Important Medicare Information and How to Find It

On Monday, I participated in a training on the Social Security and Medicare programs hosted by the Mountainland Aging and Family Services department in Utah County. It is important for me in my profession to keep abreast of the rapid changes taking place with regard to Social Security, Medicare, Medicaid and other government programs that provide such important benefits to the aging population.

On an almost daily basis I run across misinformed statements about these programs and have to help my clients understand what the law really says they are entitled to. However, I have also learned that there are significant efforts being made by both the federal government, and local governments, to provide accurate information about these programs. I wanted to make you aware of at least two of these excellent resources for getting your questions answered on what can, at times, seem to be overwhelmingly complex topics.

How Will You Die?

A few days ago, my wife and I learned that a friend we went to college with is in need of a heart transplant. As any of us would be, this woman is overwhelmed at the thought of facing her own death. Unfortunately, we can be faced with end-of-life health care decisions at any age. This is why every adult should give some thought to planning for those decisions and then take the simple step of executing an advance health care directive.

This week, Governor Herbert will sign SCR2, a concurrent resolution encouraging every adult in Utah, whether they have a known serious medical condition or not, to consider preparing an advance health care directive (AHCD). The Utah AHCD form has two parts: (1) Part I allows you to appoint someone (an agent) to make medical decisions for you when you cannot make or communicate your own medical decisions (also called a Health Care or Medical Power of Attorney). (2) Part II allows you to express your preferences about health care decisions under particular circumstances and helps ensure your health care wishes will be honored (also called a Living Will).

Sorry Folks, That Ship Has Sailed

It is not uncommon for my office to receive a call from a panicked family member of an elderly individual. The call may go something like this:

Caller: Hi, I'm calling to see how much it costs to get some estate planning done for my mom.

Paralegal: We'd be happy to help you if we can. Why don't you first tell me a little bit about your mom.

Caller: Okay. Well, mom's not doing too well these days. She's in an assisted living facility and mostly doesn't recognize us anymore. Although she sometimes has good days, most of the time she's confused and is asking for her husband who died three years ago.

Paralegal: Okay. What kind of property does your mom have?

Caller: Well, she has a home that's paid for. She has a brokerage account, a checking and savings account, some farm land in Tooele and I think she has some municipal bonds that she invested in once. But I'm not really sure.

Paralegal: Does your mom know what property she owns and does she understand its value?

Caller: Oh heavens no! She put me on her checking account years ago because she was so overwhelmed with trying to manage her finances. I don't think she has a clue how much she owns, nor could she keep it straight even if we told her.

Paralegal: I think we can help you, but you'll need to meet with an attorney to discuss some of the legal implications of your mother's situation.

Although this above excerpted conversation is a fictitious example, and a very abbreviated one at that, it illustrates a trap that many people fall into with regard to estate planning.

How Not to Lose $45,000

I'll be the first to admit that today's financial times are a bit scary. And inevitably, when people begin to worry about their investments, I get lots of questions from clients about whether they should just pull all of their money out of the banks and buy gold and silver, or just bury the cash somewhere in their backyard.

Of course, I'm not a financial advisor so I typically will defer to the advice of my client's own advisors on matters such as these. However, being an estate planning attorney, I have had occasion to witness the sometimes disastrous results of people following this course of action. Two quick examples:

The Future of Medicaid and Medicare

In May, we reported about the federal government’s efforts to decrease spending in 2011 by making sweeping cuts to numerous federally funded programs to avoid a government shutdown. Four months later, the focus on cutting Medicaid and Medicare benefits has gained momentum, despite documented evidence of the many benefits of Medicaid, as well as the huge detrimental impact cutting either program can have on individual states.

Proposed Cuts

As has been widely reported, the Obama Administration is offering to cut tens of billions of dollars from Medicare and Medicaid as part of the negotiations to reduce the federal budget deficit. The depth of the cuts depends on whether Republicans will accept any increases in tax revenues.

It appears that hospitals and nursing homes will be the unwilling recipients of some of the cuts, as Administration officials and those involved in the negotiations say that the cuts can come from health care providers like hospitals and nursing homes without directly imposing new costs on needy beneficiaries or overhauling either program. Some of the proposals being considered are:

• Gradually eliminating Medicare payments to hospitals for uncollectible patient debt. Medicare currently reimburses hospitals for 70% of debt resulting in patients failing to pay deductibles and co-payments and the hospitals have made reasonable efforts to collect.

• Reducing Medicare payments to teaching hospitals for the cost of training doctors, caring for sicker patients and providing specialized services such as trauma care and organ transplants.

• Reducing the federal share of payments to health care providers treating low-income people under Medicaid and the Children's Health Insurance Program.

Lawmakers opposed to the cuts say it would impair access to care for the poor and shift costs to the states that are already facing a huge expansion in Medicaid eligibility and enrollment beginning in 2014 under the terms of the health care reform legislation passed last year. Hospital executives say that additional cuts (besides the reduction in Medicare payments already part of the health care reform legislation) will result in hospitals discontinuing services and increasing charges to patients with private insurance.

Dad's Driving is Scaring Me!

We've all seen it before, a huge Lincoln Town car weaving down the road, with little more than a tuft of purple hair or a shiny, hairless head just barely peeking over the steering wheel. As parents and grandparents age, driving can become much more difficult for them as vision worsens, reaction times slow down, and the potential for heart attacks, strokes or other sudden physically debilitating illnesses become more likely.

Often, I have children with elderly parents come into my office and tell me "We need to take away dad's/mom's license. Can we?"

Aging and Big Brother: Orwellian Nightmare or Godsend?

The LA Times recently ran an article about new technology being developed by major health care companies (General Electric and Intel) to help the elderly population age in place.

For example:
• robotic cameras that move around grandma's house in California that can be controlled by a joystick from a family member in Montana;
• pill boxes with sensors that record when and how often medications are being taken;
• monitors in the hallway that measure the speed and gait of the resident as they walk through the house;
• devices that monitor facial expressions to look for signs of depression or anxiety
• robotic "pets" that have lifelike interactions with their owners
• and monitors on the bed that measure the rate of breathing of the occupant and can send warnings to a computer when the breathing becomes irregular or stops.
Many of these technologies are being developed in what one corporation's representative describes as a "race to see who's going to invent 21st century care services for boomers." There's a major market that is developing to serve the millions of baby boomers who are entering into the retirement stage of their lives.

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