Garland Law Offices, P.A.

Legislation to Prevent Medicare Mistake Penalties Making Progress

“The BENES Act, which cleared committee Wednesday, aims to minimize the chance that beneficiaries get slapped with life-lasting late-enrollment penalties.”

More older workers are remaining in the workplace. In 2016, about 60% of 65-year-olds were receiving Social Security benefits, compared to 92% in 2002. Consumer advocates expect that change to result in a growing number of older people making expensive mistakes, when they enroll in basic Medicare, says the article “Bipartisan bill to prevent costly Medicare mistakes advances in the house” from CNBC.com.

The hope is that the bill will make Medicare a little easier to understand. The congressional measure to help prevent costly enrollment mistakes cleared a House committee as part of a group of bipartisan health-care bills. Next up would be a vote by the full chamber.

There’s a companion bill in the Senate, but it’s stuck in the Finance Committee. The House bill, known as the BENES Act, has several goals. One is to eliminate delays between the time that someone signs up and the time that they are covered by Medicare. Another is to offer more outreach and information about Medicare to people, as they get closer to being eligible at 65.

About 62.4 million Americans—most of whom are 65 or older—are enrolled in Medicare. Most people do end up tapping their Social Security benefits before that time, and they are automatically enrolled, but today many more people are delaying their benefits beyond that age. As a result, the expectation is that many more people are going to make expensive mistakes, when they do go to enroll in basic Medicare. That includes Part A, for hospital coverage and Part B, for outpatient care and medical equipment. There are no late-enrollment penalties for Part A but coming late to Part B can lead to a world of trouble.

The penalty for enrolling late to Part B is 10% of the standard premium for each 12-month period that the person should have been enrolled but wasn’t and worse, it can increase each year as the premium adjusts. Sixty-five-year-olds who fit into the exception category—that is, they have group health insurance at work—are allowed to delay enrolling. However, once they leave that group, they face deadlines.

Last year, as many as 764,000 people paid the Part B late-enrollment penalty, which on average pushed their premiums up by 28%. Based on the 2020 standard Part B premium, that would mean an additional $40 per month (although some pay more or less than the standard).

There is also a serious coverage delay for those who sign up during the general enrollment period (that’s January 1 to March 31), if they missed their initial signup window, which means they aren’t covered until July 1. You could sign up on January 2 and not have health coverage until July!

The BENES Act also requires that the Health and Human Services Secretary submit a report on how to most effectively align the early year general enrollment period for Parts A and B with the annual fall open enrollment period, which is for enrollment for different parts of Medicare: Part C Advantage Plans and Part D prescription drug plans.

Reference: CNBC.com (July 16, 2020) “Bipartisan bill to prevent costly Medicare mistakes advances in the house”

When Social Security Makes the Most Sense

“When should you sign up for Social Security? It is a good question. Many seniors grapple with that decision, and understandably so, since the age at which you claim benefits will dictate how much money you will receive each month during retirement.”

There’s an unfortunate tendency to focus on how to get the most out of Social Security in total benefits, but that’s not always the right approach to determine when to apply for Social Security. Everyone has the same eight-year window—from age 62 to 70—when they can start applying for benefits, as explained in the article “Why Claiming Social Security at 65 Is a Smart Bet” from The Motley Fool. The year you were born determines when Social Security sets your Full Retirement Age, or FRA.

Whether you take Social Security at age 62, which is the earliest you can take it, or at 70, after which you’ve maxed out on monthly benefits and there’s no reason to delay, depends on many different factors. For example, do you expect to live a long time based on your family history? If so, it may make sense to wait. However, if you have a number of health conditions and expect to have a shorter life span, then take your benefits early and enjoy them—you earned them.

The most common age for starting Social Security benefits is at age 62. A much smaller percentage of seniors wait until age 70 to collect benefits. Doing so locks in a higher benefit for life, but if you don’t live much longer than 70, the benefit doesn’t matter quite as much.

Going from one extreme to the other points to a choice in the middle: age 65. That’s when Medicare kicks in. Some people get these benefits confused. They think that once they are eligible for Medicare, they are eligible for full Social Security benefits. This is not true. However, 65 is still a good age to start taking Social Security benefits for a few reasons.

• You’re not taking Social Security at the earliest age possible, so you have had two years for your benefits to increase.
• You’re not taking Social Security at the latest age. Therefore, if you don’t live into your 90s, you’ll still have had those years to enjoy the fruits of your labor.

The numbers-crunchers at Social Security work to make sure that everyone gets the same lifetime benefits, regardless of when they file. The logic is simple: claim early, and get a smaller benefit, possibly for a longer lifetime. Delay your claim, and the same amount of money in total will come to you, just in fewer payments.

There is another advantage for claiming Social Security around the same time you switch over to Medicare. Your Part B premiums will be directly paid from Social Security benefits. That means you’ll have some protection against rising premiums. That’s because of what’s known as the “hold harmless provision.” It is a provision that attempts to limit how much of a bite Medicare premiums can take out of Social Security benefits. It’s not a perfect solution, but it’s a little bit of a help.

Reference: The Motley Fool (July 10, 2020) “Why Claiming Social Security at 65 Is a Smart Bet”

Quirk in Medicare System’s Observation Status

“Unfortunately, over a decade, the number of observation stays has increased exponentially and is being used, even when patients have a diagnosis and have been admitted by their own physicians.”

There’s a troubling quirk in the Medicare system that occurs when older patients are hospitalized and instead of being officially admitted, they are placed on “observation status” reports the article “Caught Paying for Rehab Due to Observation Status? Medicare May Owe You” from The National Law Journal.

Observation status originally was meant to serve as a temporary status for people who were receiving medical care and tests in a hospital setting until they were either sent home or a diagnosis was made, and they were officially admitted.

However, in the past 10 years or so, the number of patients in hospitals deemed to be in observation status has increased enormously, even when patients have received a diagnosis and their doctors have admitted them to the hospital. This is a direct result of the Medicare claims review process, where hospitals risk not being paid because of inpatient services being billed without documents of certain diagnoses and levels of care.

The hospital seeks to protect itself, by designating a patient as observation status. There’s no downside to the hospital, since this is covered by Medicare, just under Part B, rather than Part A.

However, for the patient, it’s not that simple. First, the denial of Part A inpatient coverage means that the patient has to pay for each and every deductible and copay for each service. Prescription drugs received while the patient is in the hospital are billed separately and aren’t included under the Part A inpatient payment.

 It gets worse. Medicare coverage for post-hospital care is denied or extremely limited for observation status patients. Medicare only covers rehab costs in a facility, if the patient was admitted to the hospital for at least three days.

Observation status days do not count towards those qualifying days. It doesn’t matter if the treating physician had the patient admitted to the hospital, because hospitals can change the status of the patient retroactively.

Until recently, there was no recourse for patients. However, a recent class action suit in Connecticut may see that begin to change. A federal judge held that Medicare beneficiaries whose hospital stays were changed to observation status may appeal to Medicare for reimbursement of their payments to rehabilitation facilities. As a result of Alexander v. Azar, patients have the right to recover payments for their nursing home rehabilitation stays.

Patients whose doctors placed them on observation status still are not permitted to appeal.

Speak with your elder law estate planning attorney, if this scenario applies to you or family member.

Reference: The National Law Review (May 26, 2020) “Caught Paying for Rehab Due to Observation Status? Medicare May Owe You”

This Social Security Pit Could Be Costly and Stressful

“The Social Security hell morphed into Medicare hell and, will, not doubt, morph into federal income tax hell and then state income tax hell.”

A cautionary report about a man who simply wanted to apply for Social Security appears in a recent article from Forbes, “A Social Security Application Mistake or A Malicious Policy with Frightening Consequences?”

Last September, a man who turned 70 in November called the local Social Security office to request that his benefits be initiated when he turned 70. The Social Security employee explained to him that if he took his benefit early, he would receive a six-month retroactive payment. The problem with taking this retroactive payment, is that it establishes an earlier start date for monthly benefits. It, therefore, reduces the monthly benefit that is received for a lifetime, and eliminates the entire reason for delaying taking benefits until age 70.

The gentleman said no. He knew that this would give him more money in the short run, but less over the long haul. The article reports that Social Security seems to have a policy of contacting people close to age 70 and offering to start their benefits retroactively. This may save Social Security some money but creates a world of problems for recipients.

The man stuck to his guns, insisting that he did not want the early benefits and wanted his retirement benefit to begin on November 2019,.This meant that his first check would arrive in December 2019. Social Security benefits are always one month behind.

For whatever reason, he maintains that the Social Security employee did the exact opposite of what he wanted. She specified that his retirement benefit should begin nine months before he called, dating back to January 2019. Ever since then, the man has been trying to undo this mistake. Here’s what happened as a result:

A lump-sum payment was directly deposited into his bank account in October 2019.

He went to the Social Security office and filed a form to withdraw his initial benefit application, requesting to start his new retirement benefit as of November 2019. He was told to repay the lump sum, but to wait until he received a letter from the Mid-Atlantic Program Service Center in Philadelphia. The letter arrived December 3, and he sent a check for the exact amount and included a copy of the letter.

In October, Social Security stopped automatically deducting his Medicare Part B premium from his checking account. He realized this and began sending Medicare the premium directly. Had he not done this, he could have lost his coverage entirely.

On Jan. 10, 2020, Richard’s check was cashed.

On Feb. 20, he received a letter from Social Security stating that he could be paid the correct amount.

He immediately sent a letter requesting Social Security to immediately initiate the correct payment and to send him a corrected 1099, since he had received a 1099 from Social Security, indicating that he needed to pay federal and state taxes on the lump sum that he had wrongly been sent.

It hasn’t gotten much better for the man. Incorrect amounts have been reported to the IRS, Social Security has not sent corrected 1099s, his past benefits have not been corrected and a series of directly related issues have been created with Medicare. Meanwhile, his wife is seriously ill, and this has led to more stress than either of them needed.

Be careful when applying for Social Security benefits, and document every step of the way, just to be sure.

Reference: Forbes (April 1, 2020) “A Social Security Application Mistake or A Malicious Policy with Frightening Consequences?”

What Don’t I Know About Retirement?

“Retirement is a topic that regularly makes headlines, and not all of them are encouraging. Americans are living longer than ever before, resulting in lengthy periods of post-career life.”

Investopedia’s recent article, “6 Surprising Facts About Retirement,” writes that if you think most people are saving more in order to prepare for their long-term needs, you’d be incorrect. The article provides us with some of the more startling truths about retirement in the U.S.

1. Retirement May Be Longer Than You Think. The average American will retire at age 66 and live until about 79. However, many will see their retirement last much longer than 13 years. A 65-year-old woman has a 50% chance of making it to age 85, and a 65-year-old man has a 50% chance of reaching age 82. This is why younger people need to plan for 20 years or more of income in retirement. For current retirees, an ultra-conservative portfolio composed solely of bonds may not give them sufficient growth, especially with interest rates so low.
2. Social Security Doesn’t Do It By Itself. Many experts suggest replacing 80% of your usual income once you hit retirement. However, for many, Social Security payments alone won’t be nearly enough to hit that target. In 2019, the average monthly Social Security benefit is just $1,461. That’s just $17,532 per year.
3. We’re Waaaay Behind on Savings. Americans are quite far behind on saving for retirement. When the American workplace turned away from pension plans, workers needed to be responsible for securing their retirement funds. We’re not doing it: according to thestreet.com, in 2019 a typical couple in the 56-to-61 age bracket without any retirement accounts had just $17,000 in savings. For many, that’s not enough to live off for a year, let alone a whole retirement. However, the mean retirement savings of working households age 32 to 61 is $95,776, according to the Economic Policy Institute. 35% of workers have $100,000 or more saved for retirement.
4. Just Half of Americans Have a Retirement Plan. Today, the median annual pension amount for the fast dwindling number of Americans who have the old-fashioned defined-benefit plan is less than $10,000, according to CNBC.com. However, many of us aren’t replacing those pensions with a contribution plan, like a 401(k). Almost half of the population (43%) has no workplace savings vehicle of any kind in 2019, according to Bloomberg.
5. Many People are Staying in the Workforce. Because so many Americans are behind in their savings, it may not be surprising that many remain in the workforce well after reaching Social Security eligibility. Almost 19% of people 65 or older were working either full- or part-time, as of 2017. Consider this: about 20% of workers overall say they’ll never be able to retire!
6. Medicare Doesn’t pay for Assisted Living. Nearly 70% of individuals who reach age 65 will require long-term care at some point. What many seniors don’t know, is that Medicare doesn’t pay for most long-term care costs. It only covers 100 days of care at a skilled nursing facility, and only if it was preceded by a hospital stay of three days or more.

Begin your analysis, by looking at the amount of money you’ll need for retirement, based on your current spending and the standard of living you want. Then look at your savings balances and how much you’re saving regularly.

Roughly 55% of Americans build their nest eggs with a regular savings account. However, that might not be good enough, because of the low interest rates. Savers should consider other investment vehicles.

Be sure that you’re maxing out contributions to your 401(k) or 403(b) if you have one, or at least, saving enough to get the company match. If you don’t have a plan through your work, or you’re lucky enough to max out your plan each year, you can supplement your savings with an IRA. For 2019, you can contribute up to $6,000 a year to an IRA, or $7,000 if you’re age 50 or older.

Reference: Investopedia (September 27, 2019) “6 Surprising Facts About Retirement”

Does Your Retirement Plan Include Long Term Care Insurance?

“No one likes to think about needing long-term care. Yet the reality is that many people will, at some point in their life.”

Roughly 60% of those turning 65 can anticipate using some form of long-term care in their lives, according to the U.S. Health and Human Services Department. It may be a nursing home, assisted living, or in-home care.

CNBC’s recent article, “Not having long-term care insurance can be ‘the single biggest devastator’ of your financial plan,” reports that over 8 million Americans have long-term care insurance. However, the cost of that insurance is rising. This increase is because of several factors, including the fact that companies underpriced their policies for years and misjudged how many would drop coverage.

Because of those rising premiums, some individuals may choose self-insurance. That means saving a pool of money to earmark for long-term care. Coverage is also available through Medicaid, which has eligibility requirements.

Even with these increases, you should purchase some form of coverage. This is because not being insured can be the biggest devastator of a financial plan.

The rule of thumb has been to buy LTC coverage at age 55. However, it really depends on your situation. The big unknown is health, and the odds of being able to qualify for coverage at age 60, compared to age 30 or 40 is vastly different.

A traditional LTC policy will cover the costs of care for a certain period of time, generally up to six years. The amount of coverage is based on the average cost of care for your location. Most insurers offer it in the form of a monthly benefit, and possibly with some inflation protection.

There’s also a hybrid policy that covers long-term care costs but becomes life insurance paid to heirs, if it’s not used. Of the 350,000 Americans who purchased long-term care protection in 2018, 85% chose the hybrid coverage. It’s also called combo or linked-benefit. The big difference is price: you’ll pay more for the hybrid policy.

Medicaid is another option, particularly if you don’t have a way to save. To be eligible, you must deplete your assets. You can also work with an attorney to find out how you can shield your assets, before you need care. Medicaid also looks back five years into your finances, so if you have given away any money during that period of time, it will be subject to penalty.

Reference: CNBC (October 14, 2019) “Not having long-term care insurance can be ‘the single biggest devastator’ of your financial plan”

What Do I Need to Know about Medicare Advantage?

“Medicare Advantage, also known as Medicare Part C, is a private insurance alternative to original Medicare.”

Monthly premiums for Medicare Advantage (MA) plans are anticipated to decrease by an average of $3.87 to an estimated $23 in 2020. That’s a 14% drop, according to the Centers for Medicare and Medicare Services (CMS). Roughly one-third of Medicare's 60 million beneficiaries belong to these private insurance plans.

AARP’s recent article, “Medicare Advantage Premiums to Decrease in 2020,” explains that these plans include Medicare Part A. That covers hospital care, hospice, and some nursing home and rehabilitative services. These plans also include Part B, which helps pay for physician visits and other outpatient services, including lab testing, scans and other diagnostic services. Most Medicare Advantage plans also include prescription drug coverage.

The recently announced premiums represent a nationwide average. Actual monthly charges for Medicare Advantage plans will vary, depending on what the plan covers and where beneficiaries reside. CMS announced that premiums for Part D prescription drug coverage were also trending down by about 13.5% to a projected $30 a month.

Many Medicare Advantage plans also cover some dental, vision and hearing care. Over the past two years, CMS has also added other benefits that will hopefully improve the health of seniors. These services include in-home meals, transportation, adult day care services and improvements to beneficiaries’ homes. That may look like wheelchair ramps and shower grips. However, not all Medicare Advantage plans have these extra benefits.

The Centers for Medicare and Medicare Services projects that about 250 plans in 2020 will offer access to these supplemental services, impacting about 1.2 million enrollees.

Enrollment in MA plans has been steadily climbing. The Centers for Medicare and Medicare Services projects that more than 24 million people will be in an MA plan in 2020.

The agency says that 1,200 more Medicare Advantage plans will be available in 2020, than were being sold last year.

Reference: AARP (September 24, 2019) “Medicare Advantage Premiums to Decrease in 2020”

Is Medicare Coverage Free?

“After paying into Medicare through payroll withholding for many years, you might think your coverage will be free once you turn 65. You’d be wrong.”

Medicare has a variety of expenses—including premiums, copays and deductibles. CNBC’s recent article, “Here’s what you should know about Medicare costs if you’re nearing age 65,” found that half of respondents in a recent poll by consumer website eligibility.com, said they believe Medicare is free.  If you fail to sign up on time, you may face penalties for the rest of your life.

Fidelity Investments estimates that the average male-female couple will spend at least $285,000 on health care in retirement. The items not covered by Medicare—dental, basic vision, over-the-counter medicines, long-term care—would be in addition to that amount.

If you have at least a 10-year work history, you pay no premiums for Medicare Part A. This will cover hospital stays, skilled nursing, hospice, and some home health services. However, Part A has a deductible of $1,364 per benefit period and some caps on benefits. Part B—which covers outpatient care and medical supplies—has a standard monthly premium of $135.50 (in 2019). Higher earners pay more. This part has a $185 deductible (for 2019). After it’s satisfied, you typically pay 20% of covered services.

Those parts of Medicare don’t cover prescriptions, so a Part D drug plan is needed.

You can get a separate plan to use with original Medicare, or you can enroll in an Advantage Plan (Part C). This plan usually has prescription drug coverage. If you go with this, your Parts A and B benefits also will be delivered through the insurance company offering the Advantage Plan.

The average cost for Part D coverage in 2019 is $32.50 per month, according to the Centers for Medicare and Medicaid Services. However, high earners pay extra for their premiums. The deductible for 2019 is $415.

If you accessed your Social Security benefits before age 65, you’ll automatically be signed up for original Medicare. A month or two before you turn 65, you’ll be automatically enrolled, and your card will be delivered in the mail. You’ll see your Social Security check decreased by the cost of the Part B premium.

If you haven’t yet used Social Security, you must enroll proactively. There’s a seven-month enrollment period that begins three months before your birthday month and ends three months after it. If you have insurance through an employer when you reach age 65, you may be able to wait to enroll in Medicare without a penalty.

Even if you don’t take medicine right now, at least sign up for the cheapest drug plan just so you don’t face a penalty. This is because if you don’t enroll in Part B when you’re supposed to, you’ll see a 10% penalty for each year that you should’ve been enrolled. The amount would be in addition to your monthly premium. Part B enrollment isn’t required, if you have medical coverage from your job.

As far as Part D, the penalty for not enrolling when you were first eligible is 1% for every month that you could have been signed up—unless you have qualifying coverage through an employer’s plan.

Many people couple their original Medicare benefits with a supplemental policy—known as Medigap—to help cover out-of-pocket costs like deductibles and coinsurance. However, you can’t pair a Medigap policy with an Advantage Plan.

If you select an Advantage Plan, there may be limited coverage for dental and vision.

Reference: CNBC (August 29, 2019) “Here’s what you should know about Medicare costs if you’re nearing age 65”

How Can I Avoid a Retirement Home and Live at Home?

“’I’d like to move to a nursing home or assisted living,’ said no older adult ever. In fact, a recent study by AARP found that nine of 10 older Americans preferred to live in their homes as long as possible. The aging-in-place movement seeks to let seniors do just that, avoiding heading to a retirement community or skilled nursing facility for as long as possible—or forever.”

Staying at home requires planning. The sooner you begin, the more prepared you’ll be, even if you’re around at 102.

The Washington Post’s article, “Aging in place helps you to avoid a retirement community or nursing home,” explains that there’s plenty of work to do.

You might start by remodeling or retrofitting your home to suit senior-specific issues, such as decreased mobility or impaired eyesight (think replacing a bathtub with a walk-in shower or improved lighting). Some seniors add a first-floor bedroom and bathroom and an outdoor ramp onto their homes. Other changes can include wider doorways (the better to potentially accommodate a wheelchair or walker), a bathroom with grab bars and an easy-access shower.

This is known as universal design, which means building or remodeling a home to accommodate all ages and abilities. It can usually be implemented or planned by builders or contractors who are Certified Aging in Place Specialists (CAPS), an educational designation offered by the National Association of Home Builders.

Even if you can’t afford a major remodel, there are some simple changes you can do, like installing shower grab bars or improving interior and exterior lighting to avoid falls and other accidents. You can also secure throw rugs to the floor with special two-sided tape to prevent slips.

You can speak with an elder law attorney about health agencies, resources for financial assistance, elder abuse prevention, as well as estate planning, Medicare, Medicaid and other state programs.

Keep busy by taking yoga at the local rec center, business or computer classes at the public library, or even getting a roommate to help combat loneliness and keep feeling connected and emotionally healthy.

For dining, in addition to the community-based food delivery from Meals on Wheels, you can get restaurant food or groceries delivered to your home by services, such as Uber Eats, Caviar and Peapod.

There are also a number of meal prep companies—Blue Apron, Hello Fresh, and others—that make it easier to put a healthy meal on the table, without the need to journey to the grocery store.

Reference: Washington Post (July 1, 2019) “Aging in place helps you to avoid a retirement community or nursing home”

How are Baby Boomers Doing with Their Retirement Planning?

“April is National Financial Literacy Month, but this week is National Retirement Planning Week, which means it's time for yet another round of depressing statistics about how unprepared we all are for retirement.”

The baby boomers—those born between 1946 and 1964, ages 55 to 73—have about half (47%) of their group already in retirement.

CNBC’s recent article, “Baby boomers face retirement crisis—little savings, high health costs and unrealistic expectations,” says that the Insured Retirement Institute’s annual report, Boomer Expectations for Retirement, highlights the fundamental issues of too little savings, underestimating healthcare costs and unrealistic expectations of how much retirement income they’ll actually need.

Too little savings. The three "legs" of the retirement "stool" are Social Security, private pensions and personal savings. These aren’t in great shape, as the average Social Security check is $14,000 a year, and just 23% of boomers ages 56-61 expect to receive income from a private company pension plan, with only 38% of older boomers expecting a pension. Most boomers haven’t saved nearly enough in their personal savings, with 45% of boomers having absolutely nothing saved for retirement.

Underestimating health care costs. Retirees frequently underestimate health expenses, especially long-term care costs. Many people don't understand the system: half of the survey respondents say they haven’t calculated the cost of long-term care insurance, because they say they’ll rely on Medicare. However, Medicare has no coverage for long-term care. Just eight percent of boomers say they have purchased a long-term care policy.

Underestimating retirement income. The average amount spent by Americans 65-74 is $55,000 annually. However, most baby boomers don't believe they’ll need near that amount. To that point, about 60% say they will need less than that on which to live. Their backup plan is to downsize, go back to work, or ask their children for help.

Of those who aren’t confident they did an adequate job preparing for retirement, the top two things they wish they’d done differently were to have saved more (63%) and to have started saving earlier (58%).

Reference: CNBC (April 9, 2019) “Baby boomers face retirement crisis — little savings, high health costs and unrealistic expectations”