All posts by cconboy

Are you happy with your current Medicare plan or plans? Now is the time to think about whether you are in the right plan or whether a new plan could save you money. Medicare’s Open Enrollment Period, in which you can enroll in or switch plans, runs from October 15 to December 7.

During this period you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

Even beneficiaries who have been satisfied with their plans in 2017 need to review their choices for 2018. Be sure to carefully look over the plan’s “Annual Notice of Change” letter. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks.

Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals’ personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls to sell Medicare-related products and services or to someone who shows up on their doorstep uninvited. If you think you’ve been a victim of fraud or identity theft, contact Medicare. For more information on Medicare fraud, click here.

Here are more resources for navigating the Open Enrollment Period:

To learn more about Medicare Open Enrollment and discuss Elder Law planning options, please contact the attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

 

 

The median cost of a private nursing home room in the United States has increased to $97,455 a year, up 5.5 percent from 2016, according to Genworth’s 2017 Cost of Care survey, which the insurer conducts annually. Genworth reports that the median cost of a semi-private room in a nursing home is $85,775, up 4.44 percent from 2016. The rise in prices is much larger than the 1.24 percent and 2.27 percent gains, respectively, in 2016.

The price rise was slightly less for assisted living facilities, where the median rate rose 3.36 percent, to $3,750 a month. The national median rate for the services of a home health aide was $22 an hour, up from $20 in 2016, and the cost of adult day care, which provides support services in a protective setting during part of the day, rose from $68 to $70 a day.

Alaska continues to be the costliest state for nursing home care, with the median annual cost of a private nursing home room totaling $292,000. Oklahoma again was found to be the most affordable state, with a median annual cost of a private room of $63,510.

In Pennsylvania, the the median cost of a semi-private room in a nursing home in 2017 is $9,277 a month or $111.324 annually, That figure increases to $10,007 a month or $120,084 a year for a resident in a private room.  As for other types of care, the statewide average cost for an Assisted Living community in Pennsylvania is $3,650 a month or $43,800 per year. Pennsylvania residents can also expect to pay an average rate of $22/hr for Home Care Services and an average of $62 per day for Adult Day Care at a health facility.

The 2017 survey was based on responses from more than 15,000 nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey was conducted by phone during May and June of 2017.

As the survey indicates, nursing home and other elder care options continue to increase annually, with care becoming more and more expensive. Because of this, it is extremely important to consult with the experienced and knowledgeable attorneys of Zacharia Brown to learn more about protecting your assets, available benefits and all planning options that may be available to you or a loved one. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

For more information regarding specific state by state costs in Genworth’s 2017 Cost of Care Survey, click here.

 

 

No one truly wants to think about his or her own death, however, a little preparation in the form of a prepaid funeral contract can end up being very useful. In addition to easing the burden on your family after your death, a prepaid funeral contract can also be a good way to spend down assets in order to qualify for Medicaid.

A prepaid or pre-need funeral contract allows you to purchase funeral goods and services before you die. The contract can be entered into with a funeral home or cemetery. Prepaid funeral contracts can include payments for: embalming and restoration, room for the funeral service, casket, vault or grave liner, cremation, transportation, permits, headstones, death certificates, and obituaries, among other things.

One benefit of a prepaid funeral contract is that you are paying now for a service that may increase in price, and therefore possibly saving your family money. You are also alleviating the burden on your family of having to make arrangements after you have passed on, which can often be difficult emotionally as well as time-consuming. Finally, if you are planning on applying for Medicaid, a prepaid funeral contract can be a way to spend down your assets when used correctly.

In Pennsylvania, Medicaid applicants must spend down their available assets until they reach the qualifying level (either $2,400 or $8000, depending on your gross monthly income). By purchasing a prepaid funeral contract, you can turn available assets into an exempt asset that won’t affect your eligibility. In order for a prepaid funeral contract to be exempt from Medicaid asset rules, the contract must be irrevocable. That means you can’t change it or cancel it once it is signed. Additionally, the dollar amount of the contract that will be considered exempt differs from county to county throughout the state, so it is important to consult with an experienced elder law attorney to make sure you are taking full advantage of this exemption.

Finally, before purchasing a prepaid funeral and signing a contract, you should shop around and compare prices to make sure it is the right contract for you. Buyers need to be careful that they are buying from a reputable company and need to ask for a price list to make sure they are not overpaying.

For help in understanding the benefits of prepaid funeral planning, as well as the complex Medicaid rules that apply to spending down your assets, contact the knowledgeable attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

 

Many seniors and their families don’t use a lawyer to plan for long-term care or Medicaid, often because they are afraid of the cost. But an attorney can help you save money in the long run, as well as make sure you are getting the best care possible for your loved one.

Instead of taking steps based on what you’ve heard from others, doing nothing, or enlisting a non-lawyer referred by a nursing home, you can and should hire an elder law attorney. Here are a few reasons why you should strongly consider this option:

  1.  No conflict of interest.

When nursing homes refer the families of residents to non-lawyers to assist in preparing the Medicaid application, the preparer has dual loyalties, both to the facility that provides the referrals and to the client applying for benefits. To the extent everyone wants the Medicaid application to be successful, there’s no conflict of interest. However, while it is in the nursing home’s interest that the resident pay privately for as long as possible before going on Medicaid, it is instead in the resident’s best interest to protect assets for his or her own care or for the care of the resident’s spouse or family. An attorney hired to assist with Medicaid planning and the application process has a duty of loyalty only to the client and will do his or her best to achieve their client’s goals.

2.  Saving money.

The average cost of Nursing Home care in Pennsylvania is between $9.000 and $10,000 a month. So when assessing the legal fees that may be charged by an attorney, one should keep in mind the substantial savings that can be achieved by preserving assets and avoiding an extended private pay stay at a nursing home.

3.  Deep knowledge and experience.

Professionals who work in any field on a daily basis over many years develop both the depth and breadth of experience and expertise to advise clients on how they might achieve their goals, whether those are maintaining independence and dignity, preserving funds for children and grandchildren, or staying at home rather than moving to an assisted living facility or a nursing home. Less experienced advisers, however well intentioned, can’t advise on what they don’t know.

4.  Malpractice insurance.

While we should expect that every professional we work with will provide outstanding service and representation, sometimes things don’t work out. Fortunately, there is a remedy if an attorney makes a mistake because almost all attorneys carry malpractice insurance. This is probably not the case with other advisers in the Medicaid arena, where mistakes can be costly.

5.  Peace of mind.

It is possible that when you consult with an elder law attorney, the attorney may advise you that in your situation there is not much you can do to preserve assets or achieve Medicaid eligibility more quickly. Even if this is the case, a consultation will provide peace of mind that you have not missed an important opportunity. In addition, if obstacles arise during the process, the attorney will be there to work with you to find the optimal solution.

Medicaid rules provide multiple opportunities for nursing home residents to preserve assets for themselves, their spouses and children and grandchildren, especially those with special needs. There are more opportunities for those who plan ahead, but even at the last minute, there are almost always still steps available to preserve some assets. Consequently, it is always worth investigating whether these are steps you would like to take.

For help in understanding the complex Medicaid rules and assistance with asset protection planning and applying for benefits,  contact the knowledgeable attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

 

A new report finds that states have made incremental improvements in providing long-term care, but need to make more improvements in order to meet the needs of the growing number of people who require long-term care services. According to the 2017 Long-Term Services and Supports State Scorecard, while long-term care remains unaffordable for middle class families, there has been some progress in other areas.

The scorecard, a collaboration between the AARP, The Commonwealth Fund, and The SCAN Foundation, measures states’ long-term care system performance in five areas: affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions between care settings.

The 2017 scorecard found that states showed progress since the previous scorecard in 2014 in reducing inappropriate antipsychotic drug use for nursing home residents, helping family caregivers, reducing long-term nursing home stays, increasing the number of Medicaid recipients receiving care at home or in the community rather than in an institution, and reducing potentially burdensome hospitalizations for people who die in a nursing home. However, the scorecard concludes that overall improvements are not keeping up with the demand. For example, there are not enough home care workers to meet the needs of individuals with disabilities living in the community. In addition, while states have made improvements in providing home health care, progress is moving too slowly to keep up with growing needs.

According to the scorecard, the top five states for long-term care are Washington, Minnesota, Vermont, Oregon, and Alaska. The bottom five states are Tennessee, Mississippi, Alabama, Kentucky, and Indiana. Tennessee and New York made the most progress since the previous scorecard in 2014.

To see where your state ranks, go here:
http://www.longtermscorecard.org/2017-scorecard

For help in navigating the maze of long term care options and the planning required to pay for care, contact the knowledgeable attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

 

When we’re young we believe that we’re invincible, which makes it harder to admit as we age that our bodies naturally need more care. Normal aging affects the heart, bones and joints, so preventive care is key to avoiding aging that could be harmful to your health.

Medicare-eligible Americans who are signed up for Medicare Part B as part of Original Medicare or Medicare Advantage (Medicare Part C) can take advantage of the preventive services that are included. Preventive care can help save you from serious illnesses entirely or detect health conditions early enough to treat.

What are Medicare preventive services?

Preventive services include fully and partially covered screenings, vaccinations, and counseling services.

If your doctor accepts assignment, meaning your doctor agrees to accept Medicare’s fee for covered services, you can benefit from the many preventive care services that are available at no cost to you. Free preventive care services are readily available to adults age 50 or older, so it’s surprising to learn that less than 50 percent of adults age 65 and older are up to date on preventive services, according the Centers for Disease Control and Prevention. If your provider does not accept payment in full — or Medicare at all — you may pay for the services out of pocket.

Below is a breakdown of which Medicare preventive services are free and which aren’t.

Fully covered Medicare preventive services:

Screenings

    • Abdominal Aortic Aneurysm Screening
      A one-time ultrasound is covered.
    • Bone Mass Measurement
      One test every 24 months or more if medically necessary.
    • Breast Cancer Screenings
      Annual screenings, including breast exams and mammograms, are covered.
    • Cardiovascular Screenings
      Blood tests to check cholesterol, lipid and triglyceride levels every five years.
    • Cervical and Vaginal Cancer Screenings
      Pap tests and pelvic exams once every 24 months or once every 12 months if at risk for cancer.
    • Colorectal Cancer Screenings
      Sigmoidoscopy every 48 months or every 24 months if at high risk, screening every 120 months if not at high risk and fecal occult blood test every 12 months.
    • Depression Screening
      One yearly screening with your primary care physician.
    • Diabetes Screening
      Two fasting blood glucose tests are covered if you are at risk for diabetes.
    • Hepatitis C Screening Test
      One test is covered. However, if you are at high risk, yearly screenings are covered.
    • HIV Screening
      One test every 12 months is covered.
    • Lung Cancer Screening
      One yearly screening is covered for current or former smokers.
    • Obesity Screening
      The screening is covered for individuals whose body mass index (BMI) is 30 or more.
    • Prostate Cancer Screenings
      One prostate specific antigen test is covered every 12 months.
    • Sexually Transmitted Infections Screening
      Screenings for Hepatitis B, chlamydia, gonorrhea, and syphilis are covered once every 12 months.

Vaccinations

    • Flu Shots
      One flu shot every flu season
    • Pneumonia Shots
      One shot in a lifetime is typical, but a second shot is also covered one year later.
    • Hepatitis B
      Three shots for full protection

Counseling

    • Alcohol Misuse
      Four yearly sessions are covered.
    • Cardiovascular Behavioral Therapy
      One yearly session with your primary care physician is covered.
    • Medical Nutrition Therapy
      The first year includes three hours of therapy. Each year after that includes two hours of therapy.
    • Obesity
      Behavioral counseling to help you lose weight is covered.
    • Tobacco Use Cessation
      Eight sessions in 12 months are covered.

Partially covered Medicare preventive services:

Screenings

    • Colorectal Cancer Screenings
      Barium enemas require you to pay 20 percent of the Medicare-approved amount for the service.
    • Diagnostic Mammogram
      You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.
    • Glaucoma Tests
      You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.
    • Prostate Cancer Screenings
      Digital rectal exams require you to pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.

Counseling

    • Diabetes Self-Management Training
      You will pay 20 percent of the Medicare-approved amount. However, this can be applied to your Part B deductible.

If a free service leads to other non-preventive services based on the results, you may have to pay. However, Medicare plans could help cover those costs. Not all Medicare beneficiaries are eligible for all Medicare preventive services. For example, mammograms are a free service to female Medicare beneficiaries only. You may want to check your Medicare policy if you have questions about which preventive services are covered.

For more information about Medicare benefits and preventative services, contact the knowledgeable attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

 

Have you or a loved one been denied Medicare-covered services because you’re “not improving”? Many health care providers are still not aware that Medicare is required to cover skilled nursing and home care even if a patient is not showing improvement. If you are denied coverage based on this outdated standard, you have the right to appeal.

For decades Medicare, skilled nursing facilities, and visiting nurse associations applied the so-called “improvement” standard to determine whether residents were entitled to Medicare coverage of the care. The standard, which is not in Medicare law, only permitted coverage if the skilled treatment was deemed to contribute to improving the patient’s condition, which can be difficult to achieve for many ill seniors.

Three years ago in the case of Jimmo v. Sebelius the Centers for Medicare & Medicaid Services (CMS) agreed to a settlement in which it acknowledged that there is no legal basis to the “improvement” standard and that both inpatient skilled nursing care and outpatient home care and therapy may be covered under Medicare as long as the treatment helps the patient maintain his or her current status or simply delays or slows his/her decline. In other words, as long as the patient benefits from the skilled care, which can include nursing care or physical, occupational, or speech therapy, then the patient is entitled to Medicare coverage.

Medicare will cover up to 100 days of care in a skilled nursing facility following an inpatient hospital stay of at least three days and will cover home-based care indefinitely if the patient is homebound.

Unfortunately, despite the Jimmo settlement, the word hasn’t gotten out entirely to the hospitals, visiting nursing associations, skilled nursing facilities, and insurance intermediaries that actually apply the rules. As a result, the Jimmo plaintiffs and CMS have now agreed to a court-ordered corrective action plan, which includes the following statement:

The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2014), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits.

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.

The Jimmo Settlement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

“The CMS Corrective Statement is intended to make it absolutely clear that Medicare coverage can be available for skilled therapy and nursing that is needed to maintain an individual’s condition or slow deterioration,” says Judith Stein, Executive Director of the Center for Medicare Advocacy and a counsel for the plaintiffs. “We are hopeful this will truly advance access to Medicare and necessary care for people with long-term and debilitating conditions.”

While this doesn’t change the rights Medicare patients have always had, it should make it somewhat easier to enforce them. If you or a loved one gets denied coverage because the patient is not “improving,” then you may have grounds to appeal.

For more information about Medicare, and your rights under specific benefit programs, contact the knowledgeable attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

Every year at this time, many anxious parents are helping their high school graduates gather items they need to take with them to college. Families print off supply lists, visit big box stores and dutifully prepare their children for a new life away from home.  What they don’t realize, however, is that they may be forgetting the most important detail of all.

If your child has reached this point, you may likely feel as though you are losing control of his or her life. Unfortunately, this is legally true once your child reaches the age of 18 because the state considers that child to be an adult with the legal right to govern his or her own life.

Up until the time your child reaches the age of 18, you are absolutely entitled to access your child’s medical records and to make decisions regarding the course of his or her treatment. Additionally, your child’s financial affairs are your financial affairs. This changes once your child reaches the age of 18 because your now-adult child is legally entitled to his or her privacy.  You no longer have the same level of access to or authority over his or her financial, educational and medical information. As long as all is well, this can be fine. However, it’s important to plan for the unexpected and for your child to set up an estate plan that at least includes the following three crucial components:

1. Durable Health Care Power of Attorney

Under the Health Insurance Portability and Accountability Act, or HIPAA, once your child turns 18, his or her health records are now between that child and his or her health care provider. The HIPAA laws prevent you from even getting medical updates in the event your child is unable to communicate his or her wishes to have you involved. Without a HIPAA release and Durable Medical Power of Attorney, you may have many obstacles to overcome before receiving critically needed information, including whether your adult child has even been admitted to a particular medical facility.

Should your child suffer a medical crisis resulting in his or her inability to communicate for him/herself, doctors and other medical professionals may refuse to speak with you and allow you to make medical decisions for your child. You may be forced to hire an attorney to petition to have you appointed as your child’s legal guardian by a court. At this time of crisis, your primary concern is to ensure your child is taken care of.  You do not need the additional burden of court proceedings and associated legal costs. A Durable Health Care Power of Attorney will remedy this problem and enable your child to designate you or another trusted person to make medical decisions in the event he or she is unable to convey his or her wishes.

2. Durable Financial Power of Attorney

Like medical information, your 18-year-old child’s finances are also private. If your child becomes incapacitated, without a Durable Financial Power of Attorney you cannot access his  or her bank accounts or credit cards to make sure bills are being paid. If you needed to access financial accounts in order to manage or resolve any problem, you may be forced to seek the court’s appointment as conservator of your child.

Absent a crisis, a Durable Financial Power of Attorney can also be helpful in issues that may arise when your child is away at college or traveling. For example, if your child is traveling and an issue comes up where he/she cannot access his or her accounts, a Durable Financial Power of Attorney would give you or another trusted person the authority to manage the issue. An alternative may be to encourage your child to consider a joint account with you. However, this is rarely recommended because of the unintended consequences for taxes, financial aid applications, creditor issues, etc.

3. Will

Your child owns any funds given to him or her as a minor or that he/she may have earned. In the catastrophic event that your child predeceases you, these assets may have to be probated and will pass to your child’s heirs at law, which in most states would be the parents. If you have created an estate plan that reduces your estate for estate tax or asset protection purposes, the receipt of those assets could frustrate your estate planning goals. In addition, your child may wish to leave some tangible property and financial assets to other family members or to charity.

While a will may be far less important then the Durable Health Care Power of Attorney and Durable Financial  Power of Attorney, ensuring that your child has all three components of an estate plan in place can prevent you, as a parent, from having to go to court to obtain legal authority to make time-sensitive medical or financial decisions for your child.

If you have a child (or grandchild) who is approaching adulthood or leaving for college, talk to the experienced attorneys at Zacharia Brown about having the child execute these crucial documents. It is one of the most important preparations you can make as your young adult heads off to school. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

Last week we identified a type of relief that is being offered from Medicare’s Part B late-enrollment penalty for certain Medicare beneficiaries who enrolled in Medicare Part A and had coverage through the individual marketplace. As a follow-up, this week’s topic will include a discussion of how Medicare and Employer coverage are coordinated for an individual.

Medicare benefits start at age 65, but many people continue working past that age, either by choice or need. It is important to understand how Medicare and employer coverage work together.

Depending on your circumstances, Medicare is either the primary or secondary insurer. The primary insurer pays any medical bills first, up to the limits of its coverage. Thereafter, the secondary payer will cover costs that the primary insurer does not (although it may not cover all costs). Knowing whether Medicare is primary or secondary to your current coverage is crucial because it will help determine whether you need to sign up for Medicare Part B when you first become eligible. If Medicare is the primary insurer and you fail to sign up for Part B, your eventual Medicare Part B premium could start going up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it. (See last week’s blog for information on relief from this penalty).

Here are the rules governing whether Medicare coverage will be primary or secondary insurer:

1. If your employer or your spouse’s employer has 20 or more employees, your employer’s insurance will be the primary insurer and Medicare is the secondary payer. If your employer or your spouse’s employer has fewer than 20 employees, Medicare will be the primary insurer and your employer’s insurance will be the secondary insurer.

2. If you are retired and still covered by your employer’s group health insurance plan, Medicare pays first and your former employer’s plan pays second.

3. If you receive both Social Security Disability Insurance and Medicare, and your employer has 100 or more employees, your employer’s insurance pays first. Some employers are part of a multi-employer plan and if at least one employer in that plan has 20 employees or more, the employer’s insurance pays first. If your employer has fewer than 100 employees, Medicare will pay first.

4. If you have end stage renal disease (ESRD) and are in the first 30 months of Medicare coverage of ESRD, your employer’s plan pays first. After the first 30 months, Medicare then becomes the primary insurer. It does not matter how many employees your employer has.

5. If you are self-employed and have a group health plan that covers yourself and at least one other person, Medicare pays first. **Note that if you are self-employed, you may be able to deduct Medicare premiums from your income taxes by including the premiums in the self-employed health insurance deduction.

Finally, if your employer’s insurance is the primary insurer, the employer must offer you and your spouse the same coverage that it offers to younger employees. It also cannot deny you coverage, cancel your coverage once you become eligible for Medicare, or charge you more for premiums, deductibles, and copays.

For more information on how Medicare and employer insurance work together, please contact the experienced attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.

Medicare is offering relief from penalties for certain Medicare beneficiaries who enrolled in Medicare Part A and had coverage through the individual marketplace. For a short time, these individuals will be able to enroll in Medicare Part B without paying a penalty for late enrollment.

Individuals who do not enroll in Medicare Part B when they first become eligible pay a stiff penalty. For each year that they put off enrolling, their monthly premium increases by 10 percent — permanently. Some people with marketplace plans – that is, plans purchased by individuals or families, not through employers — did not enroll in Medicare Part B when they were first eligible. Purchasing a marketplace plan with financial assistance from the Affordable Care Act (aka Obamacare) can be cheaper than enrolling in Medicare Part B. However, Medicare recipients are not eligible for marketplace financial assistance plans. And because marketplace plans are not considered equivalent coverage to Medicare Part B, signing up late for Part B will result in a late enrollment penalty.

Although the Centers for Medicare and Medicaid Services (CMS) sent notice to individuals who had both marketplace plans and Medicare, it may have been too late. Therefore, CMS is allowing individuals who enrolled in Medicare Part A and had coverage through a marketplace plan to enroll in Medicare Part B without a penalty. It is also allowing individuals who dropped marketplace coverage and are paying a late enrollment penalty for Medicare Part B to reduce their penalty. To be eligible for the relief, the individual must:

1.   Have an initial Medicare enrollment period that began April 1, 2013 or later; or

2.   Have been notified of a retroactive premium-free Medicare Part A award on October 1, 2013 or later.

This offer is available for only a short time. To be eligible for the relief, individuals must request it by September 30, 2017. Individuals who are eligible should contact Social Security at 1-800-772-1213 or visit their local Social Security office and request to take advantage of the “equitable relief.”

For more information on Medicare and Medicaid, please contact the experienced attorneys at Zacharia Brown. You may schedule an appointment by visiting our website at PittsburghElderLaw.com or by calling 724.942.6200.