Medicare Open Enrollment begins Oct. 15

The Medicare Open Enrollment period begins October 15, 2014 and ends on December 7, 2014. The Centers for Medicare and Medicaid Services predicts that premiums for Medicare Advantage plans and Part D plans will rise only slightly in 2015. The Medicare Advantage Plan will cost $33.90, up by $2.94. The typical Part D premium will be $32.00, a $1 increase.

The Affordable Care Act has helped shrink the doughnut hole for 2015. Beneficiaries will enter the doughnut hole once they have paid $2,960.00 in out-of-pocket costs, up from this year's figure of $2,850.00. And once you have entered the doughnut hole, you'll pay less for your prescription drugs: 45% for brand name drugs, down from 47.5%; and 65% for generics, down from 72%.

Even if you are happy with your current Medicare health plan and prescription plan, the cost and services provided may change from year to year, so check to be sure your current plans still meet your needs. Researching plans can be a complex venture. The Centers for Medicare and Medicaid Services offers a number of resources and checklists to help you choose the best plan.  Also, you can find the 2015 "Medicare and You" booklet here.

I'll end with a word of caution: Medicare Open Enrollment is high season for Medicare scam artists. Be cautious to the extreme. The most common scenario is a call from someone posing as a government representative, asking for personal information so that a new card can be issued. Provide no information or you could have your identity swiped. Also, if you have a Medicare Advantage plan, remember it is illegal for anyone to try to sell you a Medigap plan. For an overview of common Medicare scams to watch out for, click here.

Medicare Part D: It pays to shop around

Medicare Open Enrollment began yesterday, October 15, and continues through December 7, 2012. The enrollment period ends earlier than in previous years, so those considering making a change should not procrastinate. 

Medicare beneficiaries should pay particular attention to their choice for Part D (prescription drug) coverage. A recent study from the University of Pittsburgh shows that seniors tend to overpay for Part D coverage. The study looked at 2009 data and compared seniors' choices of plans to the least expensive that would serve their needs. The results: only 5% of Medicare beneficiaries chose the most cost-effective plan.  Thirty percent of those in the study group overspent by $300 - $500, and 20% overspent by $500 - $1000. 

Researchers chalk up the findings to over-cautiousness. Many of the subjects were determined to stay out of the doughnut hole, or to avoid all deductibles, at any cost; others paid more for features they didn't need, like generic drug coverage in the coverage gap. They also tended to choose their plan based on the monthly premium alone. Moreover, other studies reveal that seniors are reluctant to change plans and often stick with the same insurers, even when better options are available.

Politicians often tout the value of the free market, arguing that more choice results in a better deal for consumers. In the case of Medicare Part D coverage, the array of choices don't always translate into better decision-making and more savings. Perhaps there are too many choices. Plans change from year to year, a drug that may have a high co-pay on one plan may have a tiny co-pay on another. A drug that was covered by a particular plan one year may be dropped from coverage the next.  The researchers conclude that "beneficiaries need more targeted assistance from the government to help them choose plans, such as customized communications about the most cost-effective plans that would cover their medication needs."

This enrollment period, you can avoid spending money on more coverage than you need by using Medicare's online tool to enter your prescriptions and dosages and then compare plans that fit your needs. The plans are rated on a one to five star rating scale. 

Will Medicare pay for your Florida nursing home?

Are you one of the many Florida residents relying on Medicare to pay your way if you ever need nursing home care? Depending on what you mean by "nursing home," you, your family and your pocketbook could be in for a big shock.

Many people fail to realize that Medicare does not cover long-term nursing care. Although it's common to refer to facilities that provide this kind of care as "nursing homes," these facilities really provide non-skilled, custodial care. Custodial care means help with the activities of daily life that a person cannot manage on his own, such as bathing, dressing, eating, toileting, etc. My office receives many calls each week from families who have just learned about the distinction Medicare makes between skilled care and long-term care, and find themselves facing  a staggering tide of long-term care costs. 


Most of my clients tell me their goal is to never be a burden to their children. Yet, over the past 15 years, the number of Baby Boomer children providing hands-on and/or financial assistance to a parent has tripled (US Department of Health and Human Services). If a loved one enters a custodial care nursing home, the family's tab will be $87,000 for a private room or $78,000 for a semi-private room (national averages according to the 2011 MetLife Market Survey of Long-Term Care Costs). Thus, it makes sense for you to plan ahead to deal with long-term care costs to protect yourself, your family and your assets! Your first step should be to contact our Florida Elder Law office. We can help you evaluate your situation and come up with a plan that may allow you to tap into Medicaid benefits for long-term care and/or Veterans benefits for home care, nursing home care, or assisted living. We can discuss long-term insurance policies with you, too. All of this planning must be discussed within the context of your overall estate planning goals and personal circumstances.  


Even if someone is already in a facility receiving custodial care, our attorneys can often develop a plan that can still preserve a good portion of assets. 


Now, let't talk about what Medicare will cover. Currently, Medicare Part A pays for up to100 days of skilled nursing care, per health incident. To qualify, you must 

• Be admitted to the skilled nursing facility no more than 30 days following hospitalization. 
• The hospital stay must have been a minimum of three days. 
• The skilled care you get must target the same condition for which you entered the hospital. 
• The skilled nursing services must be requested by your physician, provided by a health care professional, and must be of such a nature that outpatient treatment is not possible. 

Beginning on day 21 of skilled nursing care, Medicare requires you to pay a co-payment equal to one eighth of the initial hospital deductible. If you have a Medigap policy, that will often cover the co-payment. On day 100, or at any time it is determined that you are no longer improving as a result of skilled nursing care, Medicare benefits will end.  If 90 days pass after your discharge for skilled nursing care and you are again hospitalized for a minimum of three days, Medicare will once again pick up benefits for skilled nursing care, consistent with the rules above.

Alert: New Medigap Choices

Medigap plans are changing, and seniors and their families should take note.  Medigap plans are private insurance policies that cover the many expenses, for example co-pays, that Medicare does not cover. Starting June 1, 2010, three plans will no longer be available, and two new ones will be made available. This will bring the total number of available Medigap plans to 10.