What is Medicare Part D? - Part 1

What is Medicare Part D?
Starting January 1, 2006, Medicare will begin to offer prescription drug plans to help with paying rising drug costs. To be eligible for Medicare Part D, you must be enrolled in either Medicare Part A or B. It is important that you understand the changes affecting your prescription drug coverage choices. If you currently have Medicaid drug coverage, you will lose it and automatically be enrolled in a new plan through Medicare. You will still have your other Medicaid benefits. There are a number of different prescription drug plans (called “PDPs”) available through Medicare Part D that are offered by private companies. Some plans will offer drugs that other plans do not so it is important to carefully select the right PDP for you to make sure that your medication is included under the plan. Information about specific PDPs will be made available starting in October 2005.

Do I have to have Medicare Part D? And if so, what will it cost me?
No, you do not have to enroll in Part D. It is completely voluntary and you may continue to keep your current prescription drug coverage (either through your employer, union, etc) if you wish. If you later decide to enroll in Part D, however, you may be faced with a late enrollment penalty.
If you decide to enroll in the basic benefit plan, there will be an approximate drug coverage premium of $37 a month. You also have to pay a $250 deductible and then 25% co-insurance for drug costs. If your drugs cost more than $2,250 for the year, you will have to pay 100% of the cost until the cost of covered drugs reaches $5,100 (called a “doughnut hole”). Therefore, beneficiaries will have to pay a total of $3600 of out of pocket costs before Medicare will begin to pay 95% of the formulary drug prices.
Only out of pocket costs for formulary drugs that are paid for by you, a family member, or another person acting on your behalf, or a state pharmacy assistance program count toward your annual out of pocket limit of $3600. Payments by other insurance (such as employer or union plans) do not count. After $5,100 in total expenses, you will receive catastrophic coverage and will only have a 5% coinsurance or a co-payment of $2 for generic drugs or $5 for brand name drugs, whichever is greater.
If you qualify for low income assistance, costs will decrease dramatically. People currently receiving Medicaid, MSP, or SSI will automatically receive low income assistance and will only pay a small co-payment for prescription drugs. Other people will be eligible for low income assistance if their income is less than 150% of the federal poverty level ($14,595/year or $19,485 for a couple) and have limited resources($10,000 or $20,00 for a couple).

What should I think about when selecting a Part D plan?
It is important to realize that all plans are not created equal. Plans are likely to vary not only in the cost but also in the type of drugs offered. PDPs are given flexibility as long as the total value of their plan is the same as the basic benefit. Therefore some plans may have higher co-payments than others while others have lower premiums.
In addition, PDPs have considerable discretion to decide which specific drugs to include on their formularies. Therefore, PDPs do not necessarily have to pay for all the drugs that are covered by Medicare Part D. If you need a drug that is not on your plan’s formulary, you will have to pay full price for the drug. Additionally, payments for non-formulary drugs will not count toward your out of pocket expenses. Each PDP also gets to decide which pharmacies to use. It is possible that a nursing home will no longer be able to receive residents’ drugs from a single pharmacy but will have to deal with a number of pharmacies since residents are likely to have different PDPs.
Plans can vary on a wide array of matters. Some plans might also include options for mail-order drugs. Additionally, plans may place limitations on the number of prescriptions per month or the number of pills allowed per prescription. Each plan may have a different procedure and steps to go through for an appeal to get your medicine because the plans are offered by a multitude of private companies rather than a single entity. Because of all the variations in Medicare Part D plans, it is extremely important to carefully choose and select a plan that meets your needs.

Time is Running Out! Seminar Invitation

Medicaid has long served as a safety net for middle class seniors faced with the catastrophic cost of a nursing home. This program is currently under attack and likely to change. Learn how to PLAN NOW before the window closes forever. Don't limit your options and jeopardize everything you've worked a lifetime to acquire.

NOW, more than ever, it's important to learn the answers to these crucial and timely questions:

If I put together a plan right now to protect my assets from a nursing home, will I be grandfathered in?

What will Medicare cover?

If I can't rely on Medicaid in the future to pay for long term care costs, what exactly should I be doing now?

I want to learn from the Terri Schiavo case...Do I need a Health Care Proxy or a Living Will or both?

What exactly is a Living Trust?

If I become incapacitated, how will my finances and medical decisions be handled?

Do I really need a will?

I have a disabled child. How can I protect and provide for that child when I can no longer do it myself?

What is the difference between Revocable and Irrevocable Trusts?

Join Long Island's Elder Law, Special Needs and Estate Planning Firm for the one FREE seminar you can't wait to attend! Discover why planning NOW is more important than ever.

TUESDAY, AUGUST 9TH AT 10:00AM
Presentation and Luncheon
The Islandia Marriott
3635 Express Drive North

Seminar and Lunch are FREE, but reservations are required. Call today to reserve your place...bring a friend. Call 631-234-3030 or email JGrisolia@Davidowlaw.com.

Things to Think About Before You Relocate Your Elderly Parent

Your home is now miles and hours away from your parent. The best thing would be to move Mom or Dad closer…or would it? There are a lot of reasons why it might make sense to relocate an aging parent closer to the rest of the family.

But, before you suggest a move, give it some serious thought. Be sure that this move would really be the best thing for all of you. Once you have made the commitment to relocate, it will be next to impossible to undo.

Following are some important things to think about before you make the decision to relocate an older person:

1. Can my elder get along without me (at least for a while?)

If my elderly parents don’t depend on me for regular assistance now, can the move wait until I have had a chance to learn about local elder resources here?

If I am working long hours, how much will I be able to assist my parent after the move?

Who will select, pack, or sell possessions? Will a house have to be sold?

2. Social Life

Is my elder confident enough to venture out and to make new friends in a strange place? Will he/she be leaving a good network of supportive friends?

If my aging parent is driving on familiar streets now, will he/she be able and safe to do so on unfamiliar territory, where the traffic may be much heavier? Is transportation available, or will I have to be the chauffeur?

3. Important Medical Questions

Does my elder have a long and close relationship with current physicians? Can we find equivalent physicians who will treat an elderly person? Many specialists, in particular, have reduced or closed their Medicare practices.

Will health insurance transfer to this area? HMOs are geographically limited.

Will the climate be a concern?

4. Financial Issues

Is the new cost of living affordable? Social Security and retirement income will not be adjusted if your parent moves to a place with a higher cost of living.

If he/she is currently receiving state benefits or assistance, what will the requirements be to qualify in the new location? Even within the same state, there is often a wait before services resume at a new address.

If a house must be sold, what are the financial (tax and other) consequences?

And, this is the most important question of all…What does the elder think? If he is competent and able to make his own decisions, does he want to relocate? Will you spend hours of effort and anxiety trying to find the “perfect” answer, only to be told to mind your own business?


Source: by Molly Shomer of The Eldercare Team. Please visit Molly’s website at http://www.eldercareteam.com for more elder care articles and important resources for those who are caring for aging adults.”

Facts About Long-Term Care

Each year, consumers spend about $40 billion out-of-pocket for long-term care services.1 This does not include the cost of informally provided care; about two-thirds of persons with long-term care needs receive services from unpaid help only.2 Advance planning can help consumers age in place and make optimal use of available services.

About 13 million Americans report having long-term care needs; in less than 20 years, this number is expected to increase by 70% to 22 million people.3 Five percent of the elderly are in nursing homes - about 1.4 million people.4 Approximately 43% of those turning age 65 can expect to spend some time in a long-term care facility, about half of them will require care for three years or more, and 20% will spend five years or longer in a nursing home.5 One in five people who reach age 65 will spend more than two years in a nursing home.6 Rates of nursing home use are declining, associated with an increase in the use of home health care services and alternative residential care services such as assisted living.7 The fact is, 60% of people who turn age 65 this year will need long-term care as they grow older.8
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1 Feder, H.I. Komisar, and M. Niefeld, "Long-Term Care in the United States: An Overview", Health Affairs 19 (2000): 40-56.
2 R. Stone, Long-Term Care for the Elderly with Disabilities. Current Policy Emerging Trends, and Implications for the Twenty-First Century (Washington, D.C.: Millbank Memorial Fund, 2000).
3 Facts on Long-Term Care, 1997 (Washington, D.D.: National Academy on an Aging Society, 1997); available at http://www.agingsociety.org/aging-society/publications/fact/index.html.
4 National Nursing Home Survey 1999 (Hyattsville, MD: National Center for Health Statistics, 2000).
5 M. Donald Wright, "Looking Toward the Future with Long-Term Care Insurance" (Financial Gerontology), Journal of American Society of CLU & CHFC51 (May 1997).
6 P.Kemper and C.M. Murtagh, "Lifetime Use of Nursing Home Care." New England Journal of Medicine (3424): 595-600.
7 National Nursing Home Survey 1999.
8 K.J. Mahoney, L. Connolly, D. Phillips, and T. Hayaski, "Increasing Awareness of Long-Term Care Costs and Options, the Early Experience of the California Partnership for LTC," prepared for the Gerontological Society of America, Coston, MA, 1996.

The Long Island Community Foundation

The Long Island Community Foundation is a part of the nation’s fastest growing form of philanthropy. The LICF is an economic alternative to a private foundation or a commercial gift fund. The Long Island Community Foundation, a division of The New York Community Trust, distributes more than $12 million annually through the 168 charitable funds that Long Island residents and businesses have set up within LICF. If you are thinking about giving, it is an efficient and hassle-free way of giving to a public charity.

The Community Foundation’s mission is to build a permanent source of private funding for Long Island’s charities. Funds can be named for their donors, for their purposes, or as memorials. The two main types of funds are donor-advised and field-of-interest funds. Donor-advised funds allow donors to participate in the selection of the beneficiaries. Field-of-interest funds enable the Community Foundation to support charitable agencies and organizations within a geographic or charitable area (such as child welfare) specified by the donor. Either way, funds are a great way to create a family legacy and to make a real and lasting difference in the daily life of our community.

In addition to the peace of mind and goodwill of charitable donations, there are several advantages and benefits to creating a fund in the Community Foundation. You will recognize greater tax savings by establishing a fund through the LICF rather than through a private foundation. A fund can be established in less than one day, often with a single page document, whereas a private foundation takes months to establish with lots of expensive paperwork. A fund offers donors maximum tax benefits without the bother of administration. The LICF staff performs all of the administrative work (bookkeeping, accounting, and check writing) and assures that only bona fide charities are supported.

A fund in the Community Foundation is a great way to permanently give back to the community in which you live. A LICF fund allows the joy of giving and the recognition donors expect when they are donating to charity. An experienced estate planning attorney, like the ones at Davidow, Davidow, Siegel and Stern can help assist in any charitable contributions you may want to make.

Log on to the Long Island Community Foundation’s website at www.licf.org for more information.

New Technologies Spot Alzheimer's Beginnings

Even without a cure, early detection is important, experts say...

Two high-tech brain scans and a new blood test can identify Alzheiner's linked neurological changes years before actual symptoms arise, researchers report.

Besides allowing individuals to begin drug therapy early and not wait for the future, these early -detection tests might someday help those take full advantage of preventive therapies.

"We already have medications coming down the pike that already change the course of the disease, " explained William Thies, Director of Medical and Scientific Affairs at the Alzheimer's Association. "As those medications become available, there's going to be a tremendous need to identify Alzheiner's disease earlier and earlier".

Three studes outlining the new screening technologies were presented at the Alzheimer's International Conference on Prevention of Dementia, in Washington, D.C.

One study used positron emission tonography (Pet) Scans hooked up to a specially designed, MRI computer program. That program automatically tracks glucose metabolism in an area of the brain called hippocampus, a key memory center.

"If there's reduced [metabolic] activity there, you have cognitive problems, and are at risk of developing Alzheimer's." The technology grew out of the work from a team who first discovered hippocampal shrinkage to be a harmful indicator of Alzheimer's disease.

Using this computerized scanning technology, the NYU researchers followed 53 healthy participants between 54 and 80 years of age for between 10 and 24 years in a first -of-its-kind, long term experiment. Participants received PET scans at the beginning of the study and then at the three-and-six year mark.

Six of the participants did go on to develop Alzheimer's disease.

Before this, we didn't have any idicators or biomarkers, and now we can finally know what to look for and examine this further in clinical research."

Early detection methods are much further advanced than their development than the blood-based screen. "But obviously, the blood screen is much easier and requires less machinery and fits much easier into the physician's routine.

In the absence of effective treatments, however, does early detection really make sense? Studies now believe that it does.

The impact of the current medications we have is likely to be biggest in the scope of the disease. And Alzheiner's disease is so dislocating for families--knowing ahead of time allows you to plan better for the future in a number of ways. Waiting until symptoms appear--and competency is impaired--may be too late, the affected individual is taken out of the mix, and the family is left trying to interpret what they would want.

The decades long push for effective, preventive therapies may produce fruit. The advent of powerful drugs that fight Alzheimer's will make early detection even more important than it is now. At the same time, advances in imaging technology are fueling this research boom, allowing us to locate and target exactly those areas of the brain most affected by the disease.

For much more on Alzheimer's disease, visit the Alzheimer's Association.

Source: 6/19, HealthDay News, E.J. Mundell.

Time is Running Out! Seminar Invitation

TIME IS RUNNING OUT!
The one FREE seminar you CAN’ WAIT to attend.

Presented by Davidow, Davidow, Davidow, Siegel and Stern, Long Island’s Elder Law, Special Needs and Estate Planning Firm.

Medicaid has long served as a safety net for middle class seniors faced with the catastrophic cost of a nursing home. This program is currently under attack and likely to change. Learn how to PLAN NOW before the window closes forever. Don’t limit your options and jeopardize everything you’ve worked a lifetime to acquire.

NOW, more than ever, it’s important to learn the answers to these crucial and timely questions:

• If I put together a plan right now to protect my assets from a nursing home, will I be grandfathered in?
• What will Medicare cover?
• If I can’t rely on Medicaid in the future to pay for long term care costs, what exactly should I be doing now?
• I want to learn from the Terri Schiavo case…do I need a Health Care Proxy or a Living Will or both?
• What exactly is a Living Trust?
• If I become incapacitated, how will my finances and medical decisions be handled?
• Do I really need a will?
• I have a disabled child. How can I protect and provide for that child when I can no longer do it myself?
• What is the difference between Revocable and Irrevocable Trusts?

Choose from these two seminars:

Wednesday, June 22nd at 10:00am
Breakfast Buffet and Presentation
Riverhead Polish Hall
214 Marcy Avenue, Riverhead

Or

Tuesday, June 28th at 6:00pm
Dinner Buffet and Presentation
The Milleridge Inn
585 North Broadway, Jericho

Reservations are required. Call 631-234-3030 or email JGrisolia@Davidowlaw.com to reserve your seats. Discover why planning NOW is more important than ever!