Long Term Care Awareness Month

LTC Awareness Month >>>
Eight Things People Should Know

*REPOST* Brought to you by: Mutual of Omaha

November is LTC Awareness Month – time again to devote your efforts to helping people understand the importance of planning for their future long-term care needs.

This can be challenging...especially for those who find it hard to see themselves needing help with the most basic daily activities, like bathing or dressing. Yet, taking accountability for their future care and planning for that day is something everyone should do.

Here are eight things they should consider when developing a plan for long-term care:

1. Planning for long-term care is important. Most people will tell you they plan to live a long life. But with age comes the need for help with some of the things they always did for themselves. According to the U.S. Department of Health and Human Services, 70 percent of people who reach age 65 will need LTC services at some point in their lives
2. LTC services are expensive. Mutual of Omaha’s cost-of-care survey revealed that just one year in a nursing home can cost nearly $80,000 (based on national averages). Home health care is less expensive, but people still can expect to pay over $36,000 per year on average for care they receive at home.
3. You can’t rely on Medicare. Many people mistakenly believe their LTC needs are already covered. In reality, Medicare only covers services for a short time – typically just long enough to help people get back on their feet after an illness or injury.
4. Medicaid isn’t for everyone. It’s true. Medicaid does cover LTC services. But it’s important to remember that Medicaid is a program for people with low incomes and limited resources. That may mean your clients would have to spend down their assets just to qualify. Not an attractive option for people who want to protect the assets they worked a lifetime to accumulate and leave a legacy for their children.
5. There’s a hidden cost to family caregivers. It’s easy to say, "My family will take care of me." But a spouse may not be physically able to provide all the care that’s needed. And children have their own family and career obligations. The fact is family caregivers frequently suffer from stress and illness themselves. Not to mention lost wages if they have to give up a job or reduce work hours.
6. The best time to start planning is now. How will you pay for the care you need? Where will you live? Who will take care of you? These are questions people need to ask themselves now while they’re young and in good health. The need for LTC services can arise at any time. Having a plan in place when that day comes can help alleviate the emotional strain many families face. It also can help ensure your clients get to make the important decisions about the care they receive and the setting they prefer.
7. The cost of waiting can be high. The ability to obtain an LTCi policy is based on age and good health. So it’s important for people to understand that if something happens to cause a change in their health status, they may not be able to purchase LTCi at any price.
8. Some coverage is better than none. Many people who think they can’t afford an LTCi policy neglect to consider what would happen if they didn’t have one. Without a policy to help pay the bills for LTC services, they may have to liquidate assets, sell stocks, dip into savings or retirement accounts or sell property to come up with the cash they need. Even a modest LTCi policy offers some protection for their important assets.

Read More @: http://www.mutualofomaha.com/yourchoice/tips-tools-training/article-eight-things-people-should-know.php

Medicare 101: What is Part D?

What Is Medicare Part D and Who Qualifies?

*Repost* Brought to you by: TransAmerica: http://blog.transamerica.com/what-is-medicare-part-d#.V_QNDOUrJhE

Medicare Part A and B together make up what is known as Original Medicare and provide coverage for many things that are typically categorized as hospital insurance and medical insurance, including emergency care. But often, taking care of your daily health comes with medicines prescribed by your doctor. This is where Medicare Part D enters your healthcare picture.

What does Medicare Part D cover?

Simply put, Medicare Part D covers a patient’s prescription drugs. In the Medicare system, drugs are put intotiers based on formularies, which results in different price levels. Medicare Part D plans are generally set up to provide coverage at levels that correspond to the prescription drug tiers. In this guide, you can find a description of some common situations people face, as well as things to consider in each scenario regarding coverage options.

Who qualifies?

Medicare Part D is voluntary for everyone except those enrolled in Medicaid, or Medi-Cal for those in California. Because of that, anyone who is eligible for Medicare can sign up for a Part D coverage during the annual open enrollment period.

When should I enroll?

Enrollment follows the same initial rules as Plans A and B. You can apply three months before the month of your 65th birthday, within your 65th birthday month, and the three months following. Likewise, if you don’t select drug coverage when you first become eligible, and don’t qualify for an exception, you may encounter a late enrollment penalty that stays with you as long as you have Medicare drug coverage.

You don’t have to re-enroll each year, but you will have a chance to review your coverage and change plans if needed. In addition, certain changes in your circumstances throughout the year may prompt the need for aSpecial Enrollment Period (SEP). Rules for what you can change and when you can change it are different for each SEP.

How much does it cost?

The cost for prescription drug coverage isn’t as clear cut as with Parts A and B, since your cost will largely depend on which prescription drugs you take. Other variables include the plan you choose, if you use a pharmacy in your plan’s network, and if your prescriptions are part of the formulary of your chosen plan.

Since coverage for Part D is distributed through independent companies, you have a lot of options to choose from. We can assist you in getting started.

What about Part C?

Original Medicare is enough coverage for some people, but if you feel like you need extra benefits, that’s where Part C comes in. Part C plans are sometimes called Medicare Advantage plans. Medicare Advantage Plans are administered by private insurance providers, but are regulated by the government. They include most Part A and B benefits as well as prescription drug coverage, vision, hearing and dental services. Opting into a Part C plan means that you’ll receive benefits from Medicare Advantage instead of Original Medicare. Costs vary by plan.

For more information on Medicare, Transamerica Center for Health Studies^® has a guide that can help you compare the features of the different parts.

About Transamerica Center for Health Studies^®.
The Transamerica Center for Health Studies^® (TCHS) is a division of the Transamerica Institute^®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.

CMS NEWS: Part A & B Premiums

CMS NEWS

FOR IMMEDIATE RELEASE

November 10, 2015

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

2016 Medicare Parts A & B Premiums and Deductibles Announced

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016. 

“Our goal is to keep Medicare Part B premiums affordable. Thanks to the leadership of Congress and President Obama, the premiums for 52 million Americans enrolled in Medicare Part B will be either flat or substantially less than they otherwise would have been,” said CMS Acting Administrator Andy Slavitt. “Affordability for Medicare enrollees is a key goal of our work building a health care system that delivers better care and spends health care dollars more wisely.”

Because of slow growth in medical costs and inflation, Medicare Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The “hold harmless” provision would have required the approximately 30 percent of beneficiaries not held harmless in 2016 to pay an estimated base monthly Part B premium of $159.30 in part to make up for lost contingency reserves, according to the 2015 Trustees Report. However, the Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries and states, which have programs that pay some or all of the premiums and cost-sharing for certain people who have Medicare and limited incomes. The CMS Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

CMS also announced that the annual deductible for all Part B beneficiaries will be $166.00 in 2016. Premiums for Medicare Advantage and Medicare Prescription Drug plans already finalized are unaffected by this announcement.

To get more information about state-by-state savings, visit the CMS website at

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-11-10.html.  

Since 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums.  These income-related monthly adjustment amount (IRMAA) affect fewer than 5 percent of people with Medicare. Under the Part B section of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an additional amount. The IRMAA, additional amounts, and total Part B premiums for high income beneficiaries for 2016 are shown in the following table:

Beneficiaries who file an individual tax return with income:	Beneficiaries who file a joint tax return with income:	Income-related monthly adjustment amount	Total monthly premium amount
Less than or equal to $85,000	Less than or equal to $170,000	$0.00	$121.80
Greater than $85,000 and less than or equal to $107,000	Greater than $170,000 and less than or equal to $214,000	48.70	170.50
Greater than $107,000 and less than or equal to $160,000	Greater than $214,000 and less than or equal to $320,000	121.80	243.60
Greater than $160,000 and less than or equal to $214,000	Greater than $320,000 and less than or equal to $428,000	194.90	316.70
Greater than $214,000	Greater than $428,000	268.00	389.80

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse:	Income-related monthly adjustment amount	Total monthly premium amount
Less than or equal to $85,000	$0.00	$121.80
Greater than $85,000 and less than or equal to $129,000	194.90	316.70
Greater than $129,000	268.00	389.80

Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. The Part A deductible covers beneficiaries' share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The daily coinsurance amounts will be $322 for the 61^st through 90^th day of hospitalization in a benefit period and $644 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 in a benefit period will be $161.00 in 2016 ($157.50 in 2015).  

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Part A. Individuals with 30-39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $226.00 in 2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage pay the full premium, which will be $411.00 a month, a $4.00 increase from 2015.

Deductibles and Coinsurance for 2016

Part A Deductible and Coinsurance Amounts for Calendar Years 2015 and 2016 Type of Cost Sharing
	2015	2016
Inpatient hospital deductible	$1,260	$1,288
Daily coinsurance for 61st-90th Day	315	322
Daily coinsurance for lifetime reserve days	630	644
SNF coinsurance	157.50	161.00

For more information on the 2016 Medicare Parts A and B premiums and deductibles (CMS-8059-N, CMS-8060-N, and CMS-8061-N), visit: https://www.federalregister.gov/public-inspection.  

###

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov