Medigap policies that supplement Medicare’s basic coverage can cost vastly different amounts, depending on the company selling the policy, according to a new study. The findings highlight the importance of shopping around before purchasing a policy.
When you first become eligible for Medicare, you may purchase a Medigap policy from a private insurer to supplement Medicare's coverage and plug some or virtually all of Medicare’s coverage gaps. You can currently choose one of eight Medigap plans that are identified by letters A, B, D, G, K, L, M, and N (If you were eligible for Medicare before January 1, 2020, but not enrolled, you may also be able to purchase Plans C and F, but those plans are no longer available to people who are newly eligible for Medicare). Each plan package offers a different menu of benefits, allowing purchasers to choose the combination that is right for them.
While federal law requires that insurers must offer the same benefits for each lettered plan--each plan G offered by one insurer must cover the same benefits as plan G offered by another insurer--insurers set their own prices for each plan. This means that the price of each plan varies considerably depending on the insurance company.
The American Association for Medicare Supplement Insurance compared costs of plans in the top 10 metro areas and found huge cost differences. Using the most popular plan--Plan G--for comparison, the association found that in Dallas the lowest price for a 65-year-old woman to purchase a plan was $99 a month while the highest price was $381 a month. This is a yearly difference of more than $3,000 for the exact same plan.
The association also found that no one company consistently offered the lowest or highest price. In their study, investigators discovered that 13 different companies had either the lowest or highest price. This means you can’t rely on just one company to always have the better price.
When looking for a Medigap policy, make sure to get quotes from several insurance companies. In addition, if you are going through a broker, check with two or more brokers because one broker might not represent every insurer. It can be hard work to shop around, but the price savings can be worth it.
Transferring assets to qualify for Medicaid can make you ineligible for benefits for a period of time. Before making any transfers, you need to be aware of the consequences.
Congress has established a period of ineligibility for Medicaid for those who transfer assets. The so-called "look-back" period for all transfers is 60 months, which means state Medicaid officials look at transfers made within the 60 months prior to the Medicaid application.
While the look-back period determines what transfers will be penalized, the length of the penalty depends on the amount transferred. The penalty period is determined by dividing the amount transferred by the average monthly cost of nursing home care in the state. For instance, if the nursing home resident transferred $100,000 in a state where the average monthly cost of care was $5,000, the penalty period would be 20 months ($100,000/$5,000 = 20). The 20-month period will not begin until (1) the transferor has moved to a nursing home, (2) he has spent down to the asset limit for Medicaid eligibility, (3) has applied for Medicaid coverage, and (4) has been approved for coverage but for the transfer. Therefore, if an individual transfers $100,000 on April 1, 2017, moves to a nursing home on April 1, 2018 and spends down to Medicaid eligibility on April 1, 2019, that is when the 20-month penalty period will begin, and it will not end until December 1, 2020.
Transfers should be made carefully, with an understanding of all the consequences. People who make transfers must be careful not to apply for Medicaid before the five-year look-back period elapses without first consulting with an elder law attorney. This is because the penalty could ultimately extend even longer than five years, depending on the size of the transfer.
Be very, very careful before making transfers. Any transfer strategy must take into account the nursing home resident's income and all of his or her expenses, including the cost of the nursing home. Bear in mind that if you give money to your children, it belongs to them and you should not rely on them to hold the money for your benefit. However well-intentioned they may be, your children could lose the funds due to bankruptcy, divorce, or lawsuit. Any of these occurrences would jeopardize the savings you spent a lifetime accumulating. Do not give away your savings unless you are ready for these risks.
In addition, be aware that the fact that your children are holding your funds in their names could jeopardize your grandchildren's eligibility for financial aid in college. Transfers can also have bad tax consequences for your children. This is especially true of assets that have appreciated in value, such as real estate and stocks. If you give these to your children, they will not get the tax advantages they would get if they were to receive them through your estate. The result is that when they sell the property they will have to pay a much higher tax on capital gains than they would have if they had inherited it.
As a rule, never transfer assets for Medicaid planning unless you keep enough funds in your name to (1) pay for any care needs you may have during the resulting period of ineligibility for Medicaid and (2) feel comfortable and have sufficient resources to maintain your present lifestyle.
Remember: You do not have to save your estate for your children. The bumper sticker that reads "I'm spending my children's inheritance" is a perfectly appropriate approach to estate and Medicaid planning.
Even though a nursing home resident may receive Medicaid while owning a home, if the resident is married he or she should transfer the home to the community spouse (assuming the nursing home resident is both willing and competent). This gives the community spouse control over the asset and allows the spouse to sell it after the nursing home spouse becomes eligible for Medicaid. In addition, the community spouse should change his or her will to bypass the nursing home spouse. Otherwise, at the community spouse's death, the home and other assets of the community spouse will go to the nursing home spouse and have to be spent down.
While most transfers are penalized with a period of Medicaid ineligibility of up to five years, certain transfers are exempt from this penalty. Even after entering a nursing home, you may transfer any asset to the following individuals without having to wait out a period of Medicaid ineligibility:
Your spouse (but this may not help you become eligible since the same limit on both spouse's assets will apply)
A trust for the sole benefit of your child who is blind or permanently disabled.
Into trust for the sole benefit of anyone under age 65 and permanently disabled.
In addition, you may transfer your home to the following individuals (as well as to those listed above):
A child who is under age 21
A child who is blind or disabled (the house does not have to be in a trust)
A sibling who has lived in the home during the year preceding the applicant's institutionalization and who already holds an equity interest in the home
A "caretaker child," who is defined as a child of the applicant who lived in the house for at least two years prior to the applicant's institutionalization and who during that period provided care that allowed the applicant to avoid a nursing home stay.
Access to affordable medical care is especially important during a global health crisis. You should be aware that federal law prevents states that have accepted increased Medicaid funding from terminating Medicaidbenefits while the coronavirus health emergency continues.
The Secretary of Health and Human Services has declared a nationwide public health emergency for COVID-19. In light of the public health emergency, the Families First Coronavirus Response Act provides that if you were enrolled in Medicaid as of March 18, 2020, the state (provided it accepted expanded Medicaid funds during the crisis) cannot terminate your benefits even if there is a change in your circumstances that would normally cause your benefits to be stopped. The law states that your Medicaid coverage must continue through the end of the month in which the Secretary declares that the public emergency has ended. The only exceptions to this non-termination rule are if you choose to terminate your benefits yourself or you move to another state.
States that already terminated a Medicaid recipient’s benefits should be contacting recipients and encouraging them to reenroll. If the state determined that you were “presumptively eligible” for benefits before March 18, 2020, this rule does not apply to you, and the state may terminate your benefits if it eventually concludes you are not eligible for benefits. However, if you have coverage because you are appealing a decision of ineligibility that was made before March 18, 2020, the state cannot terminate your benefits during the health emergency.
For an FAQ about the Medicaid requirements under the law, click here.
The Federal Trade Commission (FTC) is warning residents of long-term care facilities and their families that some facilities may unlawfully require residents who are on Medicaid to sign over their $1,200 pandemic relief checks.
“This is not just a horror story making the rounds. These are actual reports that our friends in the Iowa Attorney General’s Office have been getting—and handling. Other states have seen the same,” writes Lois Greisman, the FTC’s Elder Justice Coordinator, in a May 15 alert.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act included one-time payments of up to $1,200 to millions of eligible individuals, based on their income. Ordinarily, nursing home and assisted living residents receiving Medicaid benefits must give all their income to the facility, minus a small “personal needs allowance.” However, the economic impact payments that are part of the CARES Act are a tax credit. According to tax law, tax credits don’t count as “resources” for federal benefit programs like Medicaid. The money belongs to the resident, not the facility.
The FTC says that if a loved one lives in a nursing facility and you’re not sure what happened to their payment, talk with them soon. If the facility took the payment already, get in touch with your state attorney general and ask them to help you get it back, and then tell the FTC at ftc.gov/complaint.
Chronic understaffing. Low-wage caregivers. Difficulty containing infections. These are problems that nursing homes faced in the best of times but that have proved especially deadly as the coronavirus pandemic has spread like wildfire though long-term care facilities. In response, many states have moved to shield nursing homes -- and in some states assisted living facilities as well -- from lawsuits related to the care they are providing during the pandemic. Long-term care advocates are fiercely opposing the measures.
The coronavirus pandemic has hit nursing homes particularly hard. One-third of all deaths are residents or workers in nursing homes or other long-term care facilities, and in 15 states more than half of all COVID-19 deaths have been related to long-term care. In the best of times, nursing homes often have problems with staffing shortages and infection outbreaks, and the pandemic has exacerbated these problems.
Residents and families who are unhappy with the way their facility has handled the outbreak may not have much recourse against the facility. According to Time, at least 18 states have granted long-term care facilities some legal immunity from lawsuits related to the pandemic and another 10 states are considering protections. These provisions tend to grant immunity from civil, but not criminal, lawsuits to facilities that are providing care in good faith during the pandemic (an exception is New York’s recently enacted law, which gives immunity to nursing homes from both civil and criminal lawsuits). While the immunity does not apply to willful or criminal misconduct or gross negligence, it may apply to harm stemming from resource and staffing shortages. As the states act, industry lobbying groups are pushing for the federal government to enact broad immunity protections as well.
Long-term care advocates are opposing the rush to grant immunity to nursing homes, with one advocate calling it “basically a license for neglect.” A group of organizations that advocate on behalf of nursing home residents sent a letter to Congress, arguing that residents need the protection that a lawsuit can provide now more than ever. The letter points out that none of the previous safeguards for residents -- including long-term care ombudsmen, regular inspections, and family supervision -- are currently available to residents due to lockdowns.
Despite states' grants of immunity, families of nursing home residents affected by COVID-19 are looking for ways to hold the facilities accountable. E-Street Band guitarist Nils Lofgren has spoken out about his anger and disappointment over New Jersey’s immunity provisions and has filed a lawsuit against his mother-in-law’s nursing home. A Florida law firm is also planning to file suit against two nursing homes for their handling of the pandemic, and a California family is suing a nursing home, arguing that the nursing home negligently allowed a staff member with COVID-19 to work at the facility.
Another potential avenue of liability for nursing homes is from staff lawsuits. Many nursing home workers contracted COVID-19 at work. The family of a deceased nursing home employee in Texas is suing the nursing home for wrongful death. The lawsuit alleges the facility did not properly respond to the pandemic and did not provide their employees with personal protection equipment.
To read an article from Time about the push to grant immunity to nursing homes, click here.
The closure of Social Security offices has caused problems and worries for recently unemployed seniors who need to apply for Medicare after losing their employer coverage. In response, the federal government has announced that seniors affected by the crisis have additional time to enroll in Medicare or change plans.
With millions of people out of work and losing their employer health insurance due to the coronavirus pandemic, the need for Medicare coverage is critical. While it is possible for some seniors to apply for Medicare online, others need to provide more information, including individuals who did not sign up for Medicare Part B initially because they had health insurance through an employer. Seniors who are applying for Medicare Part B after losing their job need to provide proof of their employer policy along with their Medicare application to ensure they aren’t subject to substantial penalties. With Social Security offices closed, Medicare applicants may have difficulty figuring out how to submit the necessary information or getting answers to their questions about their application.
The Centers for Medicare and Medicaid Services (CMS) has announced changes to Medicare enrollment periods to help seniors affected by the coronavirus pandemic. Those who missed their opportunity to enroll in Medicare will have additional time to apply. CMS is providing “equitable relief” to seniors who:
were in their Initial Enrollment Period (IEP), General Enrollment Period (GEP), or Special Enrollment Period (SEP) between March 17, 2020, and June 17, 2020; and
did not submit an enrollment request to the Social Security Administration (SSA).
Seniors have until June 17, 2020, to submit an application. Applications can be submitted via fax to 1-833-914-2016 or mailed to the local SSA field office. Although SSA offices are closed for in-person service, offices are still processing applications received by mail. For the SSA’s Social Security Office Locator, go here: https://secure.ssa.gov/ICON/main.jsp.
For questions and answers on how to submit a Medicare application and what information is needed, click here.
In addition, CMS has announced an SEP for people to make changes to their Medicare Advantage and prescription drug plans if they missed the open enrollment period or a special enrollment period due to the coronavirus pandemic. The SEP is available until July 13, 2020.