What is the Community Spouse and the MMNA in Medicaid?
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What is the Community Spouse and the MMNA in Medicaid?

Public Benefits

What is the Community Spouse and the MMNA in Medicaid?

What is a community spouse, and how is one eligible for spousal allowance in the event their loved one is moved to a nursing facility? Before we answer, it’s important to first understand cost-sharing in Medicaid and qualifications based on income. Medicaid is a cost-sharing program, meaning that the Medicaid recipient shares in the cost of their care. Each nursing home has its own Medicaid reimbursement rate, or the daily rate that Medicaid pays them for its nursing home residents. The resident contributes a portion of their monthly income, and Medicaid makes up the difference. The resident’s income contribution is [...]

Rothkoff Law Group2024-03-08T11:28:03-05:00July 1, 2022|

How Can I Fight a Medicaid Transfer Penalty?
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How Can I Fight a Medicaid Transfer Penalty?

Public Benefits

How Can I Fight a Medicaid Transfer Penalty?

If you are planning to apply for Medicaid, whether for yourself or a loved one, it can be important to be aware of and, if possible, prepare for a Medicaid transfer penalty. If a Medicaid applicant has given away assets, inclusive of cash, bank account transfers, properties and/or vehicles, without receiving fair market compensation within the last five years, the Medicaid caseworker processing the application will impose a Medicaid penalty. What is a Medicaid Transfer Penalty? A Medicaid transfer penalty is a period of time during which Medicaid will not reimburse your long-term care provider for services, including home and [...]

Rothkoff Law Group2024-03-08T11:29:52-05:00May 13, 2022|

Will Your Traditional Medicare Change?
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Will Your Traditional Medicare Change?

Public Benefits

Will Your Traditional Medicare Change?

When a new Medicare beneficiary becomes eligible for enrollment, there are two general options for coverage, Traditional Medicare or Medicare Advantage. While Medicare Advantage is gaining in popularity, the majority of seniors still elect Traditional Medicare because it gives them the freedom to choose their providers and manage their own care. However, with the creation of the pilot Medicare Direct Contracting program (DC), some seniors may unknowingly have their care managed by for-profit companies anyway. Created by the Center for Medicare and Medicaid Services late in the Trump administration, the Medicare DC program allows private insurance companies and other for-profit [...]

Rothkoff Law Group2024-03-08T11:31:41-05:00April 1, 2022|

Social Workers: The Unsung Heroes
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Social Workers: The Unsung Heroes

Caregiver, Public Benefits

Social Workers: The Unsung Heroes

March is the month to honor unsung heroes of the workforce: social workers. There are over 700,000 social workers in the United States, and the profession is growing. Social workers dedicate their lives to helping others navigate challenges. They counsel those with mental health and addiction issues, help families navigate foster care and adoption, counsel students, and are essential in a myriad of interdisciplinary teams, including those in hospitals, advocacy organizations, and elder law firms. When I transitioned to the practice of elder law, it was important to me to work for a firm employing social workers. After 10 years [...]

Rothkoff Law Group2024-03-08T11:31:57-05:00March 25, 2022|

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|