The Medicare “Donut Hole” Explained

September 21st, 2015

Seniors and others with Medicare prescription drug coverage (Part D) should be aware of the coverage gap known as the “donut hole,” so that they can plan properly for the cost of their medication.

Most Medicare prescription drug plans have a “donut hole” coverage gap, which means that when you have spent a certain amount on medication, your coverage will be reduced until your costs reach a higher amount where coverage picks up again. The Affordable Care Act reduced the effects of the donut hole, but it can still result in a significant cost for seniors. Here is exactly how the donut hole comes into play with Medicare prescription drug coverage: Littman Krooks Elder Law

First, you are responsible for 100 percent of your deductible (not more than $320 in 2015 and not more than $360 in 2016). After you have paid the deductible, you are covered (meaning you are only responsible for your co-payments or coinsurance), until you and your plan have spent a combined total on covered drugs that reaches a certain limit ($2,960 in 2015; $3,310 in 2016). Above that limit, you have entered the “donut hole” coverage gap.

Previously, Medicare Part D beneficiaries were responsible for paying 100 percent of drug costs in the donut hole. Now, under the Affordable Care Act, you pay 45 percent of the price for brand-name drugs; however, 95 percent of the price counts toward getting out of the donut hole. For generic drugs, you pay 65 percent of the price in 2015; that percentage will drop each year until it reaches 25 percent in 2020. However, for generic drugs, only the price you pay counts toward getting out of the donut hole.

You exit the donut hole when you’ve spent above a certain limit ($4,700 in 2015; $4,850 in 2016). At that point, catastrophic coverage begins, and you will pay a small copayment or coinsurance for covered drugs for the rest of the year.

Expenses that do not count toward the coverage gap include your monthly premium, pharmacy dispensing fees, and any amount you pay for drugs that are not covered.

Making Decisions on Senior Housing

September 15th, 2015

When an older person needs care and can no longer live with full independence, the senior and his or her family are faced with a number of decisions to make. There is often a range of choices available such as assisted living, in-home care, or a skilled nursing facility, and the task of deciding what is right for the individual senior can seem overwhelming.Littman Krooks Elder Law

The decision may be difficult, but families do not have to face it alone. With Americans age 85 and older the fastest growing age group, millions of Americans are now struggling with this very issue, and there are a number of specialists that are available to assist them.

The exact type of assistance that is required depends on the needs of the individual senior and the family’s situation. Families may need to seek guidance from their family doctor, a financial planner, or an elder care specialist. Crucial assistance can be provided by an elder law attorney, who can provide services such as drafting documents that give power of attorney to a trusted family member so that medical and financial decisions can be made if the senior loses the capacity to make them.

A key factor in making a good decision on senior housing is advance planning. Too often families end up making a decision because of a crisis such as a health issue that has taken a turn for the worse. However, in many cases, the need for care can be predicted and planned for. If the family waits for a crisis to develop, they may not have time to consider all the options.

Ideally, the choice of a housing situation for a senior will come out of a series of family discussions that incorporate the senior’s needs and desires, the available options, and the family’s financial situation. Taking the time to consider the options, and seek expert counsel, can allow a family to craft a unique solution for the individual’s unique needs.


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The Dispute Over Robin Williams’ Estate

September 2nd, 2015

robin williamsOne year after the death of Robin Williams, a legal battle over his estate continues.

Despite the fact that Williams’ estate was planned with a certain degree of sophistication, several disputes have arisen between his widow and his three children from two previous marriages. Williams’ estate plan provides that his widow be able to live in their mansion in Tiburon, California, and retain most of its contents. However, Williams’ children claim that the home contains memorabilia items that are designated for them. Another area of dispute concerns a fund dedicated to expenses associated with the residence, which Williams’ widow claims is being restricted by his children.

Many wealthy people die having done inadequate estate planning, or none at all, which is almost certain to lead to legal disputes among heirs. In Williams’ case, the actor and comedian had done the right thing for the most part, creating a tax-efficient estate plan that included trusts to be managed by people in whom he had confidence. However, this did not prevent legal turmoil after his death.

Estate planning experts familiar with Williams’ estate say that a lesson that can be learned from this case is that specificity is essential to proper estate planning. Especially when personal items are to be left to different people, specifically naming individual items is much better than using general language to describe categories of possessions. Leaving things open to interpretation is one way that disputes can arise. Another factor that can help prevent disputes is to set expectations by letting loved ones know the general plan for the estate, so that they are not surprised by its provisions.


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Labor Department to Facilitate State-Based Retirement Plans

August 25th, 2015

The U.S. Department of Labor is taking steps to help workers save for retirement.Littman Krooks Retirement Planning

Job-based 401(k) plans are one of the best ways for employees to build their retirement nest egg by putting aside pre-tax funds, especially if those funds are matched by their employers. However, about one-third of American workers do not have access to a job-based 401(k). While IRAs are available to workers on their own, only a small fraction of people take advantage of them. The Obama administration has proposed legislation that would make enrollment in an IRA automatic for workers who do not have access to a 401(k) plan at work, but that legislation stalled in Congress.

Now, the administration has directed the Labor Department to issue a rule supporting state-based plans that encourage retirement savings. This includes laws in some states that require employers to automatically enroll new employees into IRAs if a 401(k) is not offered, and other state laws that encourage employers to provide 401(k)s.

Until now, state initiatives have been hindered by a concern that their efforts may be preempted or nullified by federal law. According to the Labor Department, the new law will safeguard retirement savings for workers and help states adopt laws on retirement savings that are consistent with federal law.


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New Clinical Decision Tool to Help Prevent Falls with Seniors

August 17th, 2015

A new clinical decision tool is being introduced that will assist medical personnel in helping to prevent seniors from falling.

The technology is called Stopping Elderly Accidents, Deaths & Injuries, or STEADI, and is being designed based on guidelines for fall assessment from the Centers for Disease Control and Prevention (CDC). It is intended to help medical providers screen for falls, intervene to decrease risk, and give patients proper follow-up care. Littman Krooks Elder Law

The CDC already offers a STEADI tool kit to health care providers, which includes information about falls, conversation starters, case studies, standardized balance and gait assessment tests, and educational information that health care providers can give to people at risk of falling and their families. The STEADI program suggests that medical personnel ask seniors three crucial questions: Do you feel unsteady when walking or standing? Have you fallen in the past year? Do you have concerns about falling? If a senior answers “yes” to any of these questions, then they are considered to be at an increased risk of falling. Health care providers may then review medications to reduce the dosage or stop those that may increase the risk of falling, recommend vitamin D supplements with calcium, educate the patient and the patient’s family about fall prevention, and schedule follow-up care.

The clinical decision support tool, based on the CDC system, is expected to be available in hospitals by the end of the year.


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Joni Mitchell and Conservatorship

August 5th, 2015

Beloved singer-songwriter Joni Mitchell was found unconscious in her Los Angeles home on March 31, having suffered a brain aneurysm. After Mitchell spent more than a month in the hospital, her longtime friend Leslie Morris was appointed her conservator to make medical decisions for her while she recovers. As fans wish Mitchell a full recovery, they may also be wondering, “What is a conservator?”

A conservator or adult guardian is appointed by the court to make certain decisions on behalf of an adult who has become unable to make such decisions on his or her own, due to a physical or mental condition, or advanced age. The court may place certain limits on the guardianship or conservatorship. For instance, the court in Los Angeles granted Morris control only over Mitchell’s medical care, in the absence of the 24-hour care she received in the hospital. A court may also grant a conservator or guardian control over a disabled person’s financial affairs or other aspects of his or her life, such as whether the person should reside at home or in a nursing facility.

A conservator or guardian can be essential in protecting the well-being of a person who has become unable to make his or her own decisions. A conservator or guardian can pay bills for the incapacitated person, prevent financial abuse, prevent self-neglect, and advocate for the person’s health.

The court may appoint a conservator or guardian in response to a petition submitted to the court. For example, in New York, a guardianship proceeding is brought under Article 81 of the Mental Hygiene Law. However, guardianship is considered a drastic remedy, and the court is required to consider less restrictive alternatives, such as home health aides, representative payees and other solutions that may meet the person’s needs without the appointment of a guardian.

In many cases, if a durable power of attorney or health care proxy has been appointed before the person becomes incapacitated, then guardianship proceedings are unlikely to be necessary. This is one reason why people planning their estate should give such appointments careful consideration.


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Stay Socially Engaged As You Age

July 21st, 2015

Staying socially active as you age not only makes life more fun, it can be good for your health. Researchers with the Rush Alzheimer’s Disease Center conducted a study that found that seniors who were highly social had a rate of cognitive decline 70 percent lower than less-social seniors. Interacting with others and keeping your mind stimulated can help ward off depression and dementia in some cases. Perhaps surprisingly, such mental stimulation and social interaction seem to have positive effects even when they take place on the Internet. Researchers from the University of Alabama at Birmingham found a 30 percent drop in symptoms of depression among Internet users.

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There are lots of easy ways for seniors to stay socially engaged and intellectually stimulated. Seniors should, according to their ability, make an effort to attend social events, visit friends and neighbors, and keep in touch with family members, if not in person then by phone, email or social media. Seniors can also play games, such as crossword puzzles, or chess to keep their minds active.

Older individuals may also want to do volunteer work or even work a part-time job for the social benefits. Non-profit organizations like At Home on the Sound are run by volunteers and assist their members with a range of services that are designed and coordinated to empower senior citizens and support their wellness, independence and vitality while aging in place, in their own homes within the community they love.

People often become socially withdrawn as they age, but that is something that should be resisted as much as possible. It is important for seniors to take advantage of opportunities for social interaction, to get more satisfaction out of life, and to stay healthy.


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Learn the Facts About Medicare, Medicaid and Long-term Care

July 14th, 2015

More than 40 million seniors rely on Medicare for their everyday health insurance needs, and many mistakenly assume that Medicare will also cover long-term care if it is needed. In fact, there are specific limitations to Medicare coverage for long-term care, and such care is often covered instead by Medicaid, which has eligibility requirements. Therefore, it is important to understand how these two public benefit programs affect long-term care expenses.

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Medicare pays for health care for people age 65 years and older or with certain disabilities. Under certain conditions, Medicare will pay for short-term stays in skilled nursing facilities, hospice care, or home health care. Generally, Medicare focuses on medically necessary care such as doctor’s visits and hospital stays, rather than personal care services associated with long-term care.

Until recently, there was an unevenly enforced “improvement standard,” by which Medicare beneficiaries were denied coverage if their condition was no longer improving. However, the settlement of Jimmo v. Sebelius, a 2013 lawsuit, clarified that no such “improvement standard” can be enforced, and people with chronic conditions can continue to be eligible for Medicare to pay for their medical treatment.

Nevertheless, Medicare generally does not provide for room, board and custodial care such as that offered in a skilled nursing facility. Therefore, people needing such care usually use personal resources, long-term care insurance, and Medicaid. Medicaid has income and asset eligibility requirements, and many seniors will have to spend down some assets to qualify. The financial requirements for Medicaid can be complicated, and the advice of an experienced elder law attorney can be invaluable in planning for long-term care.


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The Importance of Asset Protection Strategies

July 6th, 2015

Protecting your assets from creditors is an important part of estate planning. There are several different strategies that may be effective. Because individual situations vary and the laws regarding these strategies can be complex, you should only use them with the advice of an experienced estate planning attorney. With that in mind, here is an overview of some techniques for asset protection:

lawyer-or-notary-with-cl Give certain assets away before any claims arise. When done properly, such a gift may succeed in transferring property while keeping it out of an estate that may face claims from creditors. However, creditors may try to claim the transfer is fraudulent if it is made after claims arise, if the gift makes you insolvent, or if you place limits on the gift such that you still maintain control over the assets.

In the business context, a basic strategy for protecting your personal assets is to operate businesses as limited liability entities, such as corporations or limited liability companies (LLCs), rather than as partnerships or sole proprietorships. However, be aware that if you blur the line between your personal finances and those of your company, you may open your personal assets up to creditors of your business.

At the family level, an important asset protection strategy is for a married couple to hold title to property as tenants by the entirety, rather than as tenants in common. This can prevent one spouse’s creditors from asking the court to partition the property. The laws on this vary by state, but in New York, third parties cannot partition a tenancy by the entirety. However, when a married couple may be subject to estate tax, there are reasons why owning property as tenants in common may be more advantageous.


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Seniors Affected By Housing Debt

July 1st, 2015

Housing debt is affecting the retirement plans of a growing number of seniors. Paying off a home mortgage prior to retirement has traditionally been a key part of many people’s plan for their golden years, but today many seniors find themselves still in debt in their sixties and seventies.

According to the Office for Older Americans, part of the federal Consumer Financial Protection Bureau, in 2013 there were 6.5 million seniors paying a mortgage, or 30 percent of all seniors. That is an increase from 22 percent in 2001. Data from the Federal Reserve show that 21 percent of people age 75 and older were carrying home loans in 2011, up from 8 percent in 2001.

Littman Krooks Elder LawAlong with the number of seniors with housing debt, the average debt amount is also growing. In fact, according to the financial protection bureau, since 2001 the average debt has more than doubled for people age 65 and older, from $43,400 to $88,000.

The effects of the Great Recession and accompanying collapse of the housing market are still being felt, and many older homeowners are still “underwater” on their homes, owing more than the home’s value, especially in the cities hardest hit by the housing bust.

Housing debt leaves seniors in a difficult situation: what was supposed to be a nest egg can actually hinder their retirement plans. There are no easy solutions, but seniors are addressing the issue in various ways, such as by working in retirement or downsizing their home and lifestyle.


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