New Medicare Rule Encourages Doctors to Test for Alzheimer's Disease and Offer Care Planning

Doctor-patient consultationA new Medicare rule will promote earlier diagnosis of Alzheimer’s disease. Medicare will now reimburse primary care doctors who conduct an Alzheimer’s evaluation and offer information about care planning to elderly patients with cognitive impairment.

According to the Alzheimer’s Association, more than 5 million Americans have the disease. In addition, more than 85 percent of Alzheimer’s patients also have another chronic condition. But many are unaware that they have Alzheimer’s disease because they haven’t been diagnosed.

Under the new rule, primary care doctors who test patients for cognitive impairment can bill Medicare for their services. Testing for Alzheimer’s disease can involve taking a thorough medical history, testing a patient’s mental status, doing a comprehensive physical and neurological exam, and conducting blood tests and brain imaging. Previously, there was no specific Medicare reimbursement for dementia testing, so many doctors did not take the time to do it.

In addition, doctors can bill Medicare if they offer help to Alzheimer’s patients with care planning by providing information on treatments and services. Receiving early diagnosis and proper care planning can be critical for Alzheimer’s patients. According to Robert Egge, Alzheimer’s Association Chief Public Policy Officer, “Proper care planning results in fewer hospitalizations, fewer emergency room visits and better management of medication — all of which improves the quality of life for both patients and caregivers, and helps manage overall care costs.”

While Medicare will now pay for dementia testing and care planning, Medicare does not pay for long-term custodial care services for Alzheimer’s patients. Medicare’s nursing home coverage is limited to skilled care provided by a physical therapist, registered nurse, or licensed practical nurse.

For an article about the new rule from the Santa Cruz Sentinel, click here.

 

 

How to Deduct Long-Term Care Premiums From Your Income

long-term care insuranceTaxpayers with long-term care insurance policies can deduct some of their premiums from their income. Whether you can use the deduction requires comparing your medical expenses to your income in a complicated formula.

Premiums for qualified long-term care insurance policies are tax deductible to the extent that they, along with other unreimbursed medical expenses (including Medicare premiums), exceed 10 percent of the insured’s adjusted gross income. In tax year 2016, taxpayers 65 and older only need medical expenses to exceed 7.5 percent of their income, but in 2017, taxpayers 65 and older will have the same 10 percent rule as everyone else.  

The amount of long-term care insurance premium that is deductible is based on the taxpayer’s age and changes each year. For the 2016 tax year, taxpayers who are 40 or younger can deduct only $390 a year, taxpayers between 40 and 50 can deduct $730, taxpayers between 50 and 60 can deduct $1460, taxpayers between 60 and 70 can deduct $3,900, and taxpayers who are 70 or older can deduct up to $4,870 in premiums.

What this means is that taxpayers must total all of their medical expenses and compare them to their income. For example, suppose 64-year-old Frank has an adjusted gross income of $30,000 and long-term care premiums totaling $5,000 as well $1,000 in other medical expenses. Ten percent of $30,000 is $3,000. Frank can only deduct any medical expenses that exceed $3,000. The 2016 limit for deducting long-term care premiums is $3,900. That means Frank can only count $3,900 of his long-term care premiums. If he adds the $3,900 in long-term care premiums to the $1,000 in other expenses his total medical expenses are $4,900. He can deduct $1,900 in medical expenses from his income.

If Frank is 70 in 2016, the calculation changes because his medical expenses only need to exceed 7.5 percent of his income, which would be $2,250. The amount of premiums he can deduct is also increased because of his age–he can deduct up to $4,870 in premiums. Subtracting the income limit from his medical expenses ($4,870 in long-term care premiums and $1,000 in other expenses), Frank can deduct $3,620 in medical expenses from his income. In 2017, Frank will only be able to deduct medical expenses that exceeded 10 percent of his income, so the amount he can deduct will go down. 

Watch Out for Mistakes in the List of Doctors Covered by Your Medicare Advantage Plan

doctorMedicare Advantage plans are a popular alternative to regular Medicare because the plans often offer lower out-of-pocket costs, but buyers need to make sure they know what they are paying for. A government review of Medicare Advantage plans revealed that their provider directories were often riddled with errors, causing those plans to face serious fines.

Medicare Advantage plans are provided by private insurers, unlike original Medicare, which is provided by the government. The government pays Medicare Advantage plans a fixed monthly fee to provide services to each Medicare beneficiary under their care. These plans are usually health maintenance organizations (HMOs) or preferred provider organizations (PPOs) that only cover care provided by doctors in their network or charge higher rates for out-of-network care. The plans often look attractive because they offer the same basic coverage as original Medicare plus some additional benefits and services that original Medicare doesn’t offer.

Because Medicare Advantage plans have different coverage rules for out-of-network care, it is important to know which doctors and hospitals are in a plan’s network. However, the Centers for Medicare & Medicaid Services (CMS) conducted a review of online provider directories for Medicare Advantage plans and found that there was incorrect information for half of the 5,832 doctors listed in directories for 54 Medicare Advantage plans that represented a third of all Medicare Advantage providers.

As a result of the review, CMS warned 21 Medicare Advantage insurers to fix the errors by February 6, 2017, or face serious fines. In 2016, CMS enacted a rule requiring plans to contact doctors and providers every three months to update their online directories. A Medicare Advantage plan can face a penalty of up to $25,000 a day per beneficiary if errors aren’t corrected.

Before purchasing a Medicare Advantage plan, you should double check with the doctors and hospitals you use that they are covered by the insurance.

For an article from PBS.org about errors in Medicare Advantage plans, click here.

 

 

Preventing a Will Contest

WillEmotions can run high at the death of a family member. If a family member is unhappy with the amount they received (or didn’t receive) under a will, he or she may contest the will. Will contests can drag out for years, keeping all the heirs from getting what they are entitled to. It may be impossible to prevent relatives from fighting over your will entirely, but there are steps you can take to try to minimize squabbles and ensure your intentions are carried out.

Your will can be contested if a family member believes you did not have the requisite mental capacity to execute the will, someone exerted undue influence over you, someone committed fraud, or the will was not executed properly.

The following are some steps that may make a will contest less likely to succeed:

  • Make sure your will is properly executed. The best way to do this is to have an experienced elder law or estate planning attorney assist you in drafting and executing the will. Wills need to be signed and witnessed, usually by two independent witnesses.
  • Explain your decision. If family members understand the reasoning behind the decisions in your will, they may be less likely to contest the will. It is a good idea to talk to family members at the time you draft the will and explain why someone is getting left out of the will or getting a reduced share. If you don’t discuss it in person, state the reason in the will. You may also want to include a letter with the will.
  • Use a no-contest clause. One of the most effective ways of preventing a challenge to your will is to include a no-contest clause (also called an “in terrorem clause”) in the will. This will only work if you are willing to leave something of value to the potentially disgruntled family member. A no-contest clause provides that if an heir challenges the will and loses, then he or she will get nothing. You must leave the heir enough so that a challenge is not worth the risk of losing the inheritance.
  • Prove competency. One common way of challenging a will is to argue that the deceased family member was not mentally competent at the time he or she signed the will. You can try to avoid this by making sure the attorney drafting the will tests you for competency. This could involve seeing a doctor or answering a series of questions.
  • Video record the will signing. A video recording of the will signing allows your family members and the court to see that you are freely signing the will and makes it more difficult to argue that you did not have the requisite mental capacity to agree to the will.
  • Remove the appearance of undue influence. Another common method of challenging a will is to argue that someone exerted undue influence over the deceased family member. For example, if you are planning on leaving everything to your daughter who is also your primary caregiver, your other children may argue that your daughter took advantage of her position to influence you. To avoid the appearance of undue influence, do not involve any family members who are inheriting under your will in drafting your will. Family members should not be present when you discuss the will with your attorney or when you sign it. To be totally safe, family members shouldn’t even drive you to the attorney.

Bear in mind that some of these strategies may not be advisable in certain states. Talk to your attorney about the best strategy for you.

When Can You Delay Taking Medicare?

MedicareWhile you are eligible to apply for Medicare when you are 65, there are circumstances where you might not want to, particularly if you are working full time for a larger employer or contributing to a health savings account. However, there can be penalties if you don’t sign up at the right time, so it is important to know when you can delay signing up for Medicare without facing a penalty.

You can first sign up for Medicare during your Initial Enrollment Period, which is the seven-month period that includes the three months before the month you become eligible (usually age 65), the month you are eligible and three months after the month you become eligible. If you do not sign up for Medicare Part B during this period, your Part B premium may go up 10 percent for each 12-month period that you could have had Part B, but did not take it. Your Medicare Part D premium will increase at least 1 percent for every month you wait. There is an exception to these penalties for some people who are still working.

If you work for an employer with 20 or more employees, you can usually delay signing up for Medicare Part B without penalty because your employer’s insurance will be considered the primary insurer. However, if your employer has fewer than 20 employees, you will probably need to sign up for Medicare Part B when you are first eligible or face penalties down the road.  Check with your employer to make sure your current insurer will expect Medicare to be your primary insurer.

If you are working or have other private insurance, you may be able to delay Medicare Part D without a penalty. Beneficiaries are exempt from the penalties if their insurance is at least as good as Medicare’s. This is called “creditable coverage. Your insurer should let you know if their coverage will be considered creditable.  You may also be able to avoid or delay getting Part D if you enroll in a Medicare Advantage plan that offers prescription drug coverage.

If you are working, you generally can enroll in Medicare Part A, which is free for most people, without consequences. However, if you are contributing to a health savings account (HSA) at work, you cannot sign up for Medicare. This is true even if your employer has fewer than 20 employees. Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospices, so you will need to analyze whether the HSA is worth losing out on the Medicare Part A coverage. If you are already receiving Social Security, you will be automatically enrolled in Part A, so you will have to stop contributing to the HSA.

How to Pass Your Home to Your Children Tax-Free

HouseGiving your house to your children can have tax consequences, but there are ways to accomplish it tax-free. The best method to use will depend on your individual circumstances and needs.

Leave the house in your will

The simplest way to give your house to your children is to leave it to them in your will. As long as the total amount of your estate is under $5.45 million (in 2016), your estate will not pay estate taxes. In addition, when your children inherit property, it reduces the amount of capital gains taxes they will have to pay if they sell the property. Capital gains taxes are taxes paid on the difference between the “basis” in property and its selling price. If children inherit property, the property’s tax basis is “stepped up,” which means the basis would be the value of the property at the time of death, not the original cost of the property.

There are some downsides to this plan. Some states have a smaller estate tax exemption than the federal exemption, so leaving the property in your estate may cause your estate to owe the state taxes. Also, if you were to need Medicaid at any time before you died, Medicaid might put a lien on the property and the property might need to be sold after your death to repay Medicaid.

Gift the house

When you give anyone other than your spouse property valued at more than $14,000 ($28,000 per couple) in any one year, you have to file a gift tax form.  But you can gift a total of $5.45 million (in 2016) over your lifetime without incurring a gift tax. If your residence is worth less than $5.45 million and you give it to your children, you probably won’t have to pay any gift taxes, but you will still have to file a gift tax form. 

The downside of gifting property is that it can have capital gains tax consequences for your children. If your children are planning to sell the home, they will likely face steep capital gains taxes. When property is gifted it does not receive a step up in basis, as it is when it is inherited. When you give away your property, the tax basis (or the original cost) of the property for the giver becomes the tax basis for the recipient.

In addition, gifting a house to your children can have consequences if you apply for Medicaid within five years of the gift. Under federal Medicaid law, if you transfer assets within five years before applying for Medicaid, you will be ineligible for Medicaid for a period of time (called a transfer penalty), depending on how much the assets were worth.

Sell the house

You can also sell your house to your children. If you sell the house for less than fair market value, the difference in price between the full market value and the sale price will be considered a gift. As discussed above, you can use the $14,000 annual gift tax exclusion as well as the $5.45 million lifetime gift tax exemption on this gift. The same issues with gifts discussed above will apply to this gift.

Another option is to sell the house at full market value, but hold a note on the property. The note should be in writing and include interest. You can then use the annual $14,000 gift tax exclusion to gift your child $14,000 each year to help make the payments on the note. This can be tricky and you should consult with your attorney to make sure this won’t cause tax problems.

Put the house in a trust

Another method of transferring property is to put it into a trust.  If you put it in an irrevocable trust that names your children as beneficiaries, it will no longer be a part of your estate when you die, so your estate will not pay any estate taxes on the transfer. The house will also not be subject to Medicaid estate recovery.

The downside is that once the house is in the irrevocable trust, it cannot be taken out again. Although it can be sold, the proceeds must remain in the trust. Similar to making a gift, if you apply for Medicaid within five years of transferring the house, you may be subject to a Medicaid penalty period.

Figuring out the best way to pass property to your children will depend on your individual circumstances. Talk to your elder law attorney to decide what method will work best for your family.

Part B Premium Will Rise Slightly for Most Medicare Beneficiaries in 2017

Medicare providerThe Centers for Medicare and Medicaid has announced the Medicare premiums, deductibles, and coinsurances for 2017. After holding steady at $104.90 a month for four years, the standard Medicare Part B premium that most recipients pay will rise 4 percent to about $109 a month.  However, approximately 30 percent of beneficiaries will see their Part B premium rise from $121.80 to $134 a month, a 10 percent increase.  Meanwhile, all beneficiaries will face a higher Part B deductible, which will go from the current $166 to $183 in 2017.

The reason for the two different Part B premiums is that about 70 percent of beneficiaries are protected from any increase in premiums when Social Security benefits remain stagnant, as has been the case for the last several years. Medicare beneficiaries who are unprotected from a premium rise include those enrolled in Medicare but who are not yet receiving Social Security, new Medicare beneficiaries, seniors earning more than $85,000 a year, and “dual eligibles” who receive both Medicare and Medicaid benefits.

For beneficiaries receiving skilled care in a nursing home, Medicare’s coinsurance for days 21-100 will inch up from $161 to $164.50.  Medicare coverage ends after day 100. 

Here are all the new Medicare payment figures:

  • Basic Part B premium: $109/month (was $104.90)
  • Part B premium for those not protected: $134 (was $121.80)
  • Part B deductible: $183 (was $166)
  • Part A deductible: $1,316 (was $1,288)
  • Co-payment for hospital stay days 61-90: $329/day (was $322)
  • Co-payment for hospital stay days 91 and beyond: $658/day (was $644)
  • Skilled nursing facility co-payment, days 21-100: $164.50/day (was $161)

So-called “Medigap” policies can cover some of these costs. 

Higher-income beneficiaries will pay higher Part B premiums:

  • Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $187.50 (was $170.50).
  • Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 will pay a monthly premium of $267.90 (was $243.60).
  • Individuals with annual incomes between $160,000 and $214,000 and married couples with annual incomes between $320,000 and $428,000 will pay a monthly premium of $348.30 (was $316.70).
  • Individuals with annual incomes of $214,000 or more and married couples with annual incomes of $428,000 or more will pay a monthly premium of $428.60 (was $389.80).

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

  • Those with incomes between $85,000 and $129,000 will pay a monthly premium of $348.30 (was $316.70).
  • Those with incomes greater than $129,000 will pay a monthly premium of $428.60 (was $389.80).

The Social Security Administration uses the income reported two years ago to determine a Part B beneficiary’s premiums. So the income reported on a beneficiary’s 2015 tax return is used to determine whether the beneficiary must pay a higher monthly Part B premium in 2017. Income is calculated by taking a beneficiary’s adjusted gross income and adding back in some normally excluded income, such as tax-exempt interest, U.S. savings bond interest used to pay tuition, and certain income from foreign sources. This is called modified adjusted gross income (MAGI). If a beneficiary’s MAGI decreased significantly in the past two years, she may request that information from more recent years be used to calculate the premium.

Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements.  The average Medicare Advantage premium is expected to decrease slightly, from $32.60 on average in 2016 to $31.40 in 2017. 

For Medicare’s press release announcing the new premium and deductible amounts, click here

For Medicare’s “Medicare costs at a glance,” click here.