Medicare Fraud and Unlawful Practices
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Medicare Fraud and Unlawful Practices

Public Benefits

Medicare Fraud and Unlawful Practices

Most Medicare enrollees have suffered phone calls, commercials, and mailings trying to entice them into switching plans, but how do you know when these offerings are legitimate? If you are feeling pressured into joining a plan, it is important to remember that many insurance agents and brokers may receive a large fee for securing your enrollment. It is important to recognize when a health insurance company or a health insurance advisor may not have your best interests in mind. The widespread privatization of Medicare benefits can lead some seniors, or disabled individuals, to experience Medicare fraud. Medicare has many regulations [...]

Rothkoff Law Group2024-03-08T11:33:46-05:00February 25, 2022|

Changes to Medicare in 2022
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Changes to Medicare in 2022

Public Benefits

Changes to Medicare in 2022

Every year there are a few tweaks and changes to Medicare, the federal health insurance program for those 65 and older. The most predictable changes: increased premiums and deductibles. 2022 brings the largest Medicare Part B increase in history–a $21.60 increase. The 2022 premium is $170.10. Medicare Part B covers physician appointments and outpatient services. Reasons for the increase include: Rising healthcare costs due in part to COVID-19 A congressional act to lower the planned 2021 Part B premium with the difference being repaid via the 2022 increase CMS’s decision to save money to cover the expense of the potentially [...]

Rothkoff Law Group2024-03-08T11:34:45-05:00February 11, 2022|

Extension of the 3-Day Prior Hospitalization Waiver
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Extension of the 3-Day Prior Hospitalization Waiver

Public Benefits

Extension of the 3-Day Prior Hospitalization Waiver

What does the 3-Day Prior Hospitalization waiver extension mean for seniors seeking skilled nursing facility-level care? Over the course of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services issued several waivers in response to the Public Health Emergency. These waivers were scheduled through at least January 2022. In January, it was determined that the 3-Day Prior Hospitalization waiver would remain in effect at least through April 16, 2022. This waiver allows for Medicare coverage of skilled nursing facility level of care without a qualifying hospitalization. Under the traditional Medicare guidelines, a Medicare beneficiary must be admitted to a [...]

Rothkoff Law Group2024-03-08T12:10:18-05:00February 4, 2022|

Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug
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Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug

Health Law, Public Benefits

Aduhelm Coverage: Medicare’s Decision for the New Alzheimer’s Drug

On January 11, 2022, the Centers for Medicare and Medicaid Services (CMS) proposed that Medicare would offer Aduhelm coverage. Aduhelm is a drug for the treatment of mild Alzheimer’s disease, only as part of a clinical trial approved by CMS or supported by the National Institutes of Health (NIH). The trial will help to generate the evidence that CMS suggests is currently lacking regarding whether Aduhelm is reasonable and necessary for the treatment of Alzheimer’s disease. This preliminary National Coverage Determination (NCD) comes after months of handwringing over the potential impact of this new high-priced drug on Medicare spending and [...]

Jerold Rothkoff2024-03-08T12:10:31-05:00January 28, 2022|

Know Your Rights: Special Enrollment Period
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Know Your Rights: Special Enrollment Period

Public Benefits

Know Your Rights: Special Enrollment Period

Are you eligible for a Special Enrollment Period? While annual open enrollment has come to a close, that does not necessarily mean that you missed your opportunity to make changes to your Medicare Advantage plan or your Medicare part D prescription drug plan. If you have Medicare Part C, also known as Medicare Advantage, meaning your Medicare benefits are offered through a private company, you will have a second opportunity to make changes. During the Medicare Advantage Open Enrollment period, running from January 1, 2022, through March 31, 2022, you can switch to a different Medicare Advantage Plan or go [...]

Rothkoff Law Group2024-03-08T12:12:06-05:00December 17, 2021|

2022 Elder Law Numbers
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2022 Elder Law Numbers

Public Benefits

2022 Elder Law Numbers

As 2021 draws to a close, there are important 2022 elder law numbers that should be paid attention to by seniors and their loved ones. With these new changes in mind, now is the time to plan finances ahead of the year to come. 2022 Medicare Numbers The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2022: Basic Part B premium:........................................................$170.10/month (was $148.50 in 2021) Part B deductible:................................................................$233.00 ($203.00 in 2021) Part A deductible:................................................................$1,556.00 (was $1,484.00 in 2021) Co-payment for hospital stay days 61-90:..........................$389.00/day (was $37.00 in 2021) Co-payment for hospital stay [...]

Jerold Rothkoff2024-03-08T12:12:27-05:00December 10, 2021|

The VA Aid and Attendance Pension Helps Seniors Age in Place
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The VA Aid and Attendance Pension Helps Seniors Age in Place

Public Benefits

The VA Aid and Attendance Pension Helps Seniors Age in Place

The VA Aid and Attendance program is helping veterans across the nation receive home care and avoid the need for leaving their surroundings for a nursing facility. Below we discuss the details of this program and the eligibility for seniors who have served to receive these helpful benefits. Very few people, if any, plan to spend their last days in a nursing facility. People want to remain at home. There they are surrounded by personal comforts and have control over their daily lives. Sadly, certain conditions make it untenable for some to remain at home. While disease progressions may necessitate [...]

Rothkoff Law Group2024-03-08T12:12:40-05:00November 30, 2021|

What Are Guaranteed Issue Rights in Medicare?
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What Are Guaranteed Issue Rights in Medicare?

Public Benefits

What Are Guaranteed Issue Rights in Medicare?

While many people are currently assessing their health insurance options for fall’s Open Enrollment, running from October 15 through December 7, some may have questions about their options regarding Medicare, Medigap policies, and Guaranteed Issue Rights. If you are enrolled in or interested in enrolling in a Medigap policy, these policies are not subject to Medicare’s Open Enrollment period. A Medigap policy, or Medicare Supplement Insurance policy, helps to fill the “gaps” by serving as a supplement to Original Medicare, covering a portion of remaining health costs, such as copayments, coinsurance, and deductibles. These types of policies are sold by [...]

Rothkoff Law Group2024-03-08T12:12:50-05:00November 26, 2021|

Advocacy is Essential When Applying for Medicaid
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Advocacy is Essential When Applying for Medicaid

Public Benefits

Advocacy is Essential When Applying for Medicaid

As an attorney for Rothkoff Law Group, I help support our Public Benefits staff with complicated Medicaid issues and unexpected application outcomes when applying for Medicaid. As a result, I have found the internal processes of state Medicaid agencies processing Medicaid applications do not always comply with state and federal Medicaid laws, often to the detriment of our clients. For this reason, it is essential to have an advocate when applying for Medicaid for long-term care in both New Jersey and Pennsylvania. It is worth noting I do not believe the Medicaid agency’s occasional failure to comply with Medicaid rules [...]

Rothkoff Law Group2024-03-08T12:14:27-05:00October 21, 2021|

Important Medicare Provisions Seniors Should Know About
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Important Medicare Provisions Seniors Should Know About

Public Benefits

Important Medicare Provisions Seniors Should Know About

Congress is gearing up to pass a budget reconciliation package, and there are several important Medicare provisions affecting seniors, including first-time Medicare coverage for vision, hearing, and dental care.     These Medicare provisions are proposed to phase in vision, hearing, and dental benefits in 2022, 2023, and 2028, respectively. The Congressional Budget Office has estimated that vision benefits would cost $30 billion over 10 years, hearing benefits would cost $89 billion over 10 years, and dental benefits would cost $238 billion over 10 years. The legislation would also make broader changes to prescription drug coverage under Medicare. In addition to [...]

Jerold Rothkoff2024-03-08T12:15:59-05:00September 24, 2021|