I am often asked about how diseases like Alzheimer’s Disease and Parkinson’s Disease affect a person’s ability to drive. I recently came across an article in the October/November 2014 issue of Neurology Now which covers this subject. It can be found at http://journals.lww.com/neurologynow/Fulltext/2014/10050/The_Keys_to_Safety__How_neurologic_conditions.10.aspx
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.
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 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:
- Open your mail and respond to any correspondence from the IRS
- 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)
- Contact the Taxpayer Advocate Service (http://www.irs.gov/uac/Taxpayer-Advocate-Service-6)
- Block elective on-line access to your social security records (http://ssa.gov/myaccount/)
- Contact the credit bureaus to report identity theft
- Request a credit freeze from the credit bureaus
- Request a copy of your credit report on an annual basis
- Request a copy of your IRS tax transcripts
- Report identity theft to the appropriate government agency, including the FTC and the Internet Crime Complaint Center (https://www.ic3.gov/default.aspx)
- File a police report
As of July 1, 2013, Indiana law allows Physician Orders for Scope of Treatment, or what are commonly referred to as POST forms. A POST form is a new standardized form which contains a physician’s orders for cardiopulmonary resuscitation, medical interventions, medications, and artificially administered nutrition. For example, a POST form allows the physician
- to specify whether the patient is a “code” or “no code
- to set the lever of medical intervention (comfort measures only, limited intervention, or full intervention)
- to order antibiotics for comfort only or for full treatment
- to provide full artificial nutrition, artificial nutrition for a set period of time, or no artificial nutrition
A POST form is intended for patients who are seriously ill and whose death is anticipated within the reasonably near future. It differs from a living will in that it is an actual order signed by the physician which is meant to accompany the patient throughout the course of the patient’s treatment.
For a copy of the Indiana POST form, go to http://www.in.gov/isdh/25880.htm
Well at least there are no more inheritance taxes for individuals who die as residents of Indiana. For Indiana residents who die in 2013 or later, there is no longer any need to file an Indiana Inheritance Tax Return (Form IH-6). Additionally, Consents to Transfer (Form IH-14) and Notices of Intended Transfer of Checking Account (Form IH-19) are no longer required. The is no longer any inheritance tax to be paid. For more information go to: www.in.gov/dor/3807.htm
RESOURCES TO HELP CHOOSE A NURSING HOME
Last week I discussed some points to consider when choosing a nursing home. Today I will share some online resources that can be helpful when making a decision on an appropriate nursing home.
First, review the Nursing Home Report Cards that are prepared by the Indiana State Board of Health, Long Term Care Division. http://www.in.gov/isdh/reports/QAMIS/rptcrd/search.htm
Second, check out the Nursing Home Compare page on the Medicare website. http://www.medicare.gov/nursinghomecompare/search.aspx
I am often asked about what nursing home is best. When I am asked that question I respond that everyone is different and everyone’s needs are different. So what may be a good placement for one person may be a bad placement for another. That being said there are certain things to consider when choosing a nursing home.
First, remember the number one rule of real estate: Location, location, location. This is true in choosing a nursing home. A convenient location will promote contact with family and friends for the nursing home resident which is an important part of every resident’s care plan.
Next, inspect each facility. Do not rely on second hand information. Everyone’s experience is different. Just because one person may like a particular nursing home does not mean that it is right for you or your loved one. The only way to get a true picture of a facility is to visit it in person, and it is important to visit each facility that you are considering at least three times.
First, go in during business hours, and tour the facility. Meet with the Administrator, Director of Nursing, and social worker, and ask questions. Discuss finances, and find out if the facility accepts Medicaid.
Second, go in during the evening meal. Observe interactions between the staff and residents. Pay particular attention to residents who need encouragement with meals.
Third, go in on the weekend. Talk to family members visiting other residents about their experiences with the facility. Look to see if there are activities on weekends.
Next, find out whether or not your physician sees patients at the facility. Many doctors do not see patients in nursing homes. If your doctor does not see patients at the facility, you will need to find another that does.
With this information you should be able to make an informed and reasoned decision.
The death of a loved one is difficult to deal with at any time. The family is stressed and generally has lots of questions about what to do. So I thought it might be helpful to review some of the things that need to be done shortly after a loved one dies.
First, determine if the deceased had a written funeral planning declaration.
Second, find documents such as:
- Life insurance policies
- Real estate deeds and mortgages
- Vehicle titles
- Bank statements
- Investment records
- Pension and retirement account records
- Tax returns
Third, order several copies of the death certificate.
Fourth, contact the following:
- Investment broker
- Credit card companies to cancel credit cards
- Social Security office if on Social Security
- Veterans Administration if receiving VA benefits
Of course this is just a brief list. There are other things that need to be done. But I hope that it might provide some guidance at that difficult. Of course for assistance with probate and estate administration, please contact our office.
Now that the dust has settled and the risk of going over the “fiscal cliff” has passed for the time being, it is time to look at some of the things that the American Taxpayer Relief Act of 2012 did.
Estate Tax. The federal estate tax exemption for 2013 will be $5,250,000. Had Congress not passed the Act, the estate tax exemption for 2013 would have dropped to $1,000,000. This would have put many estates at risk for a substantial federal estate tax liability which, by the way, was increased by the Act from 35% to 40%.
Income Tax. The Act made the Bush era tax cuts permanent for individuals making less than $400,000 per year and married couples making less than $450,000 per year. For individuals making $400,000 or more and married couples making $450,000 or more, the maximum income tax rate increased from 35% to 39.6%.
In addition, the “Social Security tax holiday” has officially ended resulting in a 2% increase in Social Security taxes in 2013.
Long Term Care. The Act established the fifteen member Commission on Long Term Care which is charged with developing “a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high quality system that ensures availability of long term care services and supports.”
This is a very brief summary of some of the things which the Act did. Significantly, it did not address the federal debt limit or the upcoming mandatory federal government spending cuts which will likely have a major impact on all of us.