Fong Law Group

Medicare Part B Premiums, Deductibles Going Back Up in 2024

In 2023, seniors were happy to see their Medicare Part B standard monthly premiums and annual deductibles go down for the first time in more than a decade. Unfortunately, that’s not the case for 2024, when these charges will be back on the rise.

In the fact sheet it released about the updated numbers, the Centers for Medicare & Medicaid Services (CMS) outlined the following changes for 2024:

Medicare Part B Changes

Medicare Part B enrollees will pay a standard monthly premium of $174.70 come 2024 (up $9.80 from $164.90 in 2023). (Note that beneficiaries who have higher incomes typically have a higher premium.)

The Part B annual deductible is rising to $240 in 2024 (an increase of $14 from $226 in 2023). Part B enrollees must cover all costs until they meet this deductible; Medicare then pays for most of the remaining fees.

Medicare is a federal health insurance program for seniors and people with qualifying disabilities. Medicare Part B specifically focuses on covering such services as medically necessary visits to doctors, outpatient medical treatments, ground ambulance transport, and preventative care, including vaccines. 

Updates to Medicare Part A Charges

The deductible for Medicare Part A will also see a slight increase, about 2 percent, from $1,600 in 2023 up to $1,632 in 2024. Note that most people end up paying no premium for Part A because they (or their spouse) paid Medicare taxes throughout the years they were employed.

Part A relates to medical care in institutions such as inpatient hospitals and skilled nursing facilities, in addition to other settings. If you’re an enrollee and are admitted to a hospital, Medicare Part A will pay for your expenses for the first 60 days, after you pay your deductible. If you go to a skilled nursing facility, Part A covers the first 20 days. After that, you’ll have the following co-pays:

• Co-payment for hospital stay, days 61 to 90 = $408 per day in 2024 (up from $400 in 2023)
   
• Co-payment for hospital stay, days 91 and beyond = $816 per day in 2024 (an increase from $800 in 2023)
   
• Co-payment for skilled nursing facility, days 21 to 100 = $204 per day in 2024 (up from $200 in 2023)

Medicare Open Enrollment

Each fall, from October 15 to December 7, Medicare’s Open Enrollment Period takes place. During this time, you can enroll in a plan or make changes to your existing plan.

Homelessness Among Seniors a Growing Crisis, Say Experts

Homelessness rates are rising among people aged 65 and over. In addition to the dangers unhoused people face on the street, there are exponential effects on their access to health care.

Barriers to accessible housing mean that more seniors are exposed to deadly medical conditions and are less likely to receive the preventative care they need to treat existing chronic health care issues.

Older People Experiencing Homelessness

People over age 65 are a part of a vulnerable population. They experience higher rates of chronic diseases, lack access to preventative care, and are more likely to struggle to get nutritious food. Housing insecurity exacerbates these problems, and a snowball effect leads to a greater chance of adverse health outcomes.

The number of seniors experiencing homelessness is expected to continue to grow over the next decade. A 2019 study published by the National Alliance to End Homelessness focused on senior populations in three major American cities: New York, Boston, and Los Angeles. Studying these populations helped experts predict the increase in homelessness rates among seniors, the causes and effects of housing insecurity among older people, and what subgroups need in order to eliminate homelessness.

According to the research findings, the rates of homelessness among seniors aged 65 and older in each city studied have increased yearly since 2011.

Number of Unhoused Seniors in Cities Included in the Study

In each of the cities studied, the number of older people who face homelessness or housing insecurity is projected to grow exponentially.

• New York City – The number of unhoused adults older than 65 living in New York was 2,600 in 2017. The rate of homelessness among seniors in New York may grow to 6,900 by 2030.

• Boston – In 2017, 570 seniors experienced housing insecurity or homelessness. By 2030, that number is expected to increase to 1,560.

• Los Angeles County – The number of people experiencing homelessness in Los Angeles is staggering. The city has a reputation for high rates of homelessness. In 2015, the city reported 4,700 unhoused seniors. By 2030, the number of seniors experiencing homelessness is forecasted to reach 13,900.

Reported Causes of Homelessness Across the Baby Boomer Generation

The Baby Boomer generation has lived through its share of economic instability. Multiple recessions, increasing inflation, and rising housing costs may be among the culprits for the financial crises facing this group. Meanwhile, a lack of a solid social safety net has left seniors vulnerable to housing insecurity as they age.

Lack of Housing and Adverse Health Consequences Among Seniors

There is undoubtedly a connection between homelessness and health outcomes. Cost and access to health care are both affected by housing status. Stable and affordable housing increases the chances of positive physical and mental health outcomes.

Homelessness is a public health issue. People experiencing homelessness will likely experience a higher rate of health problems, including:

• Tuberculosis
• Alcohol and drug abuse
• HIV infection

The increased rates of health problems among unhoused people are usually the result of several factors, including limited access to social services, inadequate food, no protection from the elements, and other barriers to health care.

Supportive Housing in Ending Homelessness

Policymakers share the responsibility to end homelessness and mitigate its effects. The country’s leaders have legal and policy interventions to consider in addressing homelessness.

Supportive housing may be one possibility that can help lower the cost of health care while getting and keeping people in affordable homes. Supportive care includes providing unhoused people with affordable housing options plus coordinated social services. These social services may be designed to help individuals and families gain access to:

• Food
• Medical care/insurance coverage
• Substance abuse and mental health services
• Financial support

Easing the burden that older adults face when deciding between maintaining housing and paying for health expenses will decrease the homelessness rate among this demographic. The removal of stress caused by housing instability allows seniors to focus on treating their health conditions, thereby improving survival rates and quality of life.

Increased funding to state Medicaid/Medicare programs and managed care organizations may be part of the solution. These programs pay for support services like the ones listed above, as well as tenants’ rights and responsibility training, eviction prevention, and housing location services.

Affordable Housing Options for Seniors

Closing the housing affordability gap is essential to improving health outcomes for seniors. If you are starting the search for affordable housing options for seniors, consider connecting with your attorney.

How Intermediate Care Facilities Can Serve Older Adults

Many older adults can no longer safely live on their own. However, they may not need the highly specialized care of nursing homes. Intermediate care facilities present one option for older adults who cannot live independently but require daily assistance.

As a residential option for seniors, intermediate care facilities (ICFs) can house residents on a long-term basis. Residents can get help with activities of daily living and managing medical conditions. For instance, staff can help with:

• Bathing
• dressing
• meal preparation
• bathroom use
• getting in and out of a wheelchair
• taking medication
• monitoring residents’ medical conditions

Intermediate care facilities initially focused on meeting the needs of those with cognitive disabilities and chronic illnesses. However, they have adapted to serve older adults as well, according to FindContinuingCare.com. Some facilities run independently. Others are part of larger establishments, as when they comprise units housed within such facilities as continuous care retirement communities.

Moderate Medical Care

Even though ICFs offer health supervision and nurses, they are not at the same level as a skilled nursing facility. While residents may receive periodic health care assessments and rehabilitative services, ICFs do not offer medical care for severe conditions.

Since intermediate care facilities provide moderate, custodial care, they can be appropriate for those transitioning between different levels of care. For example:

• Residents who develop more complex health needs can move on to skilled nursing facilities better suited to meet their medical needs.
• Those residing within a continuous care community can transition to an ICF unit should their health decline.
• In some cases, older adults recovering from hospitalization may reside in ICFs until they can regain independence and return home.

The Benefits of an Intermediate Care Facility

• Level of Assistance. Many older adults prefer to remain in their homes and receive in-home care as they age. Yet sometimes they may require more consistent help. In intermediate care facilities, individuals can obtain round-the-clock assistance.
   
• Cost Savings. One reason people choose intermediate care is that it is relatively less expensive than other options, such as assisted living. Since residents do not typically get their own apartments, the room and board fees can be smaller than in assisted living.
  
  And in addressing the individual needs of residents, intermediate care facilities limit assistance to what residents require, further lowering costs.
   
• Care Options. ICFs also offer a range of care options. Intermediate care facilities can serve those who need extensive help with daily living as well as those who require aid in a few areas. Individuals receiving different degrees of care can live together in the same environment.
   
• Flexibility. Support can also adapt as residents’ needs change. For example, an older adult may move into an intermediate care facility for assistance with meals and medication management. If they then develop mobility challenges, they can get additional help; ICF staff monitor and respond to the person’s needs.

Talk to Your Attorney

For those concerned about requiring consistent aid with daily living as they age, intermediate care facilities can be an option. Speak with your attorney today to learn more.

Medicare Extra Help Program Set to Expand in 2024

Seniors and disabled citizens will receive more access to the Medicare Extra Help Program as of the beginning of 2024, the federal government announced. This expansion of benefits could enable up to 3 million people to reduce their prescription drug costs.

What Is the Medicare Extra Help Program?

The Medicare Extra Help Program assists older adults and people with disabilities who have trouble paying their Medicare Part D premiums. Note that you are automatically eligible for Extra Help if you:

• receive Medicaid coverage,
• are enrolled in a Medicare Savings Program, or
• receive Supplemental Security Income.

The program was expanded through the Inflation Reduction Act, which President Biden signed in August 2022, by increasing the income limit to 150 percent of the poverty level ($21,870 for an individual and $45,000 for a family of four). When the program expands at the beginning of 2024, 300,000 participants will go from partial to full benefits. That means they will not have to pay a premium or deductible, and they will have lower, fixed co-payments on certain medications.

Expanding Access to the Program

The government estimates that nearly 3 million people who could benefit from the program are not currently enrolled. The Department of Health and Human Services will activate government agencies to increase participation. The Administration for Community Living will reach out to underserved and rural communities, while the Centers for Medicare and Medicaid Services will provide an outreach toolkit for community organizations and beneficiary advocates.

Those who participate in the Medicare Extra Help Program could save nearly $300 per year.

Where Do I Apply for Extra Help?

To apply for Extra Help, you can visit the Social Security Administration’s dedicated webpage for more information, support, and an online application.

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

On Medicare? What You'll Pay for Now That the PHE Has Ended

The Biden administration officially ended the COVID-19 Public Health Emergency on May 11, 2023. Certain policies that were implemented in early 2020 during the public health emergency will now expire. As a result, seniors are among those who may see some of the health care costs related to COVID-19 change. Other health care services may or may not be affected, depending on what type of coverage you have.

Here are some of the highlights:

If You Are Enrolled in Original Medicare

• With the end of the COVID-19 public health emergency, you will likely have to pay for:
  • At-home and over-the-counter COVID tests
  • Care in a skilled nursing facility if you have not first spent at least three days in a row admitted to a hospital (Note that being “under observation” at a hospital is not the same as being “admitted.”)
• You generally will not have to pay for:
  • Laboratory COVID tests ordered by a health care provider, if you have Medicare Part B (Note that you may have to pay for part of the cost for your visit to the health care provider’s office)
  • COVID vaccines and boosters from a health care provider who takes Medicare
  • COVID oral antiviral treatments such as Paxlovid
• Other considerations
  • In most cases, you will continue to have access to telehealth services from home through the end of 2024
  • With the end of the public health emergency, Medicare beneficiaries with Part D coverage may no longer receive three-month supplies of prescription medications

If You Are a Medicare Advantage Member

• Now that the public health emergency has ended, you may have to pay at least part of the cost for:
  • At-home and over-the-counter COVID tests
  • Laboratory COVID tests ordered by a health care provider, including part of the cost of your visit to the health care provider’s office
  • Visits to out-of-network physicians
• You will not have to pay for:
  • COVID vaccines provided by an in-network physician
• Other considerations
  • Check with your individual plan regarding telehealth service access

For more information, visit the “What Does the End of the PHE Mean for You?” resource on the Centers for Disease Control and Prevention website.

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

On Medicare? What You'll Pay for Now That the PHE Has Ended

The Biden administration officially ended the COVID-19 Public Health Emergency on May 11, 2023. Certain policies that were implemented in early 2020 during the public health emergency will now expire. As a result, seniors are among those who may see some of the health care costs related to COVID-19 change. Other health care services may or may not be affected, depending on what type of coverage you have.

Here are some of the highlights:

If You Are Enrolled in Original Medicare

• With the end of the COVID-19 public health emergency, you will likely have to pay for:
  • At-home and over-the-counter COVID tests
  • Care in a skilled nursing facility if you have not first spent at least three days in a row admitted to a hospital (Note that being “under observation” at a hospital is not the same as being “admitted.”)
• You generally will not have to pay for:
  • Laboratory COVID tests ordered by a health care provider, if you have Medicare Part B (Note that you may have to pay for part of the cost for your visit to the health care provider’s office)
  • COVID vaccines and boosters from a health care provider who takes Medicare
  • COVID oral antiviral treatments such as Paxlovid
• Other considerations
  • In most cases, you will continue to have access to telehealth services from home through the end of 2024
  • With the end of the public health emergency, Medicare beneficiaries with Part D coverage may no longer receive three-month supplies of prescription medications

If You Are a Medicare Advantage Member

• Now that the public health emergency has ended, you may have to pay at least part of the cost for:
  • At-home and over-the-counter COVID tests
  • Laboratory COVID tests ordered by a health care provider, including part of the cost of your visit to the health care provider’s office
  • Visits to out-of-network physicians
• You will not have to pay for:
  • COVID vaccines provided by an in-network physician
• Other considerations
  • Check with your individual plan regarding telehealth service access

For more information, visit the “What Does the End of the PHE Mean for You?” resource on the Centers for Disease Control and Prevention website.

Which Should I Choose? Nursing Home Care vs. Hospice Care

End-of-life decisions are never easy. One of the most important decisions you may make regarding health care as you age could be whether you need a nursing home or hospice care.

To make the best choice for you and your family, it helps to know the difference between the nature of the care provided through a nursing home as compared with hospice.

Nursing Home Care

Nursing home facilities offer residential care for the elderly and disabled. The treatment patients receive from a nursing home differs from what is available in hospice care. Residents at nursing homes receive treatment to extend their lives. Care that you can expect from a nursing home may include custodial and some skilled care.

Custodial care includes nonmedical treatment, such as assistance with dressing, bathing, cooking, laundry, and other types of personal care. The provider does not need a medical license to give residents this type of care.

Skilled nursing care is provided by licensed medical practitioners. Nursing home residents may receive some skilled care, including wound care, physical therapy, injections, and other care that they may need to ensure their physical well-being.

Note that Medicare generally does not cover custodial care. And while Medicare Part A (hospital insurance) coverage may be available for enrollees with certain medical conditions, it is often limited to those who need short-term care in a skilled nursing facility, rather than a nursing home. (Learn more about Medicare’s limited nursing home coverage.)

If you are eligible for Medicaid, a program for individuals with limited income and assets, there are nursing homes in many states that accept Medicaid patients.

What Is Hospice Care?

Hospice care is an option for patients who do not wish to receive treatment to help improve their condition or extend their life, but want comfort care as they reach the end of their lives. Your hospice care team may include doctors, nurses, social workers, spiritual advisors, and volunteers.

A hospice care team is trained in treating end-of-life pain. Hospice care can be administered in a patient’s home or in an institutional setting. It also may provide support to family members and caretakers, including respite care.

If a patient has Medicare Part A and meets the following qualifications, they may have hospice care services, including pain-relieving medication and home aide services, covered:

• A primary care physician, or a hospice care doctor, confirms that the patient’s condition is terminal and they will not live for more than six months.
• The patient is willing to receive palliative care only and not care that is intended to try and improve their condition.
• The patient signs a statement confirming that they will receive hospice care instead of any other Medicare-covered treatments related to their physical condition.

For Medicaid recipients with a terminal illness, certain states may provide help in paying for hospice.

A Note on Concurrent Care                                         

Complicating matters is the fact that Medicare will generally not cover nursing home care and hospice care, known as concurrent care, at the same time. Currently, individuals on Medicare must give up Medicare payment for care related to their terminal condition if they want to receive Medicare’s hospice benefit. As a result, many individuals facing a terminal illness may not opt for hospice support services.

Policymakers have been pushing for a benefit within Medicare that would allow patients who wish to benefit from hospice care services (for example, a hospice aide, in-home respite care, or nutritional support) to receive curative treatment (for example, chemotherapy) simultaneously.

The Centers for Medicare and Medicaid Services has spent the past several years testing various models, including one known as the Medicare Care Choices Model (MCCM). MCCM has been shown to improve the quality of patients’ end-of-life while also resulting in Medicare savings. However, this option has not yet been made permanent.

End-of-Life Dilemma: Which Should I Choose?

While considering the next steps to take in your health care plan, speak candidly with your family and health care team about your needs and how you see your future.

If you have questions about coverage options that may be available to you in a nursing home or with hospice care, speak to your elder law attorney.

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.