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|

Be Prepared for Medicare’s Annual Enrollment Period

The Medicare Open Enrollment Period for 2022 has arrived. Throughout the year, Medicare has different enrollment periods. The Open Enrollment Period, or OEP, is the timeframe during which Medicare beneficiaries can make changes to their Medicare plans. This year’s OEP will take place October 15 through December 7, 2021. Any changes you make to your Medicare plan during this period go into effect on January 1, 2022. During OEP, you can: • Switch from Original Medicare (Medicare Parts A and B) to a Medicare Advantage (Medicare Part C) plan. • Switch from a Medicare Advantage plan back to Original Medicare. [...]

Rothkoff Law Group2024-07-29T12:01:31-04:00September 23, 2021|

Planning Ahead for the Medicaid Look-Back Period
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Planning Ahead for the Medicaid Look-Back Period

Public Benefits

Planning Ahead for the Medicaid Look-Back Period

What is a Medicaid Look-Back Period, and why should you be concerned about planning ahead for Medicaid benefits? We encounter the following factual scenario on a regular basis, which will shed some light on why you may want to start planning now. Mom can no longer live independently. Mom sells her house and moves in with her son and his family. Son uses mom’s money to remodel or add an addition to his home and to help pay household expenses, such as utilities, food, maintenance. Mom never puts anything in writing indicating son can use her money for such expenses. [...]

Rothkoff Law Group2024-03-08T12:18:43-05:00September 16, 2021|

Qualified Income Trust for Medicaid
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Qualified Income Trust for Medicaid

Public Benefits

Qualified Income Trust for Medicaid

Applying for Medicaid for yourself or a loved one can be a difficult process. Many people believe they have successfully navigated all clinical and financial criteria, only to discover that the applicant requires a Qualified Income Trust, or QIT. Prior to December 1, 2014, all Medicaid applicants in the State of New Jersey with a monthly income in excess of the annual income limit, $2,382.00/month in 2021, were ineligible for the benefit. The creation of QITs has allowed for a wider range of applicants but has further complicated the Medicaid application process. Improper use of a QIT can result in [...]

Rothkoff Law Group2024-03-08T12:23:30-05:00July 22, 2021|