Monthly Archives: November 2019

For Seniors, Financial Woes Can Be Forerunner to Alzheimer’s

November 18, 2019

courtesy of NAELAeBulletin:

By Deborah DiSesa Hirsch
HealthDay Reporter
TUESDAY, Oct. 29, 2019 (HealthDay News) — Unpaid bills, overdrawn accounts, dwindling investments: When seniors begin experiencing fiscal troubles, early dementia or Alzheimer’s disease could be an underlying cause, researchers say.In the early stages of the disease, people with undiagnosed Alzheimer’s are at high risk of making foolish and dangerous decisions about their finances, mostly because families may not know they need help, researchers say.

“Individuals often aren’t diagnosed early enough, and it’s a perfect storm,” said study author Carole Gresenz, a professor of health systems administration at Georgetown University in Washington, D.C.

“They’re vulnerable to large reductions in liquid assets because they’re not making wise decisions about their finances, savings and checking accounts. This can also reduce net wealth,” added Gresenz.

Ruth Drew, director of information and support services for the Alzheimer’s Association, pointed out that Alzheimer’s destroys the brain.

“As the disease progresses, everyone with Alzheimer’s will reach a point where they need help with their finances and ultimately assistance with daily tasks and around-the-clock care. We have certainly spoken to people whose finances were significantly affected,” she said.

In some cases, people responsible for making major financial decisions, either at work or at home, were unaware of their own mental decline, added Drew, who wasn’t involved with the study.

“Others around them either did not notice or did not feel they could alert the family until there was already significant financial impact,” she said. “By the time we met them, family members were facing the challenges of caring for a person with far fewer financial resources than expected.”

The new study linked Medicare fee-for-service claims data and the national Health and Retirement Study of Americans over the age of 50 for the years 1992 to 2014. The health and retirement study included questions about households’ financial assets and liabilities.

The sample included nearly 8,900 U.S. households, of which nearly 2,800 included someone with Alzheimer’s or related dementia. In these households, the financial “head of the household” had the thinking disorder in 73% of them.

Gresenz said declining financial skills associated with Alzheimer’s may mean unpaid bills, overspending on credit cards or paying too little attention to investments and other forms of wealth. Impaired money sense also makes the elderly more vulnerable to fraud and scams.

The bottom line: “Living in a house with early-stage AD puts both the patient and family members at heightened risk of a large reduction in liquid assets — money that’s easily accessible, like checking, savings, money markets, bonds and stocks,” Gresenz explained. “One reason this is so concerning is that these core financial outcomes are occurring just prior to a time when they will have substantial costs placed on them.”

Alzheimer’s costs $341,000 on average from diagnosis to death, the Alzheimer’s Association says. Families pay 70% of this out of pocket.

Alzheimer’s disease affects 5.5 million people in the United States and 50 million worldwide, the researchers noted. As the U.S. population ages, prevalence of Alzheimer’s will rise, with a near tripling by 2050, they said.

Gresenz said families need to be involved as early as possible.

“It’s always a good idea to check in on loved ones and make sure that the vital financial activities of the household bills are happening, maybe checking credit scores. Even if there are not yet any obvious signs, making sure there’s a safety net,” she said.

“There’s also a role for financial institutions, which could play an important part in protecting elderly individuals,” Gresenz added.

Drew said that when it comes to Alzheimer’s and dementia, it’s never too early to put plans in place.

To older adults themselves, Drew said, “Talk to your financial planner early. When you’re setting up financial plans, put in provisions that say who the trusted people are in your life.” That way, if you start to show symptoms of mental decline, “your banker or financial planner will know who those trusted people are, and will have the paperwork that authorizes them to share their concerns.”

The study was published Oct. 25 in the journal Health Economics.

For Boomers Reframing Aging, Age-Proofing A Home Won’t Come Cheap

November 18, 2019

courtesy of NAELAeBulletin:

AUSTIN, Texas — Dennis and Chris Cavner, in their early 70s, are preparing to move less than two blocks away into a 2,720-square-foot, ranch-style house they bought this year. But first a renovation is underway, taking the 45-year-old property all the way back to its studs. When the work is finished, these baby boomers are confident the move will land them in their forever home.

“We wanted to find a house that we could live in literally for the rest of our lives,” Dennis Cavner said. “We were looking specifically for a one-story house and one that had a flat lot, to age in place.”

For most of American history, people have moved in with relatives or gone to a care facility to live out their final years. Baby boomers don’t want either, and those with resources have generally created the modern idea of remaking old age to fit their lifestyle and retrofitting their homes for aging in place. Design and construction firms are coming up with safety features that look good as well. Think of it as the age-defying home.

Aging in place is a major financial commitment, one that may be at odds with retirees’ plans to downsize their lives and budgets and squirrel away cash in anticipation of rising health care costs. The Cavners are rebuilding this house — assessed at $700,000 around the time of the sale — from a shell. The remodel could easily cost $300,000 in the hot Austin market.

Leaving nothing to chance, the Cavners are paying for a number of modifications they might never need. For instance, neither uses a wheelchair, but contractors are making all doorways 3 feet wide — just in case. The master bath roll-in shower, flat and rimless, will provide room to maneuver. In the kitchen, drawers, rather than cabinets, will allow easy access in a wheelchair.

The Cavners are closely watching details of the renovation, but this dramatic late-life relocation wasn’t a hard decision.

For some seniors, aging in place might amount to simple modifications, such as adding shower grab bars or replacing a standard toilet with one that sits taller. But many seniors anticipate a financial crunch as they try to plan for their future on a fixed income, uncertain how far their savings and retirement funds will stretch.

A report released last week by the Harvard Joint Center for Housing Studies may fuel these concerns. It cites growing income disparity for older Americans in the wake of the Great Recession, and says “ensuring financial and housing security in retirement will be a struggle.”

For those 65 and older, it said, “the number of households with housing cost burdens has reached an all-time high. By 2050, almost one-quarter of Americans will be 65 or older, according to the Census. Surveys conducted over the past decade show that older adults overwhelmingly want to age in their homes.

Yet many houses aren’t suited to “aging in place,” said Abbe Will, associate project director of the Remodeling Futures Program at Harvard.

“Currently, a lot do not have single-floor living — especially in certain parts of the country. There are lots of stairs and multistory homes when land is more valuable,” she said. And “many homeowners don’t necessarily have the funds to do aging in place.”

Home modifications and costs vary widely — starting with those simple safety features in the bathroom or lever doorknobs throughout the house — to more extensive changes, such as widening doorways or lowering light switches to wheelchair height. Will said simple retrofits, such as grab bars, “could be several hundred dollars,” but a “whole bathroom remodel would be in the thousands or tens of thousands.”

In a recent survey of 1,000 people age 65 and older by the California-based nonprofit SCAN (formerly the Senior Care Action Network), 80% of respondents were concerned about their ability to age in place. The driver appears to be financial: About 60% said they have less than $10,000 in savings (including investments and retirement plans).

“We don’t know what’s coming down the pipeline as we age,” said sociologist Deborah Thorne of the University of Idaho, lead author of a study that found skyrocketing bankruptcy rates among those 65 and older.

The research, recently published in the journal Sociological Inquiry, finds the share of older Americans filing for bankruptcy has never been higher. “And bankrupt households are more likely than ever to be headed by a senior — the percent of older bankrupt filers has increased almost 500 percent since 1991,” the study found.

The Harvard report also cited the burden of debt among those ages 65 to 79, with nearly half of those homeowners carrying a mortgage in 2016. And people are carrying substantially more student loan and credit card debt into retirement as well.

James Gaines, an economist with the Real Estate Center at Texas A&M University, attributes the increase “to the labor market and employment downsizing and letting older people go first. It can force them into retirement whether they’re ready for it or not. Retirement income may not be enough to carry their debts, and they don’t have enough savings.” 

“The leading edge of baby boomers has not hit 75 yet,” said Jennifer Molinsky, lead author of the Harvard report. “When you think about the next five, 10 or 15 years when they’re in their 80s, you’re really going to see the needs shift.”

Molinsky said just what financially challenged seniors should do about housing “is a good question and is a tough question.” Many states have loan and grant programs for home modifications if individuals have a documented disability, she said, yet “what we need more of are programs that help you do this before you need it.”

Molinsky said communities need to create housing near city centers so seniors don’t have to drive. And in the suburbs, communities need to offer more multifamily options, including condos and apartments to buy and rent.

“We just need options,” she said. “It’s important to think about housing options that help people stay in that community. Low-income people need housing that’s affordable. Some people want to trade that single-family home for a condo. Others want to reassess their money and sell their home for a rental. Not everybody wants the same thing.”

Don and Lynn Dille, both 75, built their Austin home with the intention of staying there for a long time. After living in California, Virginia and elsewhere in Texas, they moved to Austin in 2012 and, within a year, began drawing plans with an architect for an energy-efficient home to age in place. Their home was featured this summer in Austin’s annual Cool House Tour for its design making the most of natural light, cross-ventilation and solar panels, as well as wider-than-normal doorways and level floors for wheelchair use.

One key feature of the construction acknowledges that they might need live-in help down the road to avoid long-term nursing care. Just as the Cavners may convert a bedroom and bath on the opposite side of their new home into caregiver quarters, the Dilles constructed a second floor above their detached garage that could convert into living space.

“We think having a separate apartment where we could have a caretaker or part-time help to maintain our property makes us able to stay where we’d like to be and be independent,” said Don Dille, who retired from the federal government.

The renovations are meant to meet very personal needs, but that doesn’t mean they wouldn’t appeal to others and even add to the resale value down the road.

For his part, Cavner, an investment adviser and co-founder of a new health care startup, said he believes what they’re spending to renovate the house for the years ahead will prove a sound investment: “The modifications we’re making are not going to make it less desirable. It will feel more spacious.”

Researchers find high-intensity exercise improves memory in seniors

November 18, 2019

courtesy of NAELAeBulletin: 

Researchers at McMaster University who examine the impact of exercise on the brain have found that high-intensity workouts improve memory in older adults.

The study, published in the journal Applied Physiology, Nutrition and Metabolism, has widespread implications for treating dementia, a catastrophic disease that affects approximately half a million Canadians and is expected to rise dramatically over the next decade.

Researchers suggest that intensity is critical. Seniors who exercised using short, bursts of activity saw an improvement of up to 30% in memory performance while participants who worked out moderately saw no improvement, on average.

“There is urgent need for interventions that reduce dementia risk in healthy older adults. Only recently have we begun to appreciate the role that lifestyle plays, and the greatest modifying risk factor of all is physical activity,” says Jennifer Heisz, an associate professor in the Department of Kinesiology at McMaster University and lead author of the study.

“This work will help to inform the public on exercise prescriptions for brain health so they know exactly what types of exercises boost memory and keep dementia at bay,” she says.

For the study, researchers recruited dozens of sedentary but otherwise healthy older adults between the ages of 60 and 88 who were monitored over a 12-week period and participated in three sessions per week. Some performed high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) while a separate control group engaged in stretching only.

The HIIT protocol included four sets of high-intensity exercise on a treadmill for four minutes, followed by a recovery period. The MICT protocol included one set of moderate-intensity aerobic exercise for nearly 50 minutes.

To capture exercise-related improvements in memory, researchers used a specific test that taps into the function of the newborn neurons generated by exercise which are more active than mature ones and are ideal for forming new connections and creating new memories.

They found older adults in the HIIT group had a substantial increase in high-interference memory compared to the MICT or control groups. This form of memory allows us to distinguish one car from another of the same make or model, for example.

Researchers also found that improvements in fitness levels directly correlated with improvement in memory performance.

“It’s never too late to get the brain health benefits of being physically active, but if you are starting late and want to see results fast, our research suggests you may need to increase the intensity of your exercise,” says Heisz.

She cautions that it is important to tailor exercise to current fitness levels, but adding intensity can be as simple as adding hills to a daily walk or increasing pace between street lamps.

“Exercise is a promising intervention for delaying the onset of dementia. However, guidelines for effective prevention do not exist. Our hope is this research will help form those guidelines.”

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This work builds on earlier research from Heisz’s lab that found physical inactivity contributes to dementia risk as much as genetics.

Changes associated with Alzheimer’s disease detectable in blood samples

November 18, 2019

courtesy of NAELAeBulletin:

Researchers have discovered new changes in blood samples associated with Alzheimer’s disease. A new international study was conducted on disease-discordant Finnish twin pairs: one sibling suffering from Alzheimer’s disease and the other being cognitively healthy. The researchers utilised the latest genome-wide methods to examine the twins’ blood samples for any disease-related differences in epigenetic marks which are sensitive to changes in environmental factors. These differences between the siblings were discovered in multiple different genomic regions.

Development of the late-onset form of Alzheimer’s disease is affected by both genetic and environmental factors including lifestyle. Different environmental factors can alter function of the genes associated with the disease by modifying their epigenetic regulation, e.g. by influencing the bond formation of methyl groups in the DNA’s regulatory regions which control function of the genes.

By measuring methylation levels in the DNA isolated from the Finnish twins’ blood samples, the researchers discovered epigenetic marks which were associated with Alzheimer’s disease in multiple different genomic regions. One of the marks appeared stronger also in the brain samples of the patients suffering from Alzheimer’s disease. The link between this mark and Alzheimer’s disease was confirmed in the Swedish twin cohorts.

The researchers observed that the strength of the mark was influenced not only by the disease, but also age, gender and APOE genotype, which is known to associate with the risk of developing Alzheimer’s disease. Furthermore, the mark was stronger in those twins with Alzheimer’s disease who had been smoking.

The function of the gene where the mark is located is still not well understood. The gene product is suspected to inhibit activity of certain brain enzymes that edit the code translated from DNA to direct the formation of proteins. In a previous study conducted on mice, it was noticed that removing this genomic region caused learning and memory problems which are central symptoms of Alzheimer’s disease.

One of the leaders of the research group, Docent at the University of Turku, Riikka Lund explains that even though the results offer new information about the molecular mechanisms of Alzheimer’s disease, more research is needed on whether the discovered epigenetic marks could be utilized in diagnostics.

“The challenges of utilizing these marks include for example the variation of the DNA methylation level between individuals. More research is also needed to clarify potential impact of the marks on disease mechanisms and to identify the brain regions and cell types affected,” Lund says.

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The study was conducted in cross-disciplinary and international collaboration between the researches at University of Turku, Hospital District of Southwest Finland, University of Helsinki, Aalto University, Karolinska Institutet, Jönköping University, and University of Southern California. The research results have been published in the esteemed journal Clinical Epigenetics.

Original publication: Mikko Konki, Maia Malonzo M, Ida K. Karlsson, Noora Lindgren, Bishwa Ghimire, Johannes Smolander, Noora M. Scheinin, Miina Ollikainen, Asta Laiho, Laura L. Elo, Tapio Lönnberg, Matias Röyttä, Nancy L. Pedersen, Jaakko Kaprio, Harri Lähdesmäki, Juha O. Rinne, Riikka J. Lund. Peripheral blood DNA methylation differences in twin pairs discordant for Alzheimer’s disease. Clinical Epigenetics. 2019 September 2;11(1):130. https://dx.doi.org/10.1186/s13148-019-0729-7

Medicare would cover dental and vision if these bills pass Congress

November 18, 2019

courtesy NAELAeBulletin:

by Sarah O’Brien

  • Right now, Medicare’s 60 million beneficiaries can only get dental, vision and hearing coverage through supplemental options such as Advantage plans or standalone insurance policies.
  • Original Medicare — Part A hospital coverage and Part B outpatient care — excludes those services except in limited circumstances.
  • Allowing Medicare to negotiate with drugmakers as outlined in one of the bills would save the government $345 billion from 2023 through 2029, according to an estimate from the Congressional Budget Office.

Medicare beneficiaries would get dental, vision and hearing coverage if several bills now before Congress pass.

In addition, the government would get authority to negotiate prices with drugmakers and create a cap for Medicare out-of-pocket spending on prescription drugs. All have cleared the necessary committees over the last couple of weeks and now await full House action.

“There have been proposals over the years that would do this, but in the past they haven’t gone anywhere,” said David Lipschutz, associate director at the Center for Medicare Advocacy. “It looks like this time something could get passed in at least one chamber of Congress.”

The bills (summarized further below) are generally supported by Democrats and opposed by Republicans. This means that even if the measures get approved in the Democrat-controlled House, they would would face an uphill battle in the Republican-dominated Senate.

Roughly 10,000 baby boomers turn 65 each day and can sign up for Medicare. While the program’s 60 million beneficiaries can access dental, vision and hearing through supplemental options such as Advantage plans or standalone insurance policies, original Medicare — Part A hospital coverage and Part B outpatient coverage — excludes them except in limited circumstances.

Some of the Advantage plans now include comprehensive dental coverage as part of the plan or as an optional supplemental benefit, said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.

However, those benefits also might be limited to the carrier’s dental network or require prior authorization that the treatment is medically necessary, Gavino said.

H.R. 3: Includes provisions to allow the Medicare program to negotiate with drugmakers, cap out-of-pocket spending by beneficiaries on prescriptions at $2,000 and expand the low-income subsidy program, which helps cover Part D premiums and out-of-pocket costs.

H.R. 4650: Would add preventive and screening dental services, including oral exams and cleanings under Part B. It would also cover procedures such as tooth restorations and extractions, bridges, crowns, root canal treatments and implants and dentures. Beneficiaries would chip in the standard 20% for basic treatments and 50% for major treatments.

H.R. 4665: Would add routine eye exams to coverage through Part B, with beneficiaries generally paying 20% of the cost. It also would provide some coverage — $100 — toward contact lenses or eye glasses.

H.R. 4618: Would provide coverage under Part B for hearing exams and hearing aids, with beneficiaries contributing 20%.

This expanded coverage also might come with a cost. While some Advantage plans have no premium, the average is expected to be $23 in 2020, according to the Kaiser Family Foundation. Although down from $27 this year, any amount paid for a premium is on top of what Medicare enrollees pay for Part B: $135.50 is the standard for 2019 and forecast to be $144.30 next year. (Higher earners pay more).

Roughly 22.2 million, or 37%, of Medicare beneficiaries have Advantage plans. The remainder stick with original Medicare, which they can pair with a supplemental policy (i.e., Medigap) and a standalone Part D plan for prescription drug coverage (which also is typically included with Advantage plans).

“The majority of people on Medicare still choose to be in [original] Medicare, so having an expansion of benefits would accrue to everyone,” Lipschutz said. “It would be a significant improvement to the program and fill holes that have been there since its inception.”

The Congressional Budget Office has not yet released an estimate on how the three bills that expand benefits would impact Medicare’s budget. It did, however, offer a preliminary estimate of $345 billion in government savings from 2023 through 2029 if negotiating with drugmakers were allowed under the fourth bill.

At the same time, though, the budget office report notes the bill’s negative effects may include reduced spending on research and development.

In 2018, Medicare spent about $740 billion on 59.9 million beneficiaries through its hospital, outpatient care and prescription drug benefits, according to the latest report from the program’s trustees.

Total Medicare costs are expected to rise to 5.9% of gross domestic product by 2038, up from 3.7% in 2018, the report says. The more immediate concern among opponents of the measures now headed for a possible House vote is that the trust fund for Part A (hospital coverage) is anticipated to be depleted in 2026 unless Congress acts before then. At that point, the program would be able to fund 89% of promised Part A benefits, the trustees report says.

“We are … considering four bills that expand Medicare benefits as this important program is facing bankruptcy and have no responsible way to pay for them,” said Kevin Brady, R-Texas, in his opening remarks during a hearing on the bills in a recent House Ways and Means Committee, where he is the lead Republican.

CBO says House Speaker Nancy Pelosi’s drug pricing plan saves Medicare $345 billion over decade

November 18, 2019

NAELAeBulletin:  House Speaker Nancy Pelosi’s bill to lower prescription drug prices would save Medicare $345 billion over 10 years, according to a preliminary analysis from the nonpartisan Congressional Budget Office. 

The savings wouldn’t begin until 2023, assuming the bill gets passed by both the House and Senate and signed by President Donald Trump before the end of this year, the CBO said in the report released late Friday. The greatest savings would come in 2028 at $93 billion, according to the CBO, an independent agency that reviews congressional spending.

The CBO said the largest savings would come from the provision that allows Medicare to negotiate lower prices on as many as 250 of the most expensive drugs per year and apply those discounts to private health plans across the U.S. The legislation includes a penalty on pharmaceutical companies that refuse to negotiate or fail to reach an agreement with the U.S. government, starting at 65% of the gross sales of the drug in question.

The lower prices under the legislation would immediately lower current and expected future revenues for pharmaceutical companies, according to the CBO. The plan would also alter drug manufacturers’ incentives and have broad effects on the drug market, the CBO said.

“A manufacturer that was dissatisfied with a negotiation could pull a drug out of the U.S. market entirely, though CBO expects that would be unlikely for drugs already being sold in the United States,” CBO Director Phillip Swagel said in the report.

Current rules prohibit the Department of Health and Human Services from negotiating drug prices on behalf of Medicare — the federal government’s health insurance plan for the elderly. Private insurers use pharmacy benefit managers to negotiate drug rebates from pharmaceutical manufacturers in exchange for better coverage.

Pelosi and other House Democratic leaders had been working on the plan for months. The legislation is expected to move through House committees to a vote on the floor as soon as the end of this month.

Senate Finance Committee Chairman Chuck Grassley, R-Iowa, who is currently rallying support for a Senate drug pricing bill backed by Trump, praised Pelosi’s CBO score but noted that any bill that passes would likely need to be bipartisan.

“The legislation I authored with Ranking Member [Ron] Wyden [D-Ore.] strikes that balance and would achieve real progress for Americans,” Grassley said. “To date, it’s the only significant, bipartisan legislation to lower prescription drug prices that’s passed a congressional committee.”

He continued: “I urge my colleagues in the House and the Senate to get to work to lower costs while ensuring life-saving treatments can continue to be developed right here in America.”

High prescription drug costs have become a rare bipartisan issue, with lawmakers on both sides of the aisle demanding changes. Congress and the Trump administration are trying to pass legislation before the end of the year that would bring more transparency to health-care costs and, ultimately, lower costs for consumers.

Trump, who is seeking re-election, signed an executive order earlier this month that he said would improve private Medicare plans for seniors.

The order is intended to bolster Medicare Advantage, which is private Medicare insurance for seniors. It’s also intended to offer more affordable plan options, encourage wider use of telehealth services and promote wellness benefits, among other provisions.

The White House did not immediately respond to a request for comment on the CBO score.

Last month, Pelosi said she hoped to work with Trump on a bill to lower drug prices even after launching a formal impeachment inquiry the day before.

In response, Trump accused Pelosi of trying to distract voters from the Democratic impeachment inquiry.

Providing Medicare Beneficiaries with Complete, Objective Information to Help Them Make the Best Enrollment Decision

November 18, 2019

NAELAeBulletin: UPDATED FOR 2109
The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare have partnered once again on an education and outreach project to support Medicare beneficiaries and those who assist them enroll and re-enroll in Medicare. The Medicare Fully Informed Project provides a variety of unbiased, accurate and comprehensive information about the full range of Medicare coverage options, and includes an array of tools to assist in making the best individual enrollment choices.

Making Medicare coverage decisions is a complex task with multiple personal factors that must be taken into account. Beneficiaries need help in understanding all their complex options including all the pros and cons of traditional Medicare and private Medicare Advantage. They need to make fully informed choices given their likely health needs, personal and financial circumstances, and possible cost-sharing assistance. Our organizations and other beneficiary advocates have been concerned about the objectivity of some Centers for Medicare & Medicaid Services (CMS) enrollment materials. We hope to help fill some of the gaps.

In preparing for this project, we polled over 2,000 members of the National Committee to Preserve Social Security and Medicare in August 2018 in order to better understand Medicare beneficiaries, their unique needs, Medicare choices, and how we can better serve them. The responses helped us identify knowledge gaps and develop the suite of materials developed for this project. Key survey results that informed this project include:

    • 61% of respondents are in traditional Medicare
    • 54% of respondents make enrollment decisions through on-line research
    • Half of all respondents said they want more information about their enrollment choices
    • 77% receive the annual Medicare & You handbook from CMS
    • Less than half of respondents comparison shop between Medicare Advantage and Part D prescription drug plans
    • Only 13% changed their Medicare Advantage plan or Part D plans in the last year
    • 57% have one or more pre-existing health condition
    • 57% are not aware of Medicare’s Extra-Help program
    • Male respondents made up about 45%; female respondents comprised 54%
    • 54% live in suburban areas while 25% live in rural areas and 20% in urban areas

The results of the poll confirm that Medicare beneficiaries need additional, objective tools and information to make informed decisions about their Medicare options. They are also a diverse group who often face significant barriers when switching between plans or navigating these complex programs.

The goal of the Medicare Fully Informed Project is to help by providing a variety of educational tools for beneficiaries, and those who help beneficiaries, make enrollment decisions. We hope these various formats will help beneficiaries make fully informed Medicare and related health care coverage decisions. Project materials updated for 2019 include the following:

The 2020 Social Security Increase Will Be Smaller than 2019’s

November 18, 2019

The Social Security Administration has announced a 1.6 percent increase in benefits in 2020, nearly half of last year’s change. The small rise has advocates questioning whether the government is using the proper method to calculate the cost of living for older Americans and those with disabilities.

Cost-of-living increases are tied to the consumer price index, and a modest upturn in inflation rates and gas prices means Social Security recipients will get only a small boost in 2020. The 1.6 percent increase is lower than last year’s 2.8 percent rise and the 2 percent increase in 2018. The average monthly benefit of $1,479 in 2019 will go up by $24 a month to $1,503 a month for an individual beneficiary, or $288 yearly.

The cost-of-living change also affects the maximum amount of earnings subject to the Social Security tax, which will grow from $132,900 to $137,700.

For 2020, the monthly federal Supplemental Security Income (SSI) payment standard will be $783 for an individual and $1,175 for a couple.

The smaller increase may mean that additional income will be entirely eaten up by higher Medicare Part B premiums. The standard monthly premium for Medicare Part B enrollees is forecast to rise $8.80 a month to $144.30. According to USA Today, advocates are questioning the method used to calculate cost-of-living increases. The Bureau of Labor Statistics uses the Consumer Price Index for Urban Wage Earners and Clerical Workers to set the inflation rate. This method looks at prices for gasoline, electronics, and other items that younger workers rely on. The advocates suggest using a different index (the Consumer Price Index for Elderly) that puts greater emphasis on medical and housing expenses.

Most beneficiaries will be able to find out their cost-of-living adjustment online by logging on to my Social Security in December 2019. While you will still receive your increase notice by mail, in the future you will be able to choose whether to receive your notice online instead of on paper.

For more on the 2020 Social Security benefit levels, click here.

Medicaid’s Power to Recoup Benefits Paid: Estate Recovery and Liens

November 18, 2019

Federal law requires the state to attempt to recover the long-term care benefits from a Medicaid recipient’s estate after the recipient’s death. If steps aren’t taken to protect the Medicaid recipient’s house, it may need to be sold to settle the claim.

For Medicaid recipients age 55 or older, states must seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States also have the option of recovering all Medicaid benefits from individuals over age 55, including costs for any medical care, not just long-term care benefits.

There are a few exceptions. The state cannot recover from the estate of a Medicaid recipient who has a surviving spouse until after the spouse passes away. After the spouse dies, the state may file a claim against the spouse’s estate to recover money spent for the Medicaid recipient’s care. The state also cannot recover from the estate if the Medicaid recipient had a child who is under age 21 or a child who is blind or disabled.

While states must attempt to recover funds from the Medicaid recipient’s probate estate, meaning property that is held in the beneficiary’s name only, they have the option of seeking recovery against property in which the recipient had an interest but which passes outside of probate (this is called “expanded” estate recovery). This includes jointly held assets, assets in a living trust, or life estates. Given the rules for Medicaid eligibility, the only probate property of substantial value that a Medicaid recipient is likely to own at death is his or her home. However, states that have not opted to broaden their estate recovery to include non-probate assets may not make a claim against the Medicaid recipient’s home if it is not in his or her probate estate.

In addition to the right to recover from the estate of the Medicaid beneficiary, state Medicaid agencies may place a lien on real estate owned by a Medicaid beneficiary during his or her life unless certain dependent relatives are living in the property. The state cannot impose a lien if a spouse, a disabled or blind child, a child under age 21, or a sibling with an equity interest in the house is living there.

Once a lien is placed on the property, if the property is sold while the Medicaid beneficiary is living, not only will the beneficiary cease to be eligible for Medicaid due to the cash from the sale, but the beneficiary would have to satisfy the lien by paying back the state for its coverage of care to date. In some states, the lien may be removed upon the beneficiary’s death. In other states, the state can collect on the lien after the Medicaid recipient dies. Check with your attorney to see how your local agency handles this.

There are some circumstances under which the value of a house can be protected from Medicaid recovery. The state cannot recover if the Medicaid recipient and his or her spouse owned the home as tenants by the entireties or if the house is in the spouse’s name and the Medicaid recipient relinquished his or her interest. If the house is in an irrevocable trust, the state cannot recover from it.

In addition, some children or relatives may be able to protect a nursing home resident’s house if they qualify for an undue hardship waiver. For example, if a Medicaid recipient’s daughter took care of him before he entered the nursing home and she has no other permanent residence, she may be able to avoid a claim against his house after he dies. Consult with your attorney to find out if the undue hardship waiver may be applicable.

Don’t Let Medicare Open Enrollment Go By Without Reassessing Your Options

November 18, 2019

Medicare’s Open Enrollment Period, during which you can freely enroll in or switch plans, runs from October 15 to December 7. Don’t let this period slip by without shopping around to see whether your current choices are the best ones for you.

During this period you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

According to the New York Times, few Medicare beneficiaries take advantage of open enrollment, but of those that do, nearly half cut their premiums by at least 5 percent. Even beneficiaries who have been satisfied with their plans in 2019 should review their choices for 2020, as both premiums and plan coverage can fluctuate from year to year. Are the doctors you use still part of your Medicare Advantage plan’s provider network? Have any of the prescriptions you take been dropped from your prescription plan’s list of covered drugs (the “formulary”)? Could you save money with the same coverage by switching to a different plan?

For answers to questions like these, carefully look over the plan’s “Annual Notice of Change” letter to you. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks.

Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals’ personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited. If you think you’ve been a victim of fraud or identity theft, contact Medicare.

Here are more resources for navigating the Open Enrollment Period:

  • Medicare Plan Finder, which helps you find a plan to match your needs: www.medicare.gov/find-a-plan
  • Medicare coverage options: https://www.medicare.gov/medicarecoverageoptions/
  • The 2020 Medicare & You handbook, which all Medicare beneficiaries should have received. The handbook can also be downloaded online at: medicare.gov/forms-help-resources/medicare-you-handbook/download-medicare-you-in-different-formats
  • The Medicare Rights Center: www.medicareinteractive.org
    Your State Health Insurance Assistance Program, which offers independent counseling: https://www.shiptacenter.org