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Two Popular Medigap Plans are Being Shuttered — What It Means for You!

Q. A couple of years ago, my aunt Linda applied for a Plan F Medigap plan and the insurance company approved her. The following year, she saw a specialist about some hip problems she was experiencing, went for an MRI, and ended up needing hip replacement surgery. Medicare paid 80% of the cost of her visit to the specialist, the MRI, and the surgery. Plan F covered the other 20% owed under Part B, so Linda owed nothing!

Following the surgery, Linda spent a couple of days in the hospital, and then she had a home health care nurse come out to her home several times.

The total cost for Linda’s surgery, hospital stay and follow-up care was $70,000. Medicare paid its share of the bills and sent the remainder of about $14,000 to Linda’s supplemental insurance carrier. The carrier paid the entire bill, and Linda owed absolutely nothing for any of these Part A and Part B services. Her only out of pocket expenses were for some medications. This was all because of her Medicare Plan F!

My question is: I am eligible for Medicare this year. I thought I knew what I needed to know based on my aunt’s experience, and was going to follow in her footsteps and opt for Plan F as a supplemental plan. But, I read that Plan F and another popular plan are being taken away. What is the timeline for this, why is it happening, and what actions can I take at this time?

Thanks so much for your help!
—

A. Just when you think you finally understand Medicare and what coverage is best for you, they change it!
For decades, people on Medicare have had the option to supplement their Medicare benefits with Medigap coverage, also known as Medicare supplement coverage. And, as you can imagine, the most popular supplement plan for many years has been Plan F, the plan your aunt was on when she had her hip surgery.

The reason Plan F is so popular is precisely because of situations similar to what happened to your aunt. It takes care of all the gaps in Medicare, while leaving you with $0 out of pocket. This kind of certainty helps make planning for your healthcare spending easy to predict.

Plan F Is Being Eliminated

Sadly, all good things must come to an end. As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress is eliminating Medigap plans that cover the Part B deductible, including Plan F and Plan C, effective in 2020. Another change is that Medicare premiums for higher income individuals will also be increasing. On a positive note, if this affects you, you have time to plan ahead to minimize the financial impact.

Why is Congress eliminating Plan F?

Medigap Plan F is the most popular of all supplement plans. Plan C is similar but doesn’t cover Medicare excess charges, so it is less popular. So, why is Congress eliminating these plans?

Some legislators fear that Plan F and Plan C policyholders visit their healthcare providers more often than someone who pays their own deductible. In other words, they worry that anyone with Part B deductible coverage will run to the doctor for every sneeze or paper cut. Conversely, if you were responsible for paying your own Part B deductible, then you might think twice about visiting your doctor for minor things, such as a cold.

But, will it cost more in the long run? Critics say that eliminating Plan F might cause some people to forego care, resulting in more expensive care later on. There could be health conditions that don’t get diagnosed early enough and end up costing Medicare big bucks down the road. While that may be true, it didn’t stop Congress from eliminating these plans in the next couple of years.

Good news: This change will only affect NEW Plan F Enrollees

Fortunately, these changes only affect new enrollees after January 1, 2020, so people currently on Plan F will be able to keep that plan in 2020 and beyond!

· Grandfathering will occur for current plan holders: While Medigap plans with deductibles are going away, enrollees with this coverage will be grandfathered in.
· Premiums will rise: Over time, you can probably expect Plan F premiums to slowly rise, since the total number of people enrolled will be shrinking each year.
· Enroll now: If you want this coverage, enroll in Plan F or C prior to 2020 so that you can then keep your policy.
· Consider alternatives: If you can handle a small Part B deductible, options such as Plan G and Plan N offer significantly lower premiums today and will also still be around after 2020. It’s still great coverage and you won’t find yourself stuck in an obsolete Medigap plan that might have rising costs over time.

Remember, selecting the right coverage now can help you attain rate stability down the road.

Higher Medicare premiums are coming for higher incomes.

The elimination of Medigap plans covering the Part B deductible is just one way that MACRA might affect you. The legislation also adjusts the income thresholds for Medicare Part B premiums beginning this year.

· Higher-income beneficiaries: This will largely affect higher-income beneficiaries, who will pay more for their Part B and D than they do now. Many in this group already pay higher premiums, and the MACRA legislation will increase those premiums further for individuals earning over $133,500 ($267,000 for married couples).
· A big increase for some: While this change affects only a small percentage of the Medicare population, the Kaiser Family Foundation reports that premiums for this group will be as much as 80% higher than the Part B base premium.
· If you’re affected, plan now: If you fall into this category, your health insurance costs in retirement may be higher than expected. Working out your estimated costs now will help you better plan for when you can retire.
If you are retired or about to retire, and are part of the estimated 2.9 million individuals who will pay income-related premium adjustments, it’s a wise idea to sit down with an experienced financial planner, such as myself, to discuss how you will handle these changes.

Medicare Doesn’t Pay One Penny for Long-Term Care

Regardless of the changes described, the fact remains that Medicare does not pay one penny, ever, for long-term care (often called custodial care) —which involves help with activities of daily living such as bathing, dressing, and using the bathroom; nor does Medicare pay for supervision needed by those suffering from dementia. And this is not changing. You can read more about this in our Critter Corner article, “Does Medicare Not Care about Long-Term Care?”

This means that, regardless of what is happening with Medigap policies in the future, it is wise to plan ahead for the catastrophic cost of long-term care ($10,000 – $14,000 a month in the DC Metro area)!

If you have not done Long-Term Care Planning, Incapacity Planning, or Estate Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long- term care, please contact us to make an appointment for a no-cost introductory consultation.

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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Critter Corner: Is Original Medicare Sufficient?

Dear Angel,

My mom is eligible for Medicare this year and is exploring her options. She is not sure whether to get a supplemental plan, or if original Medicare is enough. What are your thoughts on this?

Thanks,
Iz Ittanuff
—
Dear Iz,

Most people on Medicare feel that original Medicare is not sufficient, and have some source of coverage that supplements Medicare.

Original Medicare has been around for over 50 years and is run by the federal government. Part A and Part B make up the core of original Medicare, and cover the following:

•Part A Deductibles and Copays: In 2018, if you are admitted as an inpatient to the hospital, you will pay a deductible of $1,340 per benefit period. This deductible covers your inpatient hospitalization for the first 60 days. For days 61-90 you would be responsible for a $335 per day. If you need to stay in the hospital for longer than 90 days you can tap into your “Lifetime Reserve Days.” These days can only be used once in your lifetime, and once they are gone, you cannot use them again. While you are using your Lifetime Reserve Days you would be responsible for a co-pay of $670 per day. If hospitalized longer than 150 days, you are responsible for all costs.

Medicare Part A covers short-term skilled nursing care and rehabilitation. This is when you need round the clock medical attention to recover from an illness or injury. Skilled nursing facility stays are covered 100 percent by Medicare for the first 20 days, provided that you have been admitted to the hospital, as an inpatient, for a minimum of 3 days (actually 3 midnights). Once you’ve stayed in a skilled nursing facility for more than 20 days, you are responsible for a copay of $167.50 for days 21-100. You pay all costs if you are in a skilled nursing facility over 100 days. Medicare does not cover long-term care or any type of nursing home costs beyond the 100-day period.

•Part B Deductibles and Copays: In 2018, the Part B annual deductible is $183 and most beneficiaries pay a monthly Part B premium of $134. You may have to pay more if your income is above a certain threshold. Once you meet your deductible, you will pay a co-pay of approximately 20 percent for most of your medical expenses. There are some preventive services that are free and not subject to the Part B deductible.

Part A and Part B are not enough

Part A and Part B cost-sharing can really add up, especially when you consider what Medicare doesn’t cover (including eye exams, hearing evaluations, dental care, routine foot care, and more). And, original Medicare has no cap on out-of-pocket spending. So, it’s definitely not enough for most seniors!

Make sure you do your homework and explore all your options when selecting the Medicare supplemental plan that is right for you. See Medicare.gov for details and helpful tips. And see today’s other article for important information about supplemental plans that are going away in the next couple of years.

Hope this is helpful,

Angel

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Senior $afe Act and Other Safeguards Against Financial Exploitation

Joseph and Carol are in their 80’s and are retired. Recently, their daughter Karen moved in after a tough divorce that left her broke. One of the reasons Karen’s husband left was because of her spending habits. Shortly after moving in with her parents, Karen began making bank withdrawals of money she didn’t intend to repay from her parent’s account without their knowledge, leaving them with thousands less in their savings. The withdrawals took place over a series of months, but the bank never reported them! If they had and action was taken sooner, the couple’s debt could have been less devastating.

What occurred in our example is a form of what’s known as financial exploitation. Financial exploitation occurs when a person misuses or takes the assets of a vulnerable adult for his/her own personal benefit. This frequently occurs without the knowledge or consent of a senior or disabled adult, depriving him or her of vital financial resources for his or her personal needs.

Common Forms of Financial Exploitation

Are you or a loved one a victim of financial exploitation? These are some of the most commonly reported forms that you should be aware of, as reported to Adult Protective Services agencies:

• Theft: involves assets taken without knowledge, consent or authorization; may include taking of cash, valuables, medications other personal property.
• Fraud: involves acts of dishonesty, often by persons entrusted to manage assets. who misappropriate assets for unintended uses; may include falsification of records, forgeries, unauthorized check-writing, and Ponzi-type financial schemes.
• Real Estate: involves unauthorized sales, transfers or changes to property title(s); may include unauthorized or invalid changes to estate documents.
• Contractor: includes building contractors or handymen who receive payment(s) for building repairs, but fail to initiate or complete the project; may include invalid liens by contractors.
• Lottery scams: involves payments (or transfer of funds) to collect unclaimed property or “prizes” from fake lotteries and sweepstakes.
• Electronic: includes “phishing” e-mail messages to trick persons into unwittingly surrendering bank passwords; may include faxes, wire transfers, telephonic communications.
• Mortgage: includes financial products which are unaffordable or out-of-compliance with regulatory requirements; may include loans issued against property by unauthorized parties.
• Investment: includes investments made without knowledge or consent; may include high-fee funds (front or back-loaded) or excessive trading activity to generate commissions for financial advisors.
• Insurance: involves sales of inappropriate products, such as a thirty-year annuity for a very elderly person; may include unauthorized trading of life insurance policies.

What’s Being Done to Stop Financial Exploitation?

The Senior $afe Act, a bipartisan bill with the goal of helping to protect older adults from financial exploitation and fraud, unanimously passed in the House of Representatives on Monday and is expected to be considered by the full Senate soon.

The Senior $afe Act would protect banks, credit unions, investment advisers, broker-dealers, insurance companies and insurance agencies from being sued for reporting suspected exploitation or fraud as long as they have trained their employees about how to identify the warning signs of common scams and make reports in good faith to the proper authorities. So, in our example above, the bank may have been more likely to report the financial abuse.

The bill has 26 co-sponsors in the Senate — Republicans, Democrats and an independent — and has been endorsed by the AARP and several financial, credit union, and banking-related organizations. We will keep you up to date on the status of the bill!

The federal government, states, commonwealths, territories and the District of Columbia currently all have laws designed to protect older adults from elder abuse and exploitation, and guide the practice of adult protective services agencies, law enforcement agencies, and others. These laws vary considerably from state to state. Visit the US Department of Justice website for details.

Additional Resources to Help

Know someone who is a victim of financial exploitation? Here are some resources to protect yourself or a loved one:

Tips from Virginia Department of Aging and Rehabilitative Services
Virginia Adult Protective Services
Maryland Adult Protective Services
DC Adult Protective Services 
National Adult Protective Services Association 
Elder Financial Exploitation and Response Network Guide 
Federal Trade Commission- Spotting Elder Financial Abuse

For more resources about elder abuse prevention, check out the federal government’s Eldercare locator.

Planning to Protect Loved Ones

Protecting seniors from financial exploitation is very important, which is why we continually share information on the topic. It is also very important to plan for your future and for your loved ones. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long- term care, please contact us to make an appointment for a no-cost introductory consultation.

Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301-519-8041
DC Elder Law: 202-587-2797

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After-Death Communication—A Comforting Presence

Ever get a sign from a deceased loved one or felt the person’s presence — perhaps a through a familiar scent, a tactile sensation, or the lights flickering at just the right moment? These feelings of contact can certainly be a comforting presence, and are more common than you might think.

After-Death Communication (ADC) is the clinical term for a visit from a deceased loved one. 1 in 3 people experience ADCs, with 75 percent of those experiences occurring in the year after a loved one dies. ADCs take a wide range of forms, as described in a recent Next Avenue article.

I also encourage you to read some or all of the books on my spiritual book list. If you have very limited time, start with either one of the first two listed.

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Supporting Kinship Guardian Assistance Program (KinGAP)

Keeping families together by helping relative foster families become legal guardians

When a child is placed in foster care by the court, sometimes a relative is approved to become the foster parent of the child. After the child has been placed in this relative foster home, in some circumstances—if the court determines that the child can never be returned to the parent, and the child cannot be adopted—it’s possible for that child to either stay in foster care with the relative foster family, OR for the relative foster parent(s) to become the child’s permanent legal guardian(s).

For these children, almost always teenagers, the opportunity to have a permanent family can become a reality. But many relatives, though they may wish to become the child’s permanent guardian, may hesitate to do so due to the costs. Relatives may have children of their own whose needs they are responsible or maybe their grandparents are on a fixed income.

Kinship Guardian Assistance Program (KinGAP) would allow those relative foster families to receive some funds to help support their relative child when the child leaves foster care and they become their legal guardian. They may need assistance to pay for a larger apartment, for bedroom furniture, or other costs.

Unlike in foster care, the relative family would not be entitled to receive the monthly foster care maintenance payment. They may receive an amount for fixed costs (such as furniture), or a monthly payment to cover ongoing expenses–which may change over time–but never more than what foster care payments would have been.

Kinship guardians provide one of the best opportunities for children to thrive when their parents are unable to care for them. In 2016, 71,000 kids in Virginia lived in the care of grandparents.  That’s 4% of Virginia kids. An additional 55,000 live in kinship care with other relatives: 3% of Virginia kids. While fewer than 20 of these families would qualify for KinGAP, it’s a start.

Who is eligible?

Only a few kinship families would actually qualify for KinGAP payments under federal law.

●          In order for a family to be eligible for KinGAP, the child must be related by blood, marriage, or adoption to the foster parent, have been placed with the relative in foster care for 6 months, and the options of reunification with the birth family or adoption must have been ruled out by the court. The relative must demonstrate a commitment to permanently care for the child.

●          While there are many families who take in relative children, ONLY those children who were first in foster care placement with the kinship guardian, and who cannot be adopted, would be eligible. Children who come to live with relatives through other pathways would not be.

How is KinGAP funded? 

Title IV-e of the federal Social Security Act provides approximately 50% of the funding for KinGAP for each child eligible. As in adoption and foster care, the additional funding is the responsibility of the state or locality.

How can we afford KinGAP? 

Without KinGAP, the state is likely to continue to be responsible for payments to support the child in foster care. Under KinGAP, costs will be minimized when the child becomes permanently placed with the relative.

Why does KinGAP matter? 

KinGAP provides another means for children to exit the foster care system when adoption is not an option– yet still provide a permanent placement for the child.

●          Through KinGAP, trauma is reduced — children will no longer wonder where they belong or if someone is going to show up at the door and move them to a new placement.

●          Children maintain a relationship with family even if their parents cannot parent them.

There are three KinGAP bills pending in the General Assembly: HB1333 (Brewer); SB44 (Favola); and SB636 (Dunnavant). The House version of the bill is pending in Appropriations; the Senate bills are on the Senate floor.

KinGAP will give these foster children a permanent home with members of their own family. Contact your legislator and ask them to support KinGAP funding.  

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Critter Corner: My Dad Doesn’t Recognize Me; is it Still Worth Visiting?

 

Dear Magic,

My dad is in a nursing home, and has dementia. I visited him a lot when he first got there, but my visits have tapered off a bit. I’m not sure if he knows who I am anymore, or if there is a benefit to him if I visit. Visiting him can be emotionally draining, but I’d gladly continue going if I knew it was beneficial for him. In his current state, is he getting anything out of my visits?

Thanks,

Cee Endad

—-

Dear Cee,

A recent survey found that 42% of the public think it’s pointless to stay in contact with loved ones who have dementia, after they are unable to recognize the faces of family and friends. 

Contrary to what most people think, advocates and researchers stress that family and friends SHOULD stay active in the lives of their loved ones with Alzheimer’s or other forms of dementia.  This is because, although it seems they may not recognize you, studies show that there is a strong emotional memory and long lasting benefits from visits from loved ones. Even people with advanced dementia can still hold an emotional and energetic memory, meaning that they remember how someone made them feel, and they sense a loved one’s energy, long after they have forgotten the event that brought those feelings.

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