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. Learn more about Medicare.

In helping clients prepare for their future, estate planning and elder law attorneys use many acronyms. Understanding some of the common medical and legal terms in this field can give you added confidence in your approach to planning for your own future or that of your loved ones.

1. AEP (Accredited Estate Planner) — An AEP is an estate planning professional who has attained a graduate-level designation in estate planning. Attorneys and other estate planning experts, including accountants, financial advisors, and financial planners, can seek this accreditation. Although accreditation is not necessary for a lawyer to do estate planning, accredited estate planners have gone through additional education in estate planning. They are recognized by the National Association of Estate Planners & Councils.

2. CCRCs (Continuing Care Retirement Communities) — Older adults who want to stay in one place as their care needs progress can reside in continuing care retirement communities, which provide different levels of care as their medical and care needs change. Residents can start out living independently and then receive assisted living or nursing home care when required.

3. CMS (Centers for Medicare & Medicaid Service) — CMS is the federal agency that regulates Medicare, Medicaid, and Children’s Health Insurance Programs, as well as the Federally Facilitated Marketplace, an online health insurance marketplace.

4. DNR (Do Not Resuscitate Order) — A DNR allows individuals to choose not to have physicians prolong their lives with CPR or cardiopulmonary resuscitation. The person as well as their physician must sign the order. DNRs differ from living wills. Whereas DNRs are specific to CPR, living wills allow individuals to state whether or not they want general medical care to prolong their lives.

5. DPA (Durable Power of Attorney) — Using a DPA, you can appoint a trusted individual to manage your health care decisions or financial decisions in the event that you cannot make choices for yourself. A health care agent can make decisions about what kind of care you receive, whereas a financial agent can help manage your finances and pay your bills. Having a durable power of attorney in place can help you avoid needing a guardian in the future if you become incapacitated.

6. GAL (Guardian ad Litem) — When the court has concerns about a person’s ability to handle their personal or financial affairs, it can appoint a guardian ad litem to advocate for the individual’s best interests.

7. IRA (Individual Retirement Account) — Individual Retirement Accounts are accounts that allow individuals to save money for retirement on a tax-free or tax-deferred basis. Traditional IRAs use tax-deductible income and are tax-deferred, whereas Roth IRAs use post-tax income and are not taxed upon withdrawal.

8. MMNA (Monthly Maintenance Needs Allowance) — When one spouse goes on Medicaid and enters a nursing home and the other remains at home, federal spousal impoverishment rules provide that the spouse remaining in the community can retain a certain amount of the couple’s income.

The Minimum Monthly Maintenance Needs Allowance is the minimum amount of the couple’s income the spouse who remains at home must receive. When the healthy spouse’s income falls below the minimum, the spouse receiving Medicaid can give a portion of their income to the community spouse.

9. SNF (Skilled Nursing Facility) — Individuals with acute illnesses and injuries can recover in skilled nursing facilities, which are short-term rehabilitation centers. Skilled nursing facilities provide skilled nursing that meets residents’ unique needs and are distinct from nursing homes, which provide long-term care.

10. SSA (The United States Social Security Administration) — The Social Security Administration regulates Social Security retirement, survivor, and disability insurance benefits programs. It is the agency responsible for allocating the Supplemental Security Income program for individuals with disabilities and assigning Social Security numbers.

11. UAGPPJA (The Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act) — The majority of states have adopted the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act, which was drafted in 2007. The Act covers guardianship transfers, making moving between states easier and more efficient.

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.

ElderCounsel, the creator of Medicaid Asset Protection Trusts (MAPTs), offers them on its website.

More than 8 million Americans aged 50 and older have billions in outstanding federal student loan debt. Whether you have taken out these loans for yourself or for your family members’ education, several programs are currently seeking to assist you through debt cancellation or other relief measures.

Here are three avenues available at this time for student loan debt relief:

• Public Service Loan Forgiveness (PSLF) Program — The federal government is prepared to cancel all of your remaining federal student loan debt if you have served full time for 10 years or more in a public service role – including the U.S. military, public elementary and secondary schools, or public colleges and universities, among other organizations. Find out if you are eligible for the PSLF Program. Due to temporary changes to this program, you must apply by Oct. 31, 2022.
• COVID-19 Emergency Relief and Federal Student Aid — When the pandemic hit, the government automatically paused student loan payments. This suspension on payments was initially set to end in August 2022; it has now been extended until Dec. 31, 2022. You do not need to take action; the extended pause is automatic. However, you can learn more, and find out which loans are eligible, on the Federal Student Aid website.
• Department of Education Student Loan Debt Cancellation — Did you take out a federal student loan for your own education or for your child’s education before July 1, 2022? Depending on your income and the types of loans you received, you may be able to cancel up to $20,000 in federal student loan debt. The U.S. Department of Education is working to set up an application process for this debt cancellation initiative; sign up online to be notified by email regarding its forthcoming Federal Student Loan Borrower updates.

For additional information, check out the National Consumer Law Center’s Student Loan Borrower Assistance blog and StudentAid.gov.

Dementia is a general term that refers to severe memory loss and problems with thinking, behavior, and social skills that interfere with daily life. According to the National Institutes of Health, this neurological condition affects one in seven adults over age 71.

Alzheimer’s disease is a type of dementia and makes up 60 percent to 80 percent of dementia cases, per the Centers for Disease Control and Prevention. Most cases of Alzheimer’s occur when people reach their 70s and 80s.

Although Alzheimer’s disease accounts for many dementia cases, other types of dementia are distinct from Alzheimer’s disease, such as vascular dementia and Lewy body dementia. Alzheimer’s disease differs from other diseases involving dementia when it comes to its symptoms, effect on the brain, and treatments.

Alzheimer’s Disease

The most prevalent type of dementia is Alzheimer’s disease, which is the fifth-leading cause of death for adults 65 and over. The illness is marked by difficulty remembering recent events. People with Alzheimer’s can usually recall the past, but have trouble remembering what transpired recently. An individual with Alzheimer’s disease may be able to tell you about their childhood in detail, but not about the previous day’s events. As the condition progresses, people can have challenges walking and talking, and may experience personality changes.

Physicians believe that a buildup of proteins in the brain causes Alzheimer’s disease. Alzheimer’s disease degrades neurons and their connections in parts of the brain involved in memory, and lesions form in the brain, preventing those affected from storing new memories. As the disease progresses, the brain shrinks. To treat Alzheimer’s, doctors prescribe medicine targeting the lesions in the brain.

In some cases, people can inherit a genetic predisposition for the condition. According to the Centers for Disease Control and Prevention, a parent with Alzheimer’s increases a person’s risk by between 10 percent and 30 percent. However, the Alzheimer’s Society reports that the genetic link is more robust in early-onset Alzheimer’s, where adults show symptoms beginning in their 60s.

Lewy Body Dementia

After Alzheimer’s, Lewy body dementia (LBD) is the second most common type of dementia; people with LBD often also have Alzheimer’s. LBD impairs areas of the brain involved in problem-solving and reasoning and is related to Parkinson’s disease, a neurological disorder affecting movement.

Symptoms of LBD include:

• Disruption in rapid-eye-movement (REM) sleep, where most dreaming occurs
• Poor regulation of body functions due to problems with the autonomic nervous system
• Movement difficulties, such as rigid muscles and slow movement
• Visual hallucinations
• Cognitive issues, such as confusion, diminished attention, and memory loss

In the brain, an abnormal buildup of proteins, known as Lewy bodies, causes LBD. These proteins are related to Parkinson’s. People with LBD also have the same kind of brain lesions as those with Alzheimer’s.

When individuals receive an LBD diagnosis, physicians often prescribe medications for Alzheimer’s and Parkinson’s.

Like Alzheimer’s, advanced age is the most significant predictor of LBD. However, a stroke increases a person’s risk of developing the disease.

Vascular Dementia

Although vascular dementia shares symptoms with Alzheimer’s disease, such as memory loss, there are significant distinctions. The characteristic symptom of vascular dementia is slow speaking and thinking, as well as trouble with problem-solving.

Vascular dementia can happen when a stroke blocks a blood vessel in the brain. In many cases, more strokes follow, and the symptoms become more severe with each additional stroke.

Conditions that harm blood vessels and impair circulation, preventing oxygen and nutrients from reaching the brain, can also cause vascular dementia, such as diabetes, high blood pressure, and high cholesterol. Treating vascular dementia typically encompasses treating the underlying conditions. For example, a person with hypertension might focus on taking steps to lower their blood pressure.

People who have vascular dementia tend to experience symptoms earlier than those with Alzheimer’s, as the onset of vascular dementia commonly happens between ages 60 and 75.

Other Types of Dementia

In addition to Alzheimer’s, LBD, and vascular dementia, many other types of dementia exist, including:

• Frontotemporal dementia — Impairs the front and sides of the brain. People with frontotemporal dementia tend to develop the disease younger than those with other forms of dementia. The average age of onset is between 45 and 65.
• Creutzfeldt-Jakob Disease — Occurs when proteins infect the brain and cause problems with cognition, memory, balance, speech, vision, and mobility. Creutzfeldt-Jakob Disease is fatal, with most people passing away within a year of diagnosis.
• Huntington’s disease — A genetic condition that causes dementia. People can inherit Huntington’s from parents with the disease.

Check out resources for caregivers of individuals with dementia. Or, for support and to learn more about Alzheimer’s disease and related disorders, reach out to your local Alzheimer’s Association chapter.

Over the course of just one year, from 2020 to 2021, nearly 1 million more seniors in the United States found themselves living below the poverty line, according to data in a newly released government report.

The U.S. Census Bureau’s annual report found that, as of 2021, more than 10 percent of Americans aged 65 and older — or about 6 million people — were experiencing poverty, as calculated by the Bureau’s Supplemental Poverty Measure (SPM). This represents a statistically significant increase compared with 2020.

Notably, older adults were the only age group to have endured such an increase. Seniors of color were significantly more likely still to be living in poverty than their white counterparts. 

Each year, the U.S. Department of Health and Human Services issues federal poverty level income numbers, which are used to calculate a person’s eligibility for certain public benefits. In 2021, the federal poverty level was $12,880 per year for an individual.

Read the Census Bureau’s news release summarizing the report and view a chart depicting the change in percentage of people in poverty by age group and other categories. To download the 2021 poverty report in full, visit the Census Bureau’s website.

Many people use Google to get information about health care services, including benefits programs such as Medicare and Medicaid. Recently, Google announced changes to the search experience for users seeking information about Medicare and Medicaid eligibility and enrollment. The announcement about the updates comes as part of the annual Google Health Equity Summit.

Updates to the Google Experience

This autumn, Google is implementing several changes to its search engine to help you access essential resources about Medicare and Medicaid:

• When you look up Medicare and Medicaid information, you will see eligibility requirements and steps on how to enroll.
• Google will tailor the information to your location, showing your state’s eligibility criteria and enrollment process.
• If you already have Medicaid or Medicare coverage, you will be able to use the browser to find local health care providers who accept your plan. The new Medicaid search feature will complement an existing Medicare filter, making it easier to find providers who accept Medicaid.

The updates, set to go into effect in the coming weeks, may also help underserved populations access information about Medicare and Medicaid.

On its blog, Google also announced other health-focused endeavors:

• YouTube will work with the Kaiser Family Foundation to support videos about health, including mental health and health access.
• This year, Google will expand its Fitbit Health Equity Research Initiative, advancing research about health disparities.

Read the full blog post from Google.

Image credit: Google Keyword blog

Many use the terms “skilled nursing facility” and “nursing home” interchangeably. However, they are separate care facilities. Although skilled nursing facilities and nursing homes sound similar, they have fundamental differences, including the level of medical care they provide.

Whereas nursing homes are long-term residential facilities that serve people with chronic conditions, skilled nursing facilities are rehabilitation and treatment centers. Nursing homes are appropriate for long-term residents, while skilled nursing facilities support short-term recovery from acute medical issues.

Duration of Stay

How long a person needs to stay at a facility can determine whether they go to a nursing home or a skilled nursing facility. People usually remain in nursing homes for longer durations than in skilled nursing facilities. Many older adults move into nursing homes permanently. Those in skilled nursing facilities tend to stay for shorter periods of time and then move back home or into long-term care. 

According to the National Care Planning Council, people who enter nursing homes stay for an average of more than two years. The average stay in a skilled nursing facility is about a month.

Skilled Nursing

In addition to the length of stay, a significant difference between skilled nursing facilities and nursing homes is the type of care available. Skilled nursing facilities specialize in addressing residents’ unique medical needs.

Skilled nursing requires qualified practitioners with advanced training and specific certifications. Licensed health professionals work at skilled nursing facilities, including:

• Registered nurses (RNs)
• Licensed practical nurses (LPNs)
• Speech and language pathologists
• Physical and occupational therapists

Depending on the type of care you need, note that you can obtain skilled nursing services in other settings as well, including your home and nursing homes.

Types of Care Available in Skilled Nursing Facilities

Individuals who have severe accidents, such as falls, might need short-term care in a skilled nursing facility. Others may go to skilled nursing facilities to receive treatment for severe illnesses like cancer. People might also need to stay in a skilled nursing facility when recovering from surgery.

Types of care available at skilled nursing facilities include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Wound care
• Intravenous therapy
• Injections
• Catheter care
• Medical monitoring

As part of medical care, specialized medical equipment is available at skilled nursing facilities.

Nursing Homes

When individuals can no longer live in their homes safely and need assistance with daily living, they may choose to move into a nursing home. Nursing homes also offer activities to residents, such as social events, shopping excursions, and access to religious services. Day and night, residents have access to nursing services.

However, unlike skilled nursing facilities, nursing homes do not offer medical care that meets all residents’ specific needs. Residents at nursing homes with specific medical needs often travel to healthcare facilities to receive care. Family members can drive residents to appointments, or they may use transportation services to access medical care that meets their unique needs.

In addition, while registered nurses work in nursing homes, fewer licensed professionals might be available to residents in this type of facility.

Learn more about choosing and evaluating nursing homes.

Assistance With Daily Living

Both skilled nursing facilities and nursing homes provide round-the-clock assistance with daily living, including:

• Showering and bathing
• Getting dressed
• Cooking and meals
• Personal hygiene
• Walking
• Mobility
• Getting in and out of bed
• Moving in and out of a wheelchair

As our parents get older, we must make tough decisions regarding their health care. It can be hard to know when to bring in professional support in the form of home care. Consider the following as you decide whether your aging parents need home care.

What Is Home Care?

Home care is professional, supportive care offered to seniors in their homes. Home care is intended to allow older adults to stay in their homes for longer as they age, as opposed to having to move to a nursing home or other facility. Home care is typically focused on personal and medical care or temporary help with daily tasks, versus long-term care for severe illnesses.

Do My Parents Need Home Care?

As you decide the right time to get your parent home care, consider their overall needs. For example, if your parent cannot prepare a meal for themselves, they may benefit from a professional coming in to handle some of their daily tasks.

Other examples of signs that your parent needs assistance include:

• Your parents' mental status has changed. If you notice that they are having a hard time remembering things like the names of family members, their addresses, or other information that should be easily recalled, it may be time to take the next step and secure home care for them.
• They cannot care for themselves properly. If they do not know how or remember to take their medication, for example, you may need someone to remind them to take their medication promptly. This also goes for cooking themselves meals and tending to their personal hygiene.
• Your parents are at risk of falling. If your parents have unexplained bruises or show other signs of physical distress, a home care provider may give you peace of mind that your parents are not alone if they have an emergency.

You may find this needs assessment worksheet from the National Caregiver Library helpful in assessing the level of care your loved one may need.

Do Medicare or Medicaid Cover Home Care?

While Medicaid varies by state, Medicare covers certain home care services if patients meet the following requirements:

• The patient is homebound, and their treating physician certifies they are homebound.
• The patient needs occupational therapy, speech, or physical therapy services.
• The patient needs the services of professional nurses.
• The patient is under a doctor's care and regularly gets check-ups for their condition.

Choose a Home Care Plan Today

We all want to protect our parents as they age. Home care services can be the best way to protect your family and provide them with the safety they deserve. Consider consulting with an elder law attorney in your area if you need more information on securing home care.

For nearly 60 years, Medicaid has helped support tens of millions of low-income Americans, including seniors and people with disabilities, with low-cost or free health coverage. Come 2023, a new set of rules proposed by the federal government could improve timely access to this program for millions of eligible individuals.

In an effort to enroll and retain eligible people in programs like Medicaid more effectively — while also ensuring that state agencies avoid more administrative work — the proposal outlines various steps intended to:

• Simplify the Medicaid enrollment process
• Reduce the number of eligible Medicaid applicants who are denied coverage – including automatically enrolling most Supplemental Security Income (SSI) recipients
• Prevent eligible Medicaid beneficiaries from losing coverage – for example, by eliminating the requirement for in-person interviews or giving individuals sufficient time to provide any documents required for renewing coverage
• Ensure consumers are enrolled in the Medicare Savings Programs, such as the Qualified Medicare Beneficiary (QMB) program, for which they are eligible
• Strengthen recordkeeping regulations to prevent inconsistent practices across states

These proposed changes are in addition to a number of adjustments made previously, which were similarly aimed at helping to close gaps in coverage.

The Centers for Medicare & Medicaid Services (CMS) is seeking comment on this new proposal no later than Nov. 7, 2022. Visit the CMS’ dedicated page on this proposed rule to learn how you can submit comments electronically or via regular mail.

Learn more about Medicaid.