Differences Between Medicare and Medicaid

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Most people who work in healthcare may recognize the acronym LASA, which stands for “look-alike-sound-alike” and is usually seen when referencing medications. When it comes to federal programs, Medicaid and Medicare, in written form, look alike and they do sound alike but work very differently.

Both Medicare and Medicaid were started in 1965 under Lyndon B. Johnson’s administration in response to the inability of older and low-income people to purchase private insurance. Both Medicare and Medicaid were started in 1965 under Lyndon B. Johnson’s administration in response to the inability of older and low-income people to purchase private insurance. Medicaid is an assistance program, funded federally and at the state level, that provides coverage for health care to low-income individuals regardless of age. It is governed federally with each state administering its own plan, which can vary from one state to the next. Medicare is a federal insurance program that provides health coverage for people aged 65 and over or to those under age 65 with a severe disability such as end-stage renal disease or Lou Gehrig’s disease, also known as ALS-amyotrophic lateral sclerosis. Dependents are not typically covered.

Medicaid eligibility is needs-based, meaning both income and assets are counted when determining eligibility. Both Medicare and Medicaid will cover a broad range of health care services, including hospital stays and physician office visits, yet Medicaid will cover nursing home care, in-home care services, long term care, and transportation to receive medical care which Medicare will not pay for. It is possible to qualify for dual coverage, which means both Medicare and Medicaid will work together to provide health care coverage and lower costs.

Regarding cost, Medicaid in most instances is free of cost, though a small copay may be required depending on the plan. Medicaid can also recover against assets in a recipient’s estate after the death of the recipient. This could mean a lien is placed and executed on a recipient’s home, depending on whether a surviving spouse or blind or disabled child is residing in the home. Medicare is not free in that premiums and co-payments may be required for some parts of Medicare, and may be larger for those with a higher income, but eligibility is not income-based.

With Medicare, one has to work for about 10 years (40 qualifying quarters), at which point no premiums are required for Part A,  which covers hospitalizations. Premiums may be necessary if you sign up for a Medicare Advantage plan, which is different from Original Medicare where you are permitted to purchase supplemental coverage for out of pocket costs. Because Medicare is not administered by each state, a Medicare recipient will usually have the same coverage and pay the same copays and deductibles regardless of the state of residence.   Co-pays and deductibles are required for Medicare’s Part B (outpatient services) and Part D (medication) plans. Also, a financial penalty can be assessed if one does not sign up for Medicare Part B when you first become eligible, and there may be a delay in getting coverage.

Though basic differences are covered here, there is much more information to know regarding both plans, so research is encouraged before you hit the age of eligibility for Medicare to determine which Medicare plan may be right for you. Medicaid plans and coverage differ from state to state, and sometimes county to county.  We would be happy to answer any questions you have about your potential eligibility for either program.

If you have questions about planning for yourself or planning for a loved one, contact our Ruston, Louisiana offices by clicking here to send us a message or give us a call at (318) 255-1760.

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Law Aimed at Stopping Financial Elder Abuse

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President Trump signed the Economic Growth, Regulatory Relief, and Consumer Protection Act into law on May 24, 2018. The Act contains a section that was once a stand-alone bill from Sen. Susan Collins (R-Maine) which is designed to encourage the reporting of elder (age 65 and older) financial abuse witnessed by financial institutions. The Act does not mandate that these institutions report financial abuse directed towards elders to avoid penalties, rather it gives them an incentive to do so. The Act provides immunity from any lawsuit alleging elder financial abuse if the financial institution reports it to state or federal law enforcement agents. To qualify for immunity, a financial institution has to create and administer a training program for employees to teach the employees how to spot elder financial abuse. This Act provides immunity to financial institutions because they are often the first to witness elderly clients making unusual transactions that may be linked to a scam.

The Act was inspired by the Senior$afe program in Maine. Senior$afe encourages state regulators, financial institutions, and legal organizations to work together on educating banking and credit union workers to spot and stop elder financial abuse. When elders have a trusted third party to talk to about their finances, they are less likely to fall victim to elder financial abuse, and this program has found success in reducing the number of elders who fall victim to these scams.

However, this isn’t an entirely new idea. In 2016, the Consumer Financial Protection Bureau (CFPB) issued a report that found how reporting elder financial abuse has already become a respected norm in hundreds of counties around the country. The report found that these counties created voluntary community-based partnerships to prevent, detect, and respond to elder financial abuse situations. These partnerships often include entities such as financial institutions, adult protective services, and law enforcement. The CFPB found that these partnerships can be incredibly effective in protecting their elderly citizens. What’s more, in states without elder financial abuse protection laws, these community efforts have created a sense of responsibility within these counties to protect their most vulnerable from financial scams, without reward or threat of prosecution against financial institutions. Following this report, the CFPB released a resource guide and best practices to help and encourage other counties across the US to adopt their own protection partnerships. Among other recommendations, the CFPB encourages communities to directly include law enforcement and financial institutions in these partnerships. Financial institutions are often the first to spot these cases, and law enforcement has an obligation to investigate once a claim is made. Also, the CFPB recommends that partnerships that serve diverse areas engage with groups that are already entrenched in the community, such as service groups or faith-based organizations.

Protecting our most vulnerable is important in providing a safe and prosperous society for all citizens. These community-based partnerships and the Economic Growth, Regulatory Relief, and Consumer Protection Act are both steps in the right direction towards protecting those who aren’t able to protect themselves. If you have any questions about something you have read, please do not hesitate to contact our Ruston office by clicking here are by dialing us at (318) 255-1760.

 

Medicare, Medicaid, and Alphabet Soup

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Many people confuse Medicare and Medicaid. And why not? The words are similar, and both are government programs that have to do with health care. However, the programs are very different. A proper understanding of these two programs is necessary to make sure that you or your loved one does not misstep when making health care or long-term care decisions.

Medicare

Medicare does not pay for long-term nursing home care. Medicare is a health insurance program funded by and administered by the federal government. It is thus uniform from state to state.  As with any government program, a person must meet specific requirements before receiving Medicare. To qualify for Medicare benefits, one has to be at least 65 years old or have a severe disability.

To qualify at age 65, a person must be a United States citizen or a permanent legal resident that has lived here for at least five consecutive years. Additionally, he or she must have worked long enough to be eligible for Social Security retirement benefits. (He or she does not need to have started receiving those benefits.)  For a disabled person under the age of 65 to receive Medicare, he or she must have received Social Security Disability Insurance (SSDI) for two years.  (SSDI is not the same as SSI, which is Supplemental Security Income, a means-based program.) If a person meets Medicare’s eligibility requirements, he or she can receive Medicare without regard to his or her income or assets. Costs for Medicare are based on the recipient’s work history. This means that costs are determined by the amount of time a person paid Medicare taxes. These costs, like all insurance, include premiums, co-pays, and prescriptions.

Another thing that can be confusing about Medicare is its so-called alphabet soup of “plans” we all hear advertised. Part A works like hospitalization insurance. Part B works like the insurance one may have for medical bills. Parts A and B are covered in Original Medicare offered by the government. Part D is an optional plan that provides prescription drug coverage. Part C is often called the Medicare Advantage Plan. This is a private health plan. Medicare Part C plans are required to include the same coverage as Original Medicare, but they usually also include Part D. Part F, sometimes referred to as Medigap, is optional supplemental insurance that covers those costs that Medicare does not.  It is essential to do your homework on these plans to find what works best and is the most cost-effective.

Louisiana Medicaid

Medicaid is a health care assistance program administered at the state level. Although each state’s program is different, all must work within the guidelines that the federal government provides.  Medicaid eligibility is based on a person’s income and assets. Generally speaking, it is available to people with disabilities, people over age 65, children (and the parents of eligible children), and pregnant women.  In addition to covering health care costs, Medicaid can also pay for long-term nursing home care.  With proper planning by an elder law attorney, seniors can become qualified such that they have only a nursing home co-pay. Medicaid covers the rest. There are extensive regulations and laws that govern who can legally qualify for Medicaid, so it is essential to talk with a lawyer skilled in this field regarding your or a loved one’s eligibility.

If you are interested in learning more about how you or a loved one may be able to qualify for having Medicaid defer some or all of your or your loved one’s nursing home costs, please contact Ruston, Louisiana elder law attorney Add Goff at (318) 255-1760 or go to www.GoffandGoffAttorneys.com.

U.S. Government Says Seniors Should Exercise

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The U.S. Department of Health and Human Services has released its latest findings addressing healthy exercise guidelines for older adults. The overall conclusion is that all aging adults should include aerobic and muscle-strengthening exercises as well as add balance training. The authors of the study by the Journal of the American Medical Association (JAMA) state “All three aspects are important for this population because older adults are at an increased risk of falls, and strength and balance are needed to prevent falls.” Physically active adults are better able to engage in activities of daily living and have improved physical function.

The good news is, even if you have never exercised before, you can get benefits from beginning today. Determine your level of fitness and talk to your doctor before beginning any program. To exercise safely, adults with chronic conditions may require exercise modifications either in physical technique or time allotment. Even with a chronic condition older adults should be as physically active as their circumstances allow. The goal is not to outlive your muscles.

General recommendations include all adults get a minimum of 150 to 300 minutes of moderate or 75 – 150 minutes of vigorous-intensity aerobic activity weekly. Two or more days of the week should include muscle strength training. Balance exercises can be natural daily incorporation in your routine with multicomponent physical activities such as dance, certain sports, or yoga. Additional balance (and brain!) training can be achieved by walking backward.

While some of these exercise routines may require a treadmill or weight training equipment, there are ways to add more motion to your daily routine by swapping sedentary behavior with light or moderate-intensity physical activity. Many household tasks like vacuuming, dusting, laundry, and gardening are excellent ways to keep you moving, and the work effort provides a more restful, clean environment for when you are ready to sit down and relax.

Aerobic activity is large muscle movement for a sustained period and it improves cardiorespiratory fitness. Many adults know it as endurance or cardio training. Good examples of aerobic exercise include bicycling, jumping rope, running, or brisk walking. All of these, except for bicycling, is bone-strengthening activity because the force exerted on your bones helps promote bone growth and strength. If you can’t exercise outdoors gym memberships are often available through your insurance company for free or at a reduced rate and are good places to exercise both for safety and social connection with others.

A gym is also an excellent place for a muscle-strengthening activity to increase skeletal muscle strength, power, endurance, and mass. If you are not actively working to strengthen your muscles, they will atrophy with age. Weight lifting or resistance training helps keep your muscles healthy. Proper form and familiarity with the gym equipment is a necessity so be sure to get proper training and oversight especially when you are beginning a muscle-strengthening program.

Balance activity is designed to improve your ability to resist forces within or outside of the body that can cause a person to fall while stationary or moving. Lunges are a straightforward technique that helps your balance. Walking backward is an excellent balance activity but must be approached slowly. There are great mental benefits from learning how to walk backward as well as physical ones. Benefits include an enhanced sense of body awareness, better body coordination, sharpened thinking skills, and cognitive control enhancement. However, be sure to consult with the gym personnel before engaging in backward treadmill walking.

Multicomponent physical activity is also excellent for improved balance. These activities include certain sports and dance, but one of the best overall is yoga which challenges your static balance as you stand in position and hold without swaying as well as dynamic balance which is the ability to anticipate and react to changes as you move. Yoga is also meditative and is very good for your brain and your ability to calm and center yourself. You can find yoga DVDs available to do at home or at a friend’s house. Yoga is an excellent multi-component physical activity for men and women.

The benefits that can be achieved by following this three-pronged approach for exercise cannot be overstated. Overall it will lower all-cause mortality including lower cardiovascular disease and its associated mortality, lower risk of hypertension, type 2 diabetes, and an adverse blood lipid (fat) profile. It can also lower risks of some cancers like bladder, breast, colon, esophagus, kidney, lung and stomach.  In conjunction with one another these three exercise activities improve cognition and quality of life, reduce anxiety and the risk of depression as well as reduce the risk of dementia (including Alzheimer’s). Exercise will improve your sleep and can help reduce weight gain. These three exercise activities will improve your bone health, physical function, and lower the risk of falls and fall-related injuries.

Proper exercise is one of the components to aging successfully, as noted in the Department of Health and Human Services report. Group exercise can also be a great way to socialize with others and reduce feelings of isolation.

If you have any questions or would like to discuss how we could help you or a loved one with a comprehensive legal plan, please don’t hesitate to contact our Ruston office to schedule an appointment or call us at (318) 255-1760.

 

These Trends in Senior Living May Surprise You

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The traditional senior housing market is undergoing a profound change. In 2018 senior housing occupancy fell to an eight-year low, even as the senior population continues to increase, as competition for the younger baby boomer market is ramping up and forcing a change to more traditional independent and assisted living options. Active adult concepts like Margaritaville are addressing this market segment that is turned off by the idea of “senior living.” Atria Senior Living is in a joint venture with Related Companies to build $3 billion in senior luxury housing in major metro areas while overall multifamily development with an intergenerational mix of renters is also fragmenting the traditional senior housing market. Occupancy challenges in traditional independent living and assisted living communities are also finding the retention of a reliable workforce to be a continuing challenge. The truth is that the advent of smart home technology and on-demand services ordered via a smartphone, as well as home care aides, are enabling apartment and single dwelling living for more extended periods than ever before. Younger seniors tend to want to age in place for as long as possible.

In the skilled nursing arena, Medicare fee-for-service payment reform brings forward three major provisions: the change to the case-mix classification system, the skilled nursing facility Value Based-Purchase Program, and the skilled nursing facility Quality Reporting Program. The case-mix model focuses on the patient’s condition and resulting care needs rather than the number of care services provided to determine Medicare payment. The Value Based-Purchase Program shifts Medicare payments from volume to value-driven. Finally, the skilled nursing facility Quality Reporting Program is designed, through innovation, to provide meaningful, quality measure reporting, a reduction of paperwork, and a lowering of administrative costs.

These and other changes in Medicare are helping to create an influx of capital into the senior care market incentivizing innovative partnerships and cross-continuum service development. Investors and providers will be partnering with Medicare Advantage payors, retail giants, home health, pharmacies, technology, and other provider groups to reinvent and manage the quality and cost of senior care housing, products, and services. This influx of investment capital combined with technology is destined to create fresh ways to approach senior living needs and the services that provide for them. Web-based platforms and data analytics software continue to address the battle for the retention of the health care workforce while Telehealth solutions are enabling elders in rural markets to reach providers and connect with specialists. Voice recognition software is increasingly being integrated into resident units whether they are private homes or pay for service facilities. Partnering opportunities and joint ventures will continue to create new service models that will, in particular, meet the needs of home and community-based services.

When aging in place is no longer a viable strategy a senior is faced with where to go next. Marketing senior housing to the younger baby boomers is changing, and it is data-driven. In particular, the adult Gen X children of these seniors are helping their parents to make informed decisions, and they typically get their information from online sources. Social media has become a tech tool replacing older marketing models of senior housing communities. Operators can tell their stories, address negative reviews, promote positive news items, and create conversations. Gen X adult children will be looking to social media platforms to get real and varied opinions to validate their parents’ choices.

As Medicare Advantage increases its integration in the overall health care system, data collection and its conclusions are more critical than ever. Potential residents will also be addressing concerns about health care data. More data is being gathered than ever before by Centers for Medicaid and Medicare Services (CMS) on hospital readmission rates, the prevalence of falls, and other related health information and consumers will demand to know what these statistics are before entering into a contract with a senior living community.

Seniors are being presented with more living options than ever before and the competition for their dollars will keep providers in the senior living industry highly focused and fiercely competitive. Questions facing seniors include: How and where do you want to live as you age? Are you well informed about the changing options available to you? Do you have a plan in place that is legally documented for the stages of your senior life?

We can help. Give us a call and let’s start planning together. You can reach Goff & Goff Attorneys at our Ruston, Louisiana office by clicking here to send us a message or by dialing (318) 255-1760.

How Seniors Can Shop Safer

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When we think of shopping, there are certain risks that are always a possibility. Unfortunately, seniors are often more vulnerable to these risks. The holiday season often brings with it criminals who are targeting shoppers, both in stores and online. Below are some tips to help senior shoppers stay safe whether shopping with mobility issues, shopping in general, or shopping online.

General Shopping Safety Tips for Seniors

Shopping can often be overwhelming for all of us, including seniors. Seniors often are less mobile and may move more slowly than others in crowded stores, thus putting them at greater risk for criminal activity. Here are some tips to make shopping safe and successful for you or your elderly loved one.

  1. Shop early in the day, especially on weekdays, to avoid large crowds. Often this is a time when stores are less crowded and seniors can navigate the stores more easily. Another benefit to shopping on weekdays is that many stores offer senior discounts throughout the week. During weekends and evenings after work, many stores become overcrowded and more difficult to get around.
  2. Have a “shopping buddy.” Shopping with a friend gives added safety if you or your loved one has issues with mobility.  There’s much to the saying, “safety in numbers.” Plus, shopping with a buddy makes shopping more enjoyable.
  3. Don’t wait until the last minute. Often stores are busy in the last few days before the holidays. Shoppers can become less careful and more irritable which can present problems for seniors.
  4. Always keep your car locked and store packages in the trunk or out of sight. This will help deter thieves from breaking into the vehicle.
  5. Shop during daylight hours whenever possible. If it is necessary to shop at night, park as close as possible to the door and always in well-lit areas. The light often serves to deter predators.
  6. Be aware of your surroundings and personal belongings. This can go a long way in helping to protect seniors from those who may attempt to take advantage of them or who may try to steal personal belongings.

Online Shopping Safety Tips for Seniors

There are many unscrupulous people who attempt to scam online shoppers. Being aware of this fact and shopping with eyes wide open is key in keeping financial information safe while online shopping. Below are some tips for seniors to remember while online shopping.

  1. Many online sellers offer excellent deals, but it is important to remember that if a deal seems too good to be true it probably is. Check on unknown companies. A quick Google search can provide reviews or information about the legitimacy of online companies.
  2. Create strong and unique passwords. This makes it more difficult for hackers and those trying to steal personal information to get into the accounts. Unique passwords can be difficult to remember, so be sure to keep them written down and in a safe place.
  3. Shop with trusted and known retailers. Most of these websites provide built-in security for their shoppers.
  4. Watch extra costs such as shipping. Companies will sometimes offer low prices, but then increase shipping prices to recoup some money.

For seniors, shopping can sometimes seem overwhelming no matter what method of shopping is chosen. It doesn’t have to be. It can be a fun and enjoyable experience just by following these safety tips.

If you have any questions about something you have read or would like additional information regarding planning for yourself or a loved one, please feel free to contact Goff & Goff Attorneys in Ruston, Louisiana by clicking here to send us a message or by calling us at (318) 255-1760.