Fong Law Group

Getting Medicare Food Benefits

As people age, accessing healthy meals can become more challenging. According to Feeding America, one in five older adults was food-insecure in 2020. Some older adults struggle with affording healthy foods, whereas others have difficulty going to the grocery store and preparing meals when recovering from an illness or injury.

Although original Medicare does not offer food benefits, some Medicare Advantage plans provide a grocery allowance or cover meal delivery. Some programs also include nutrition education and cooking classes.

Certain Medicare Advantage plans may provide Part C food benefits in addition to Part A hospital, Part B medical, and Part D prescription drug coverage. They may also supply vision, dental, and hearing coverage. The Medicare Advantage plans available to you depend on your state.

Medicare Advantage

Medicare Advantage differs from traditional Medicare, as private companies contract with Medicare to offer Medicare Advantage plans. Plans vary, and finding insurance that fits your unique needs is essential.

Potential enrollees should also be wary of predatory marketing practices and evaluate their options before committing to a plan. Even if you qualify for a Medicare Advantage plan with food benefits, traditional Medicare could be a better option for you, depending on your circumstances.

Special Needs Plans

Special needs plans, which tailor membership to beneficiaries who meet specific criteria, offer grocery and meal benefits options.

Qualifying for grocery benefits through a special needs plan generally requires an individual to have an underlying condition. Examples of conditions that can qualify a person for Medicare Advantage food benefits include diabetes, cancer, heart disease, kidney disease, end-stage renal disease, arthritis, an autoimmune disorder, and obesity.

Grocery Benefits

When Medicare Advantage plans have grocery benefits, they typically give beneficiaries a card that they can use to check out at approved stores like Kroger and Walmart.

The benefits only cover whole foods such as vegetables, legumes, meat, and dairy, as well as pantry staples and water. Only covered food items can go on the card. Enrollees must pay out of pocket for soda, baked goods, and processed foods like chips.

Meal Delivery Services

Instead of grocery benefits, some Medicare Advantage Part C plans cover meal delivery services. Meal delivery services can benefit those who face challenges getting to the grocery store and preparing meals. A service must meet Medicare’s nutritional guidelines for Medicare Advantage to cover it.

Many Medicare Advantage plans only supply meal delivery for a set period. This type of plan can suit those discharged from a hospital or skilled nursing facility who only need help with meals for a set time.

Less common is long-term meal delivery coverage for those homebound with chronic medical conditions.

Other Meal Delivery Options

For older adults who do not qualify for a special needs program with meal benefits or who do not elect to enroll in original Medicare, alternative meal resources are available.

• Meals on Wheels is a federally funded meal delivery program for people aged 60 and above who meet location-specific eligibility requirements.
• You use the Administration for Community Living’s Elder Care Locator to find meal delivery organizations.

Speak with your attorney to access your options before selecting a Medicare Advantage program with grocery or meal benefits.

What You Need to Know About Medicaid’s Personal Needs Allowance

Seniors who rely on Medicaid and live in nursing homes receive a personal needs allowance — a monthly stipend the Medicaid recipient can use to pay for needs that Medicaid does not cover. Medicaid restricts the amount of the allowance and how it is used. If recipients do not use all the money they received in a month, they may risk losing their coverage.

What Can I Buy with My Personal Needs Allowance?

The items a Medicaid recipient can buy with their personal needs allowance are limited to things that Medicaid does not cover. A recipient can buy vitamins, hair care, snacks, clothing, and other personal-use items. However, since the nursing home facility is required to cover toiletries, the personal needs allowance generally cannot be spent on those types of items.

How Much Money Do I Get for My Personal Needs Allowance?

The Medicaid personal needs allowance has not adjusted for inflation for more than 30 years. In the 1980s, the federal government increased the Medicaid personal needs allowance to a minimum of $30 per month, which has not increased since. The monthly amount Medicaid recipients receive for their expenses varies from state to state. For example, in California, Medicaid recipients get $35 per month while senior citizens in Alaska receive $200 per month.

Am I Allowed to Manage My Personal Needs Allowance Funds?

The recipient may manage their funds. Those who are unable to manage their own money can have a guardian or the nursing home take charge of their personal needs allowance.

If the nursing home where the recipient resides manages their personal needs allowance, the facility must provide an accounting for how it spent the money. Medicaid prohibits the nursing home from using the money on anything that Medicaid provides.

Guardians can manage the recipient’s personal needs allowance on their behalf. The guardian is held to the same standards as the nursing home where the recipient resides and so must provide an accounting, usually some itemization of expenses.

What Happens If I Don’t Spend the Entire Allowance in a Month?

A recipient is not required to spend their entire allowance each month. Sometimes the money accumulates. However, recipients should be careful if they regularly do not spend all the money. Any money from the personal needs allowance a recipient does not spend is deemed an asset. Medicaid limits the value of assets that recipients are allowed to have, and if the recipient accumulates more assets than allowed, they may lose Medicaid eligibility. The Medicaid asset limit for 2022 is $2,000 in most states.

Resources for Caregivers of Older Adults with Dementia

Every year, 16 million people in the United States care for family and friends with dementia, the Centers for Disease Control and Prevention reports. Caregivers of people with dementia provide care for longer durations than those who assist individuals with other conditions. They also have comparably higher risks for anxiety, depression, and reduced quality of life. One-third of caregivers of elders with dementia are older adults themselves.

Although caring for people with dementia can be challenging, a variety of resources can help caregivers assist their loved ones. Apps, devices, activity subscription services, caregiver training, and online resources can aid caregivers with their responsibilities, providing valuable information, structure, and support.

Technology for Caregivers of People With Dementia

Research suggests that technology may benefit people caring for those with dementia, alleviating some of the stress associated with caregiving. Technology should be inexpensive, scalable, and user-friendly to be effective. Among the numerous mobile apps and wearable devices available today are the following:

• Carely — Carely is a free, easy-to-use smartphone app for caregivers. The app facilitates care coordination, connecting families, friends, and healthcare providers. App users can share information about the daily schedule of an older adult with dementia as well as organize appointments and activities on the app’s calendar. Fostering communication between loved ones and caregivers, Carely promotes more companionship for older adults and seeks to lessen families’ stress.
• Care Predict — Individuals with cognitive decline may wear devices that keep loved ones informed about how they are doing. Care Predict provides this kind of technology, recording wearers’ daily patterns, such as how long they spend in bed or in the kitchen and revealing possible health issues family members may otherwise miss. For instance, spending all day in bed could indicate depression or other physical health issues.
  
  CarePredict’s Care Circle App alerts family members of changes and potential concerns. For example, when people living with dementia are at risk for falls, the technology notifies family members, and when falls occur, individuals can use the wearable device to contact family.
  
  The service requires an initial fee for the CarePredict™ @Home device plus a monthly subscription fee.

Activities for Dementia Patients and Loved Ones

Whereas tools such as wearable devices may support the health and safety of individuals with dementia, enrichment activities can also be beneficial. Engaging individuals with dementia promotes higher life satisfaction and better connections with family, friends, and other caregivers.

Caregivers looking to find things to do with their loved ones may subscribe to Connectivities, a monthly subscription box with activities for adults with dementia. Each kit contains eight activities with written and digital instructions, as well as exercise and music therapy videos.

Information for Caregivers

When their loved ones receive a dementia diagnosis, families may feel overwhelmed. Many resources can help those caring for people with dementia learn about the disease and caregiving strategies.

• The Savvy Caregiver is a free, nationally recognized training program for family members of people with dementia. The main program has six weekly two-hour video sessions — available in person or online. Those who have completed the training course reported less depression and distress.

The course covers:

• Understanding dementia diseases
• The elements of cognition
• Confusion in dementia
• Caregiver self-care
• Dementia’s progression
• Methods for helping with daily activities
• Decision making
• Community resources
• Family support

• Individuals caring for people with dementia can make an account on the Family Caregiver Alliance website, which provides a dashboard with resources all in one place and a list of services by state.
   
• The Alzheimer’s Association offers information specific to Alzheimer’s disease, which 50 percent to 80 percent of adults with dementia have.

Savings for Seniors: Lower Medicare Part B Premiums in 2023

For the first time in more than 10 years, Medicare Part B enrollees will see some of their costs decline. In an announcement issued by the Centers for Medicare and Medicaid Services (CMS), the agency outlined changes to the premium, deductible, and co-payment amounts for numerous Medicare costs taking effect in 2023.

• Medicare Part B basic monthly premium = $164.90 = Savings of about $62 for the year
   
• Medicare Part B annual deductible = $226 = Savings of $84 for the year
   
• Other amounts, meanwhile, will rise slightly in 2023:
   
  • Medicare Part A deductible = $1,600 (up from $1,556)
  • Co-payment for hospital stay, days 61 to 90 = $400 per day (up from $389)  
  • Co-payment for hospital stay, days 91 and beyond = $800 per day (up from $778)
  • Co-payment for skilled nursing facility, days 21 to 100 = $200 per day (up from $194.50)

Note that beneficiaries with higher incomes pay higher monthly premiums. For further details, read the news release from CMS.

If you wish to make changes your coverage, Medicare’s Open Enrollment Period will take place October 15 through December 7. 

Comparing Traditional Medicare and Medicare Advantage

Recent research by the Kaiser Family Foundation examined the differences between traditional Medicare and Medicare Advantage. While people in either program were similarly satisfied with their care and overall care coordination, some distinctions became apparent.

Traditional Medicare’s Strengths

Traditional Medicare is a federal health insurance program for adults 65 and older and individuals with disabilities. Medicare Part A covers hospital fees, Part B applies to medical expenses, and Part D involves prescriptions.

The Foundation reviewed 62 studies released since 2016. The research findings revealed the following:

• Beneficiaries of traditional Medicare were more likely to receive cancer care in higher-quality hospitals.
• They also tended to get superior care in skilled nursing facilities and home health agencies compared with their Medicare Advantage counterparts.
• Traditional Medicare recipients may be less likely to have problems related to expenses.

Findings on Benefits of Medicare Advantage

Medicare Advantage is an alternative to traditional Medicare. It offers plans encompassing Part A hospital fees, Part B medical expenses, and Part D medicine. In some cases, the cost of Medicare Advantage can be lower, but not always. Privately owned companies contract with Medicare to provide Medicare Advantage.

According to the study:

• Some research indicated that Medicare Advantage had slightly better preventive services, providing increased access to routine health checkups, screenings, and vaccinations.
• Patients with Medicare Advantage were more likely to have a consistent health care provider.
• Medicare Advantage had lower hospital readmission rates, received more information during care transitions, and had more favorable experiences getting prescription drugs.

Switching Rates

The researchers looked at the rates at which people switched programs as a way of understanding program dissatisfaction. Medicare Advantage had a higher switching rate relative to traditional Medicare. Yet both had a low turnover, possibly suggesting that people tended to be satisfied with both programs.

Switching from Medicare Advantage to standard Medicare was more common among:

• people of color
• residents of rural areas
• those eligible for both Medicare and Medicaid
• individuals who experienced a health impairment that affected their daily functioning

Cost Issues

Beneficiaries of traditional Medicare reported higher rates of cost difficulties than enrollees in Medicare Advantage. Yet recipients of conventional Medicare with supplemental coverage had the lowest rates of expense complaints overall.

Seek Professional Guidance

Since each plan’s benefits and drawbacks can depend on individual circumstances, consider speaking to your elder law attorney before enrolling. They can explain the differences between these programs and help you plan for retirement.

What Are Medicaid Asset Protection Trusts?

Medicaid imposes strict rules on how much money and assets an applicant can have. To qualify for Medicaid, you must fall under the asset limit, which is $2,000 in most states.

Even with greater than $2,000 in assets, however, you may be able to get on Medicaid by establishing a Medicaid Asset Protection Trust (MAPT). When you put your assets in a MAPT, Medicaid will not count the money in the trust toward its resource limit.

Using Medicaid Asset Protection Trusts to Transfer Assets

After you create a Medicaid Asset Protection Trust, you no longer own the assets within it, allowing you to qualify for Medicaid following the five-year lookback period. People who are currently healthy but plan to go on Medicaid in the future might choose to use this Medicaid planning strategy.

It is essential to understand that MAPTs are irrevocable: Once you make the trust, you cannot change your mind and take those assets back. Your trust must be irrevocable for you to qualify for Medicaid because it means that you no longer own or control these assets.

In contrast to MAPTs, many types of revocable trusts, such as family trusts, are often ineffective in preparing for Medicaid. Having the power to revoke your trust would allow to retain control over your assets, and Medicaid would count the contents of your trust as part of your resources.

Creating a Medicaid Asset Protection Trust

Three parties are involved in a MAPT: the grantor, the trustee, and the beneficiary. When you make a trust, you become the grantor, the person who places assets into the trust. The trustee manages the trust, and the beneficiary — or beneficiaries — will receive your assets.

If you want your MAPT to ensure you qualify for Medicaid, you must name someone other than yourself or your spouse as the beneficiary. Designating yourself as the beneficiary would mean giving yourself assets, which Medicaid would count toward its asset limit.

You can, however, select your children or parents as beneficiaries. Using a MAPT, you can also make sure they get those assets when you pass away.

What Can You Place in a Medicaid Asset Protection Trust?

As part of your Medicaid planning strategy, you can place many types of assets in a MAPT, including:

• Checking and savings accounts
• Stocks and bonds
• Mutual funds
• Certificates of deposit
• Real estate that is not your primary residence
• In most states, your home

Although many states allow you to place your home in MAPT so that it will not count toward Medicaid’s resource limit after five years, Medicaid regulations vary by state. In Michigan, for example, placing your home in a MAPT will not prevent it from counting toward the asset limit.

Benefits and Drawbacks of Medicaid Asset Protection Trusts

Medicaid Asset Protection Trusts offer several benefits to individuals planning to apply for Medicaid:

• MAPTs preserve generational wealth, safeguarding assets for family members.
• After you pass away, the state cannot take your assets from your beneficiaries to reimburse them for your long-term care, as MAPTs avoid probate.
• Since nursing home fees can be exorbitant, MAPTs can save your family money, as they let you qualify for Medicaid once the lookback period has ended.

The drawbacks of MAPTs include the following:

• Once you establish a MAPT, you forfeit the control and use of your assets. If you need money, you will not be able to draw from the trust.
• The fees associated with preparing a MAPT can be costly, ranging from $2,000 to $12,000.

Speak with your attorney to learn about how using a Medicaid Asset Protection Trust could help you plan for your future.

Majority of Adult Children Cannot Support Boomer Parents, Surveys Find

A recent survey by the American Advisors Group (AAG) finds that 55 percent of adult children say they are not financially prepared to help their Baby Boomer parents cope with rising inflation and living expenses.

“Americans want to see their parents age with grace and dignity and have the resources they need to live comfortably, but for many families the current economy is making that difficult,” AAG Chief of Marketing Martin Lenoir said in a news release.

AAG surveyed more than 1,500 adult children, ages 40 to 55, across the country. Known as the “sandwich generation,” this group faces the responsibilities not only of raising their children, but also of serving as caregivers for their aging parents.

Among the survey’s other key findings:

• More than a third of adult children say they worry that their parents will become a financial burden for them.
• Nearly 60 percent say they cannot afford any kind of professional elder care for their parents.
• Yet almost half admit they have never broached the subject of finances with their senior parents.
• A full 50 percent of them do not know how much debt their parents are carrying.

1 in 3 Adult Children Already Assisting Their Parents Financially

Another survey, conducted in 2020 by GoHealth, Inc., explored GenXers’ and millennials’ involvement in their parents’ financial and health care needs. It found that one in three GenXers and millennials are supporting their parents financially. Nearly the same number are managing, or helping to manage, their parents’ health care.

The survey’s 2,000 GenX and millennial respondents also reported the following:

• On average, they spend 11.5 hours per week managing their parents’ health care by providing transportation, scheduling doctor visits, and explaining insurance claims. They also estimate they’ll spend 14 to 16 years continuing to do so.
• 2 in 5 spent more than $10,000 of their own money supporting their parents in 2020.
• The vast majority (86 percent of GenXers and 82 percent of millennials) worry about having enough money to support themselves and their parents.

Squeezing the Sandwich Generation

Adult children will continue to feel the pressure for the foreseeable future. Every day, on average, 10,000 Boomers (those born between 1946 and 1964) reach age 65, and another 10,000 of them turn 75. According to research by the Blackstone Group, an independent research firm, nearly 80 percent of middle-income Boomers do not have any savings designated to cover their retirement care.

Meanwhile, 30 million Boomers retired from the workforce amid the COVID-19 pandemic. Saddled with college debt, as well as rising inflation and housing costs, those GenXers and millennials who still depend on their parents for financial assistance or housing may no longer be able to count on that support.

Have ‘The Talk’

It’s important for families to have an honest and respectful financial conversation before a medical event occurs or the need for care arises. Talking about money with aging parents can be a delicate matter, but it’s necessary to understand both the degree of care that may be needed and the financial resources available to provide it.

For help planning for the future of your Boomer parents, or for your GenXer and millennial children, consult your attorney.

Can a Nursing Home Hold Friends or Family Members Responsible For a Resident's Care?

If your loved one is entering a nursing home, you may worry whether you could be liable for their care. Under federal law, a facility cannot require a family member or friend to co-sign an admission agreement and take on personal liability. However, nursing homes around the country still try to do so, and often these matters end up in court.

What can you do to prevent this from happening to you? It starts with educating yourself on what is and is not allowed.

A law known as the Federal Nursing Home Reform Law prohibits a nursing home or facility from requiring or asking for a financial guarantee from a third party. Federal regulations regarding Medicare and Medicaid have similar restrictions.

These laws and regulations state that a home cannot have a resident’s family member or friend co-sign an admission agreement to take on financial liability. However, a nursing facility may obtain the signature of the resident’s agent, who has access to the resident’s income or assets, agreeing to use these resources to pay for care. Still, this agreement may not impose personal financial liability on the agent.

Review Before You Sign

If you are assisting a loved one with entering a nursing home, you should carefully review all the admission paperwork before you sign it. Many facilities have unscrupulous practices of using admission agreements that violate federal law or regulations.

You do not have to sign or “volunteer” to sign a financial guarantee that makes you personally responsible. It is incorrect if a nursing home claims a guarantee is necessary because the federal law only applies to Medicaid-eligible individuals. Nursing homes are also not allowed to condition admitting or keeping a person on receipt of a third-party guarantee.

Today, the most common tactic used by nursing homes is an admission agreement that obligates the signor as an agent with supposed control over the resident’s money. These agreements stipulate the agent will apply these resources to the nursing home expenses and apply for Medicaid on the resident’s behalf. Often, the person signing this document doesn’t know how to handle this situation, does not have this control, or makes mistakes in the resident’s Medicaid application, causing coverage to be denied.

What follows may be a lawsuit by the nursing home, claiming the agent violated their duties in the agreement and must pay the care costs. Courts have gone both ways on whether these agreements are enforceable, and the agent’s conduct often influences a court’s decision. Egregious conduct can lead to courts ruling in favor of the nursing home. An example is where an agent used the resident’s money for luxury items or other people’s expenses rather than their loved one’s care.

Plan Ahead As Much As Possible

The best action is to plan before nursing home care is necessary. This can put you or your loved ones in a position to be ready to apply for Medicaid should the need arise. At the same time, an aging individual can do proper asset protection planning and avoid look-back periods creditors could otherwise exploit against the resident or an agent.

However, this is not always possible for many older adults and their family members. Individuals who will take on the responsibility of being an agent should understand what this entails and seek the advice of your elder law attorney before starting the admission process.

How Much Long-Term Care Insurance Should You Purchase?

Long-term care insurance helps you prepare for financial costs associated with aging, such as nursing home care, assisted living, or in-home care. Yet long-term care insurance policies vary widely in terms of the amount of coverage and how long the protection lasts.

The Average Costs of Care

The 2021 Genworth cost of long-term care survey provides national median monthly costs for the following:

• Nursing home care = $9,034 (private room); $7,908 (semi-private room)
• Adult day health care = $1,690
• Assisted living = $4,500
• Homemaker services = $4,957
• Home health assistance = $5,148

Whether you have a health condition that you know will require care in a skilled nursing facility or prefer to prepare for unexpected medical events, you may consider purchasing a certain amount of long-term care insurance to account for future care.

Evaluate which services you expect to need. Although many individuals need nursing home care, others can avoid nursing home costs by combining assisted living services with in-home care or day health services.

How to Calculate Your Monthly Benefit

Most policies provide between $2,000 and $10,000 of funds per month. To estimate how much long-term care insurance you will need:

1. Review how much you can expect to spend on long-term care.

2. Subtract the cost of services from the amount of money you can budget toward your long-term care expenses; the remainder is the amount you need long-term care insurance to cover.

Suppose you have a monthly income of $2,500 and plan to move into an assisted living facility that costs $4,500 per month. In that case, you will need a minimum of $2,000 per month in long-term care insurance to cover the cost of assisted living.

In addition to determining how much coverage you need each month, think about how long you want your plan to last. Long-term care insurance that lasts longer can be relatively more expensive, yet it provides increased protection.

The Department of Health and Human Services states that most people need long-term care by age 65. The majority of people need care for two years, but 20 percent require care for longer than five years. Most people should obtain at least two years of coverage and contemplate purchasing additional coverage.

Medicaid Planning

As you plan for your future, consider purchasing long-term care insurance that protects you for five years if you intend to apply for Medicaid. Since the Medicaid lookback period is five years, you may transfer your assets to your family and begin to spend down your assets so that you can qualify for Medicaid after your five-year coverage ends. After five years on private insurance, you may be able to transition to Medicaid.

The amount of long-term care insurance you buy should fit your unique circumstances. 

Speak with your attorney to learn more about preparing for your future with long-term care insurance.

Be Cautious of Generic Health Care Proxy Forms

Doctors, nurses, and hospital staff work hard to care for their patients when they are sick or hurt. However, even when a procedure is done to save a patient’s life, a hospital cannot act without patient consent. If a patient cannot speak for themselves and express their wishes, the hospital relies on what is known as a health care proxy form.

If you have ever been admitted to the hospital, you have likely been asked to sign a health care proxy form. Hospitals use proxy forms to obtain consent in advance from patients in case they become incapacitated and medical professionals need to administer medication, perform surgery, or otherwise treat the patient. However, the generic version used by most hospitals can fall short for many patients and may infringe upon their autonomy. Always be cautious when you sign a boilerplate document.

What Is a Health Care Proxy?

A health care proxy is a form that a patient uses to name an agent who will carry out their wishes regarding medical care if the patient cannot speak for themselves. Having a health care proxy specifically tailored to your needs can be important. For example, you can outline what kind of treatment you do — or do not want — if you become terminally ill or are in a coma; at the same time, you can indicate other wishes, such as whether you would want pain medication administered or your organs donated.

The agent only has the power to make decisions on the patient's behalf once a doctor confirms that the patient requires medical attention but cannot advocate for themselves. The agent's power ends when the patient can once again state their treatment preferences. Appointing an alternate agent is a good idea, too.

What Is the Problem with Signing a Generic Health Care Proxy?

A health care proxy is important because it instructs your agent to speak for you and, if well-written, it will give specific instructions about what medical treatments you want and which treatments you refuse. An estate plan is not complete unless it includes a health care proxy form.

The problem with relying on the generic health care proxy form the hospital provides is that, in some cases, these forms will not take your individual wishes into account. Every person treated at the emergency room or admitted into the hospital signs the same health care proxy form. Anything that could have a life-or-death consequence should be tailored to you and specifically address your needs.

If you have a health care proxy, inform the hospital staff so they can make the document a part of your medical record.

How Can I Complete My Own Health Care Proxy?

Part of creating an estate plan is having a health care proxy drafted. If you have not created an estate plan or health care proxy, contact your attorney to draft the estate planning documents that you need.