Category Archives: Health Reform

Retirement medical costs…

Fidelity Investments recently released a report heralding an 8% drop in medical expenses that a couple retiring in 2011 would expect to pay.  See Full Report.  That’s good news, the bad news is that this is still expected to top $230,000 and that’s a number that’s likely to grow.   A visit to your retirement planner is in order if you aren’t factoring this into your savings.  If you need names of reputable financial advisors who specialize in retirement planning, I’m happy to share the names of those I work with here on the North Shore.  Call or e-mail if you need a referral.  bridget@bmurraylaw.com

And all my contact info can be found at www.bmurraylaw.com

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Health Care Proxy–Who decides on my care?

Everyone over the age of 18 should have a health care proxy.  Period.  Everyone.  That means you, too.  A health care proxy appoints the person of your choice to make health care decisions for you if you are unable to do so.  If your college student has a car accident and is taken to the local hospital, you want to be called, consulted, and listened to.  A health care proxy can assist in this process.  (Have him or her keep a copy in the glove box).  A beloved family member is fading from a variety of age related illnesses, a health care proxy will help her get (or not get) the type of treatment SHE would choose.  Will your frail parent want to be resuscitated if it will result in pain, broken ribs, and the extension of their terminal illness?  Are you a “keep on trying no matter what!” type of person? Make that clear to your health care proxy.

A health care proxy in Massachusetts does not replace a living will.  It appoints one person who can direct the medical decisions of the person who has made the document (principal).  The best way to assure that your wishes are honored is to speak with the person you have chosen, and have some honest conversations about your wishes, well before the need arises.   What makes a life worth living, rather than simply existing in pain or incapacity?  This is a personal viewpoint, and one that it’s hard to know about someone else.  Two tools I use with my clients are the “What If Workbook” and “Five Wishes”.  Each lays out some of the questions and decisions we face with end of life medical care.

One final point.  If you want your children or spouse or best friend to be able to speak with your medical provider, they should be named in a HIPPA release form.  Our privacy laws can be a great help in protecting confidentiality, but can frustrate our families attempts to understand our condition and prognosis.  A health care provider may not speak to you even if you are a parent, spouse, or child without legal permission to do so.

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Free Medicare Preventive Care Has Kicked In

 

One of the benefits of the health reform law took effect January 1, 2011: free preventive services for Medicare recipients. Under the law, people with regular Medicare will no longer have to pay a copay, coinsurance or deductible to receive preventive services that are highly recommended by the U.S. Preventive Services Task Force — services that include screenings for breast cancer, colon cancer, diabetes and heart disease, as well as smoking cessation counseling. Private Medicare plans (also known as Medicare Advantage plans) may still charge for these services, but many do not.

Also under the health reform law, Medicare Part B beneficiaries will now receive an annual wellness visit free of charge. During this yearly visit, your doctor or other health practitioner recognized by Medicare (such as a nurse practitioner) will update your medical history and current prescriptions; measure your height, weight, blood pressure and body mass index; create a screening schedule for the next 5 to 10 years and screen for cognitive issues. And Medicare now pays in full, without patient co-pays or deductibles, for the initial "Welcome to Medicare" that Medicare has offered since 2005 to beneficiaries within 12 months of their becoming covered under Medicare Part B. (For a CommonHealth article on what to expect from a wellness visit and how to get the most out of yours, click here.)

"Preventing diseases that can be prevented, and detecting others at earlier, more treatable stages, are among the keystones for transforming Medicare," said Jonathan Blum, deputy administrator and director of the Center for Medicare at the Centers for Medicare and Medicaid Services.

"By eliminating the beneficiary’s out-of-pocket costs for most preventive services, we are removing a barrier to access and paving the way for improved health for seniors and people with disabilities who rely on Medicare for their health coverage."

For a detailed list from the Medicare Rights Center of preventive services that will no longer require out-of-pocket payments,click here. For more on Medicare’s preventive services from the Medicare Rights Center, click here, and from the Center for Medicare Advocacy, click here.

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Health Reform: What Changes Are in Store for the Elderly?

From ElderLawAnswers.com
 

After a year of legislative wrangling and premature forecasts of death, historic legislation overhauling the nation’s health insurance system has passed the Congress and been signed into law by President Obama. The measure that finally prevailed, the Patient Protection and Affordable Care Act, is the same legislation the Senate had approved on Christmas Eve of 2009, although it was amended somewhat by a separate “budget reconciliation” measure that President Obama also signed into law. Because the core health reform measure enacted is the Senate version, much of what we wrote in our earlier article, “The Effects of Health Care Reform on Long-Term Care,” still applies. Just substitute “the newly enacted law” wherever “the Senate bill” appears in the earlier article. The legislation that President Obama signed still contains:

     

  • The nation’s first publicly funded national long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Act. Its original sponsor, the late Sen. Edward M. Kennedy, did not live to see one of his legislative dreams enacted into law;
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    Help for Medicare Recipients and Early Retirees

    Of perhaps greatest interest to seniors, the law will eventually close the Medicare Part D coverage gap known as the “doughnut hole.” As most seniors know, the Medicare Part D prescription drug program covers medications up to $2,830 a year (in 2010), and then stops until the beneficiary’s out-of-pocket spending reaches $4,550 in the year, when coverage begins again. Many seniors fall into this “doughnut hole” around Labor Day, at which point they have to pay for the medications out of pocket through the end of the year.

    The law starts the process of closing the gap by providing a $250 rebate to Medicare beneficiaries who fall into the doughnut hole in 2010. Then, beginning in 2011 there will be a 50 percent discount on prescription drugs in the gap, and the gap will be closed completely by 2020, with beneficiaries covering only 25 percent of the cost of drugs up until they have spend so much on prescriptions that Medicare’s catastrophic coverage kicks in, at which point copayments drop to 5 percent.

    In addition, starting January 1, 2011, Medicare will provide free preventive care: no co-payments and no deductibles for preventive services such as glaucoma screening and diabetes self-management. Also, the legislation increases reimbursements to doctors who provide primary care, increasing access to these services for people with Medicare.

    The law provides help for early retirees by creating a temporary re-insurance program that will help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Scheduled to run from June 21, 2010 through January 1, 2014, the reinsurance program will pay 80 percent of eligible claim expenses incurred between $15,000 and $90,000.

    The law calls for an increased Medicare premium for those individuals earning more than $200,000 a year and married couples whose income exceeds $250,000. The law also applies the Medicare payroll tax to net investment income for couples earning more than $250,000 a year or individuals earning more than $200,000 a year.

    Most of the cost savings in the law are in the Medicare program, which has made many seniors fearful that their benefits will be cut. The cost-saving measures do not affect the basic Medicare benefits to which all enrollees are entitled, but they may affect those enrolled in private Medicare Advantage plans. Medicare has been paying insurers who offer these plans more than it spends on average for Medicare beneficiaries. The original idea of Medicare Advantage was to save money by paying them less, the idea being that private insurers could be more efficient than the federal government. The opposite turned out to be the case.

    Health care reform will pay the private insurers less, meaning that some will choose not to continue their plans and others will curtail extra benefits they offer enrollees, such as reimbursement for gym membership or free eyeglasses. But the cuts will be gradual, with the largest not beginning until 2015. The law also offers bonuses to efficiently run Advantage plans.

    Another provision in the law will cut Medicare reimbursements to nursing homes by about $15 billion over the next decade. While nursing homes get only about 13 percent of their revenue from Medicare, the industry relies on the money to make up for low Medicaid reimbursement.

    A combination of the additional revenue and savings are estimated to extend the life of the Medicare Part A trust for an additional 7 to 10 years from its current insolvency date of 2017.

  • The Elder Justice Act, which will establish an “Elder Justice Coordinating Council” and provide federal resources to support state and community efforts to fight elder abuse.
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  • Provisions that will help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to; and
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  • A number of provisions aimed at ending Medicaid’s “institutional bias,” which forces elderly and disabled individuals in many states to move to nursing homes;
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