Jay Seeger’s Elder Care Blog

Medicare Enrollment Is Now Open

The annual Medicare Open Enrollment Period has begun. From October 15 to December 7, 2013, Medicare beneficiaries have to opportunity to change their Medicare managed care plan and prescription drug coverage for 2014. In other words, you can enroll in or change your Medicare Advantage plan during this period. You can also change Part D plans.

What does this mean for you? You should review your current drug prescriptions to make sure that your Part D plan provides the best coverage for the medicines that you are currently taking. If there is a significant gap in your current benefits, you should compare the drug formulary for your current plan with other plans to see if it makes sense to change plans. You should also compare co-pays and other costs.

You should also make sure that you have received all of your “no cost” preventative health screenings that are available to Medicare beneficiaries for this year.

Remember that Medicare is not part of the ACA. You are not enrolling through the Health Insurance Marketplace. You are not replacing your Medicare insurance with Marketplace Insurance. You will continue to have the Medicare benefits that are available to you.

Update on Jimmo v. Sebelius

As many of you may know, a class action lawsuit involving Medicare payments for nursing home and in-home care was settled earlier this year. In that lawsuit, Jimmo v. Sebelius, the application of Medicare’s “Improvement Standard” which was being used to cut off Medicare benefits for patients receiving nursing home or in-home care was challenged. Under the terms of the settlement, the government agreed to that patients could no longer be cut off from Medicare benefits for the reason that the patient was no longer making any progress toward recovery, if the patient continued to need such care to prevent or slow further deterioration.

The Centers for Medicare and Medicaid Services has now issued a fact sheet regarding the settlement (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf). Should a facility or provider attempt to cut off services based upon the Improvement Standard, this factsheet can be used to show that such services should be covered.

Identity Theft and the Elderly

Identity theft is a real and growing concern for everyone, but more and more identity thieves are targeting the elderly in their illegal endeavors. Using fraudulent telemarketing schemes and email phishing expeditions, these criminals obtain Social Security and credit card numbers from vulnerable seniors, and then redirect government benefits to their own accounts and make purchases using the stolen credit card numbers. In the most recent issue of Bifocal, a Journal of the ABA Commission on Law and Aging, author Sarah Anderson offers the following tips on how seniors can protect themselves from tax and government benefits identity theft:

  1. Open your mail and respond to any correspondence from the IRS
  2. File an IRS Identity Theft Affidavit if you are a victim or suspect you are a victim (http://www.irs.gov/pub/irs-access/f14039_accessible.pdf
  3. Contact the Taxpayer Advocate Service (http://www.irs.gov/uac/Taxpayer-Advocate-Service-6)
  4. Block elective on-line access to your social security records (http://ssa.gov/myaccount/)
  5. Contact the credit bureaus to report identity theft
  6. Request a credit freeze from the credit bureaus
  7. Request a copy of your credit report on an annual basis
  8. Request a copy of your IRS tax transcripts
  9. Report identity theft to the appropriate government agency, including the FTC and the Internet Crime Complaint Center (https://www.ic3.gov/default.aspx)
  10. File a police report