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Patricia Carrera

How does Medicare work with my job-based health insurance when I stop working?

Once you stop working, Medicare will pay first and any retiree coverage or supplemental coverage that works with Medicare will pay second.

You may be able to get COBRA coverage to continue your health insurance through the employer’s plan (usually up to 18 months).

Don’t wait until your COBRA coverage ends to sign up for Part B — Getting COBRA doesn’t extend your limited time to sign up for Medicare.

If you get COBRA: Before you sign up for Medicare – Your COBRA coverage will probably end when you sign up for Medicare. (If you get Medicare because you have End-Stage Renal Disease and your COBRA coverage continues, it will pay first.)

If you get COBRA: After you sign up for Medicare – COBRA pays after Medicare (unless you have End-Stage Renal Disease).

For more info, Click Here.

Why should I stop contributions before I retire?

To avoid a tax penalty, you and your employer should stop contributing to your Health Savings Account (HSA) 6 months before you retire or apply for benefits from Social Security (or the Railroad Retirement Board).

If you’re 65 or older, your Part A coverage will start up to 6 months back from the date you sign up for Medicare or apply for benefits from Social Security or the Railroad Retirement Board. You’re not eligible to make contributions to your HSA after you have Medicare. If your Medicare Part A coverage overlaps when you or your employer made contributions, you’ll have to pay a tax penalty. 

You can withdraw money from your Health Savings Account after you sign up for Medicare to help pay your share of costs (like deductibles, premiums, coinsurance or copayments). 

For more info Click Here

Medicare Open Enrollment Information

Call us today and compare your choices! This is the time to review your Medicare Advantage or stand alone prescription coverage choices.

  1. Think about your Medicare coverage needs for 2022. Carefully review your current Medicare coverage, and note any upcoming changes to your costs or benefits. Decide if your current Medicare coverage will meet your needs for the year ahead. If you like your current coverage, and it’s still available for 2022, you don’t need to take any action to keep it.
  2. Review your 2022 “Medicare & You” handbookIt has information about Medicare coverage and Medicare plans in your area. If you want to get your handbook electronically, you can go paperless by logging into (or creating) your secure Medicare account.

The Cost of Part B Medicare

Some people automatically get  Medicare Part B (Medical Insurance), and some people need to sign up for Part B. Learn how and when you can sign up for Part B.

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.

Part B premiums

You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you don’t get these benefit payments, you’ll get a bill. 

Most people will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. This is the most recent tax return information provided to Social Security by the IRS. 

Depending on your 2019 Income will determine Part B premium

For more information, CLICK HERE

Medicare Coverage for Home Health Aide Care

Medicare coverage can help older adults and people with disabilities obtain necessary home care. When individuals meet the home health benefit criteria, Medicare-covered care can include home health aide services. As defined by federal law, home health aides provide hands-on personal care, including assistance with the activities of daily living. This care is often critical to beneficiaries’ health, safety, and ability to remain at home. 

Read our new Practice Tip for more information. 

How to spot Medicare fraud

Review your Medicare Summary Notices for errors and report anything suspicious to Medicare.

  • Compare the dates and services on your calendar with the statements you get from Medicare to make sure you got each service listed and that all the details are correct.
    • These include the “Medicare Summary Notice” (MSN) if you have Original Medicare , or similar statements from your plan if you’re in a Medicare Advantage Plan. They list the services you got or prescriptions you filled.
    • Check your claims early—the sooner you see and report errors, the sooner you can help stop fraud. Log into (or create) your secure Medicare account to view your Original Medicare claims as soon as they’re processed, or call us at 1-800-MEDICARE (1-800-633-4227).
  • Check the receipts and statements you get from providers for mistakes.

If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got, or they may realize a billing error was made.

If you’ve contacted the provider and you suspect that Medicare is being charged for health care you didn’t get, or you don’t know the provider on the claim, find out how to report fraud.

Concerns over eldercare beginning to show up in workplace

Without adequate caregiving support for employees, companies incur millions of dollars of hidden costs. More than half of survey respondents say their supervisors were not as supportive as they needed them to be about their outside-of-work caregiving responsibilities.

An aging population and a trend toward remote work may increase demand for eldercare as a voluntary benefit.

Two-thirds of respondents in the Homethrive 2021 Employee Caregiving Survey said expanding access to home-based care for the elderly is important. This expansion is more popular than free pre-kindergarten and childcare assistance to middle-class families.

Moreover, this concern may affect job performance:

  • 43% of respondents said they are distracted, worried or focused on caregiving five or more hours per week.
  • One in five are distracted at work more than nine hours per week.
  • Nearly 40% said their supervisor either is not aware of their caregiving responsibilities outside of work or aren’t sure if their supervisor is aware.
  • More than half indicated their supervisors were not as supportive as they needed them to be about their outside-of-work caregiving responsibilities.
  • One-third of respondents said their supervisor had noticed a change because it was affecting their performance or because they were noticeably under stress because of their caregiving responsibilities.

For complete article, CLICK HERE.

What is Medicare and what does it cover?

Medicare pays for health care for:

  • People age 65 years and older
  • People under age 65 with receiving Social Security Disability benefits
  • People of all ages diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) or end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).

Medicare covers medically necessary care for acute care, such as doctor visits, drugs, and hospital stays.

Except for the specific circumstances described below, Medicare does not pay for most long-term care services or personal care— such as help with bathing or for supervision (often referred to as custodial care).

When Does Medicare Pay for Long-term Care Services?

Following Hospitalization

Medicare will help pay for a short stay in a skilled nursing facility if you meet all of the following conditions:

  • You have had a hospital admission with an inpatient stay of at least three days
  • You are admitted to a Medicare-certified nursing facility within 30 daysof that inpatient hospital stay
  • You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy

If you meet all these conditions, Original Medicare will pay a portion of the costs for up to 100 days for each benefit period as follows:

  • For the first 20 days, Medicare pays 100 percent of the cost.
  • For days 21 through 100, you pay a daily copayment, which was $164.50 as of November 2017), and Medicare pays any balance.
  • Medicare does not pay costs for days you stay in a skilled nursing facility after day 100.

(Medicare Advantage plans must cover the same services, but the cost sharing may vary.)

To treat medical conditions

Medicare pays for the following services when your doctor prescribes them as medically necessary to treat an illness or injury:

  • Part-time or intermittent skilled nursing care
  • Physical therapy, occupational therapy, and speech-language pathology provided by a Medicare-certified home health agency.
  • Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
  • Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, Medicare pays 80 percent of approved amount and you pay 20 percent.

There is no limit on how long you can receive any of these services as long as they remain medically necessary and a doctor reorders them every 60 days. There also is no requirement for your condition to improve, or for improvement to be expected.

To prevent further decline due to medical conditions

In some cases, Medicare also covers ongoing long-term care services to prevent further decline for people with medical conditions that may not improve. This can include conditions like stroke, Parkinson’s disease, ALS, Multiple Sclerosis, or Alzheimer’s disease.

Hospice care

Medicare covers hospice care if you have a terminal illness, are no longer seeking a cure, and you are not expected to live more than six months. With hospice care, Medicare covers drugs to control symptoms of the illness and pain relief, medical and support services from a Medicare-approved hospice provider, limited respite care, and other services that Medicare does not otherwise cover, such as grief counseling. You may receive hospice care in your home, in a nursing home, or in a hospice care facility. Medicare also pays for some short-term hospital stays and inpatient care for caregiver respite.

Resources for additional Medicare information or help:

Last modified on 02/18/2020
For more information – www.longtermcare.gov or www.acl.gov

5 opportunities Social Security’s new statements offer advisors, participants

Social Security statements already served as handy tools. But the changes that the Social Security Administration is rolling out will help advisors and clients even more.

Advisors who have never used their clients’ Social Security statements to provide a clearer picture of how much they will get when they retire have been missing an opportunity, according to advisors and financial planners interviewed by BenefitsPRO’s sister site, ThinkAdvisor.

That opportunity has grown even larger with the enhanced statement, which shows the effects of starting benefits each year between age 62 and 70. The SSA recently rolled out the new, shorter statements to a limited number of Americans.

Research has shown that people who see their statements tend to make better retirement choices, according to Jeffrey Levine, chief planning officer at Buckingham Wealth Partners.

He and the others we interviewed pointed to five key things advisors can do now with Social Security statements to help clients.

1. Take advantage of the enhanced statement’s standout feature.

The new version of the statement provides a “really easy graphical way of showing people, right on that first page, what their benefit will be by delaying” their retirement,” said Levine.

After all, rather than just ages 62, 67 and 70, the redesigned statement shows what the estimated monthly benefits would be for each of nine years if you start receiving benefits from ages 62-70 — in a personalized graphic with a series of horizontal bars. At 62, it is tempting to say “70 is so far away,” he said. But when you’re talking about 63, the client might say, “63’s not so bad and look, next year I get more if I wait,” he noted.

“That is the biggest change on the form and that’s what probably” will drive the most advisor conversations with clients once the enhanced version is made available to more Americans, he added.

Advisors can already illustrate this through software. But the new statement offers a “very quick and dirty way of going about this,” Levine told ThinkAdvisor.

Jody King, vice president and director of wealth planning at private wealth management firm Fiduciary Trust in Boston, said she had yet to see an enhanced statement. But, based on what she saw and heard about the redesigned statement, she too gave a thumbs-up to the expanded number of retirement ages included in it.

Robert Conzo, CEO, managing director and co-founder (with Eric Diton) of The Wealth Alliance, an RIA based in Melville, New York, agreed also.

“That one change, from a financial planning perspective, really makes” the client’s cash flow and “retirement picture going forward much, much more accurate,” Conzo said.

2. Discuss if the amount clients will receive when they retire will be enough to live on.

Even before the enhanced statement, “there’s plenty that advisors should be doing with respect to Social Security statements,” according to Levine.

The statement could already be used by advisors to help clients in “understanding the various benefits to which [they] may be entitled,” he said.

For example, he said, an advisor can ask a client: If he or she were to become disabled, would the amount that person stands to receive each month be enough for them to get by on, based on what the statement shows for specific retirement ages?

“The answer in most cases for advisors’ clients is going to be no,” he said, and “that leads to other discussions, such as: Do we need to look for disability coverage? How would we reduce your expenses if these things happen?”

3. Make sure clients are reviewing their statements for errors.

Going through the statement and looking at the earnings history for each client is something that advisors should be doing regularly, according to Levine. For clients who are still working, they should be checking to make sure that earnings are reported properly each year and, if not, helping the clients contact the SSA to rectify that, he said.

4. Check that clients have created online SSA accounts.

In addition to making sure that clients are seeing their statements, it is crucial for advisors to make sure clients have created an online account at the SSA’s website so they can access the statements digitally, Levine said.

Agreeing, King said, “it’s so important for so many reasons and people don’t do it.” Unfortunately, the “vast majority” of her clients do not set up online SSA accounts until her firm encourages them to do so, she said.

Also, because of all the data breaches in recent years, “probably most of our Social Security numbers are out there,” she said. Therefore, she explained: “It’s better to be proactive. Set up your account so somebody else can’t.”

5. Be sure clients understand that Medicare costs come out of their monthly Social Security payments.

“The most misunderstood aspect of Social Security is how Medicare is paid” among Conzo’s clients, he said. “Most people don’t realize that Medicare … gets paid out of your Social Security benefit,” he said.

One way to further enhance the statement, therefore, would be if it includes a noticeable, “very short blurb” explaining this, he said. “Even sophisticated people that are smart” still don’t understand this, he added.

By Jeff Berman | July 22, 2021 at 03:01 PM | The original version of this story was published on ThinkAdvisor

Ask Your Legislators to Put an End to the Observation-Status Loophole

Currently, Medicare beneficiaries who are not officially admitted to a hospital may be classified under “observation status,” which is treated as an outpatient procedure for billing purposes. Unfortunately, the common practice of placing a beneficiary on observation status can have significant financial consequences for Medicare beneficiaries since Medicare Part A and its related coverage rules only apply to actual inpatient care admissions. This may lead patients, many who are extremely sick and may need skilled nursing care, to spend many days in the hospital and be charged for services that Medicare would have otherwise paid had they been admitted. Furthermore, hospitals have up to one year to retroactively change admission status to observation, leading unsuspecting beneficiaries with thousands of dollars in bills for SNF care they believed would be covered by Medicare.

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