as a Pooled Income Trust. Pooled income trusts work by the individual sending his or her income from Social Security, pensions, or annuities to non-profit organizations to pay bills and other expenses to stay below the Medicaid threshold. Any income left over after the individual passes away goes to the non-profit.

What Can I Do if I Have Been Denied Medicaid?

Published on: July 28, 2017 | by Ettinger Law Firm

As people age, many count on Social Security and Medicare to help them live happy, healthy, and comfortably in their golden years. However, some older Americans are unable to fully provide for themselves and must seek assistance before they become eligible for the landmark elder social services we have become accustomed to. Hard economic times, disability, and other unforeseen events are just some of the reasons elders may be eligible for Medicare.

One of the most important parts of the Medicare program is the nursing home care services members are eligible to receive, particularly seniors. However, not everyone may qualify for Medicare after applying, leaving many families to wonder how they will take care of their beloved elders. Fortunately, denied applicants are eligible to receive a Fair Hearing at their local Medicare office.

What is a Fair Hearing?

New York Medicaid Law – Pooled Trusts

Published on: August 23, 2016 | by Ettinger Law Firm

Pooled Trusts Eligibility

Pooled Trusts are a type of trust applicable to those individuals who are seeking public assistance benefits, such as Medicaid, to become eligible financially by setting aside funds in a trust for additional needs. The trust allows its beneficiaries to preserve a specified amount of money in a trust to pay for supplemental care not covered by public assistance programs. For the elderly, many need public benefits assistance as they continue to age but do not qualify based on higher income. In these situations, a pooled income trust will benefit an elderly person by allowing them to continue their lifestyle, which is usually seeking to stay in the home, while also obtaining homecare services and paying for what their budget requires.

New York Medicaid Rules