August 9, 2018

Help with Healthcare Costs in Retirement

“A financial planner’s client was traumatized in the dentist’s chair, but it was not the drill that scared her. It was the dentist’s bad news.”

The frightening news was that she needed thousands of dollars of dental work, a cost she had not anticipated when she retired a few months before the appointment. What if this happens again, she thought. Am I going to run out of money? She was in good shape, her financial planner assured her. But not everyone is as fortunate, as reported by Reuters in an article titled “How to shockproof your retirement healthcare costs.”

Almost all retirees fear that a medical expense shock will decimate their savings. In a national survey by Brightwork Partners, as many as four out of five boomers agreed that they are worried about this. However, they are too confused by all of the details, to actively plan for medical costs during retirement.

Help is on the way from national retirement researchers and investment companies. While most retirement healthcare research focuses on the big picture, like Fidelity’s recent estimate that a couple is likely to spend $280,000 on healthcare costs in retirement, a new study from Mercer Health and Benefits and Vanguard Research got a lot more granular.

The goal of the study is to develop a model that can be used by people before they retire, so they can create a budget that includes this admittedly staggering number. This model will be able to help set necessary saving goals and plan on how to achieve the goal.

An average 65-year-old woman retiring and using Medicare in 2018 will need $5,200 to pay for medical expenses. That’s including Medicare, additional health insurance and out-of-pocket costs. By 85, the cost jumps to $10,100 annually, or, for a less healthy person, $14,000. As they age, people need more health care and researchers say we should consider “healthcare inflation” as starting at 6.6% annually, with a rate of 4.5% over time.

Before retiring, experts say people need to be honest with themselves about their health and the costs that will ensue. If they have chronic illnesses like diabetes, cancer, heart disease or arthritis, they need to expect to spend more than the average amount.

The biggest medical care shock to retirement savings is long-term nursing home care. However, these researchers found that only one in seven will face those costs for two years or more.

Rather than panicking, think about these issues in advance and prepare for the costs. You should also consider what you can do to address expenses. One option is to move closer to family members, who might be able to help with care at home.

Reference: Reuters (July 11, 2018) “How to shockproof your retirement healthcare costs”

March 21, 2018

Hospital Discharge Planning

Before a Medicare patient can be discharged from the hospital, there must be a plan in place for any needed continual care. Patients and their families should double check some information in that plan.

When Medicare patients are ready to leave a hospital after an extended stay, they often are not ready to go home and resume their normal lives. They might need to be transferred to another facility, such as a nursing home or a rehabilitation center. It depends on the needs of the specific patient being discharged.

Medicare requires that a plan for care be developed with a social worker who can help the patient understand the plan. Just taking the word of the social worker about what options are available, is not always advisable as the Pittsburgh Post-Gazette points out in "Doublecheck when they say the rehab center doesn't have room."

Patients are sometimes told that their preferred facilities for care after being discharged from the hospital do not have room for them. Sometimes that is true, but it is not always true.

Hospitals that have financial interests in other facilities, all too often try to steer patients into those facilities and away from others. For that reason, it is a good idea for patients and families to call facilities for themselves to ask about availability.

If you think a hospital is not doing what Medicare requires it to do, then it is a good idea to contact an elder law attorney.

Reference: Pittsburgh Post-Gazette (Feb. 26, 2018) "Doublecheck when they say the rehab center doesn't have room."

December 27, 2017

Being Under Observation in the Hospital

Many elderly people face gigantic medical bills for hospital stays because of how they are classified by the hospital. This makes a big difference in how much Medicare will pay.

When an elderly person has an extended stay in the hospital, they are almost always under the impression that Medicare will cover most of the costs. However, many stay in the hospital for weeks and only later discover that they are responsible for most of the costs of their stay.

This is because Medicare is very particular about when it will pay for hospital costs.

For Medicare to pick up the bill, the patient must be classified as an inpatient. This means that the patient has been formally admitted to the hospital.

If the patient is an outpatient, Medicare will not pay and those patients who are in the hospital "under observation" are still considered to be outpatients, no matter how long they are actually in the hospital.

The story is picked up by The New York Times in "Under 'Observation' Some Hospital Patients Face Big Bills."

Elder law advocates have long pointed out that the rule is absurd.

The patient does not always get to choose what the hospital writes down in the file. The patient also does not always know the importance of being formally admitted, instead of just being under observation.

There has never been a way for the patients to challenge their designations later, until now.

A judge in Connecticut has recently opened the door for legal challenges.

Reference: New York Times (Sep. 1, 2017) "Under 'Observation' Some Hospital Patients Face Big Bills."

June 29, 2017

Medicare Penalty Waived for Some

People who are eligible for Medicare and who do not sign up on time can face stiff penalties. Some of them have been granted a small window to have those penalties waived.

The federal government has always been particular about Medicare. Eligible people either sign up at the right time or they face stiff penalties, if they attempt to sign up later.

Elder law advocates have always thought that this was a harsh way to penalize many people who simply made honest mistakes and were not aware of those penalties.

Advocates' complaints have typically fallen on deaf ears, since the government was more concerned about cost controls. However, an important victory has been won for some who would otherwise face penalties for not signing up for Medicare on time.

NPR reports on this latest development in "Feds to Waive Penalties for Some Who Signed up Late for Medicare."

People who purchased their health insurance through the Affordable Care Act's marketplaces were not made aware that they needed to sign up for Medicare, when they became eligible.

When looking at the marketplace website, it appeared they were doing everything properly as long as they continued to purchase insurance on the marketplace. They have been granted a waiver of the penalties.

People affected will need to apply for the waiver. They only have until Sept. 30, 2017 to do so.

This waiver is only being granted to those who continued to purchase insurance through the Affordable Care Act, but it is an important step for many elderly people.

Reference: NPR (June 6, 2017) "Feds to Waive Penalties for Some Who Signed up Late for Medicare."

June 6, 2017

Massive Medicare Fraud Alleged

A former insurance company executive has made public allegations that insurers have systematically overcharged Medicare and cost the government billions of dollars.

Every few years it seems the federal government needs to do something to fix Medicare or risk running out of available funds for the program. One attempt to fix Medicare was undertaken in the early 2000s. It is now known as Medicare Advantage.

The program privatized parts of Medicare by turning things over to insurance companies. The idea was that insurers would do a better job of controlling costs in the program than the government.

Instead of doing that, however, a whistle-blower alleges that insurers have used the program to make billions of dollars from Medicare they are not entitled to, as The New York Times reports in "A Whistle-Blower Tells of Health Insurers Bilking Medicare."

The alleged fraud is a relatively simple one.

Insurers are said to have used the medical coding system to make patients look sicker than they really are. As a result, the insurers easily collect more money from the government than they actually should.

The government has already announced plans to sue one insurer based on these allegations and more lawsuits against other companies are expected.

It is important for the government to stop this fraud, if true, and any other Medicare fraud.

The Medicare system is yet again close to running out of funds and in need of a fix. The government cannot afford to lose billions to fraud.

Reference: New York Times (May 15, 2017) "A Whistle-Blower Tells of Health Insurers Bilking Medicare."

Building Legacies that Last Estate Planning and Elder Law

Tag: Medicare

Help with Healthcare Costs in Retirement

Hospital Discharge Planning

Being Under Observation in the Hospital

Medicare Penalty Waived for Some

Massive Medicare Fraud Alleged

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