216-346-7002 BG@BradleyGreene.com

What's the difference between Medicare and Medicaid?

The world of health insurance is a complex one, even for those of us who work in it every day. So it’s no surprise that many seniors and their adult children struggle to make sense of all their insurance options. It can be overwhelming to try and determine what services are covered and what coverage you are eligible for. Two of the most frequently confused programs are Medicare and Medicaid. In fact, some people aren’t even sure which one they have!
The following information should clarify several major differences between the two programs and help you understand when/how/if you may be eligible for benefits.
Medicare is a national health insurance for Americans over the age of 65 and the disabled. This is intended to pay for standard medical care and short term nursing care or rehabilitation. This is a federally funded program and benefits are the same for everyone (based on which Medicare plan you are registered for) regardless of what state you live in.  Medicare DOES NOT cover the cost of long term, custodial, residential, extended nursing home or assisted living care.  The video below explains in more detail each type of Medicare coverage and you can review options here for how to select care based on each person’s needs and finances.
Medicaid is a cooperatively administered health insurance program supported by both federal and state funding. The guidelines and benefits for Medicaid will differ depending on where you live. In the state of Ohio, Medicaid insurance covers nursing home, assisted living and long term care for seniors and disabled adults or children. In order to be eligible for Medicaid in the state of Ohio, a senior has to demonstrate an ongoing need for medical care or health care services in which the costs exceed his/her income.
Medicaid is not a guaranteed benefit. You have to qualify and apply for coverage based on income and assets. In some situations, such as when one spouse stays in the community, you do not have to exhaust all of your financial resources in order to apply for Medicaid. Planning ahead with the assistance of a qualified Elder Care attorney can make completing a Medicaid application easier when the time comes.
For more information about Trusts and Estate Planning or for assistance with a Medicaid application. Please contact our offices. For more information about your Medicare options, please visit Medicare.gov or contact one of our Care Coordinators who can direct you to local resources.

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Medicare Demystified: Understanding Observation Status

Over the last several years, many unsuspecting seniors and disabled persons have been opening the mail to receive large bills for health care procedures and medications they assumed were covered during a recent hospital stay. Even worse, some patients have transferred to rehab after a hospital stay only to find out their skilled nursing care wasn’t going to be covered and they would be billed at a cost of over $400 per day for care they needed to recover from an illness or injury.
These situations are both a result of a technical, financial loophole in Medicare billing called “Observation Status” – and thankfully, as of August 2016 hospitals will be required to notify patients in writing if their stay is not going to be covered, so there should be less surprises in the mailbox.
But that doesn’t make the billing issue any easier to understand, and it doesn’t ensure that people who need hospital care will be able to afford it. Here are a few of the key points you need to know about Observation Billing, Medicare Part A/B coverage and Skilled Nursing Rehabilitation.
Outpatient Services – Covered under Medicare Part B (Outpatient Insurance) includes medical services that are typically performed in the community such as doctor visits, lab work, x-rays and some home health care.
Observation Status – If the hospital determines that they are “watching you” overnight or collecting information to determine an accurate care plan and diagnosis, then you are probably being admitted under “Observation Status.” This means that any medications and services provided for pre-existing conditions will likely be billed under Medicare Part B, probably at a much higher rate than anything you would pay if you were getting those same meds from a local pharmacy.
Inpatient Hospital Services – Covered under Medicare Part A (Hospital Insurance) and includes all hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term acute care hospitals.
Qualifying Stay – This is the Medicare requirement that says in order for someone to have Skilled Nursing Facility (SNF) rehabilitation covered under Medicare Part A, he/she must be admitted to an INPATIENT hospital bed at midnight for three nights in a row. The tricky part is that if the hospital is billing your stay as OBSERVATION status, then you don’t qualify for the SNF benefit coverage.
How to reduce the costs of care:

  • If you are being admitted under observation status, ask the hospital staff if you can bring in medications from home. Cleveland Clinic and University Hospitals both have policies in place regarding this process. This can drastically reduce the expense of Outpatient/Observation Care because medication is often the highest part of bills that patients receive.
  • You also have a right to question your bill. Errors are not uncommon, and rates are often negotiable for patients who are willing to pay their bill in full. Don’t hesitate to contact our Care Coordinators if you need help navigating this process.
  • Finally, if you need rehab, but a SNF stay isn’t going to be covered, consider going to assisted living or supportive senior apartments where there is staff to help you. The cost of these will be lower than paying privately for a bed at rehab facility. Your doctor can then order Home Care services for nursing care, home health aides and physical and occupational therapy which can be billed under Medicare Part B at a much lower out-of-pocket cost that nursing home care.

There is still much work that needs to be done in order to avoid burdening seniors with the expense of care under the current Medicare guidelines and legislation has been put forth by Senator Sherrod Brown that would allow Observation Status to be considered a qualifying hospital stay for skilled rehab benefits. He presented this bill with the support of many Cleveland-area hospitals and nursing homes including Cleveland Metrohealth and Menorah Park, but the Improving Access to Medicare Coverage Act has not received the congressional support it needs to become law.

Power of Attorney: The Legal Basics and Why Everyone Needs One

What’s the difference between a POA, DPOA, and HCPOA?
And what about a Living Will – do I need one of those too?

Many people assume that determining how your assets will be managed after death is the most important legal decision you need to make. But at BLG, we believe that identifying who you trust to handle financial and health care decision-making on your behalf in the event of illness or injury is equally if not more important.
Technically, the state you live in already has a plan in place for the distribution of assets in the event of your death. But if you become sick or incapacitated, even temporarily, your family may not be able to access the information they need to make health care decisions, pay your bills or apply for public benefits.
Having a Durable Power of Attorney (DPOA) and Health Care Power of Attorney (HCPOA) ensures that your values and best interest are supported by the person (or agent) you have designated to handle specific legal, health and financial responsibilities.
The following guidelines offer a brief overview of each document, along with the answers to frequently asked questions:
Power of Attorney or POA – A legal document, signed by a competent adult, giving authority and permission for a trusted family member or other agent to manage specific decision making on their behalf. Health care and legal/financial are the two primary types of POAs. You can also designate secondary agents, who can assume responsibility if the primary agent is unable to fulfill his/her duties.
Durable Power of Attorney or DPOA – The word Durable means that the authority granted to a POA agent will continue in the event of incapacity or incompetence. This is especially important for children who want to help with an aging parent’s finances and is required for the Medicaid application process. Many POAs are drafted with limited powers, which can make the planning process difficult or impossible. A Financial POA should give your agent broad authority to do all the things that you can do.
Health Care Power of Attorney or HCPOA – This document outlines who can have access to health care information about you and who you trust to make decisions if you are unable to for any reason.  Your HCPOA should also include a HIPPA release clause. This authorizes providers to release protected health information such as test results, medical records, etc.  Facilities often ask to keep a copy of the HCPOA on file, and they may also ask for a Living Will.
Living Will – This is a signed legal document outlining what your wishes are regarding medical care if you are no longer able to give informed consent.  Our HCPOA document includes this language in it, outlining what each client’s wishes are regarding life sustaining measures and end of life care. This can ensure that your family and care providers have a clear sense of what your values and priorities are.
Once you have these important legal documents in place, we encourage you to talk with each person who might be involved in future decision making and, if you trust them implicitly, provide them with a copy of the documents. It’s especially important for family members to be aware of any Advanced Directives and know where to locate them, so that if an emergency occurs they feel confident making decisions.
Our professionally licensed counselors are available to help guide you through these discussions. And for additional peace of mind, ask about creating a Life Care Plan to receive ongoing support and guidance throughout all of life’s transitions. This includes helping you decide which benefits and providers are best for your needs and planning ahead whenever possible. For more information, please email BG@bradleygreene.com or call 216-575-5200.
Bradley L. Greene, Esq. is a Life Care Planning and Elder Law firm located in Beachwood, OH specializing in Estate Planning, Medicaid Planning and Elder Abuse – offering personalized support and family guidance through all of life’s transitions.

4 Essential Questions to Ask Your Aging Parent

Many people put off asking about their parents’ financial and legal affairs until faced with crisis – such as an unexpected illness or the death of a loved one. Too often, children find themselves sitting in a hospital room with a busy social worker, forced to make important, life-changing decisions without having all the information they need. Do they have Long-Term Care Insurance? A Living Will? Who is Power of Attorney? Where can they afford to go for rehabilitation if home is not an option? Where do they keep their checkbook and is anyone else listed on the account?
Whether you are an aging parent or the child of one, the 4 questions below will help you prepare ahead of time for inevitable life-changes and the decisions that come with them.  Having the conversation early, before you need it, will alleviate stress and empower your family with information. Then, if something happens, they can focus on more important things, like spending time with you and supporting each other.

  1. Do you have advanced directives? This includes Power of Attorney forms, a Health Care Proxy, Living Will, a Life Care Plan, etc. These documents are the first thing medical professionals will ask for when sharing health care information or if any medical decisions need to be made. Whether it’s as simple as sharing test results or as complex as making a decision about heroic measures, having these documents allows family members and care providers to act with confidence, knowing they are following Mom or Dad’s wishes.
  1. Do you have a financial advisor or attorney? Knowing who manages accounts and where documents are filed can make things much simpler if/when your family needs to access information. Even just having the contact information on file can save time and energy during stressful moments. This is also important so  you can feel confident that the person who is offering legal and financial advice is a reputable provider.
  1. Where do you keep important papers? Now, I know that we don’t all keep everything neatly filed in fire-safe boxes, alphabetized and cross-referenced by date. Most people have a specific file-folder, drawer or filing cabinet where this information is kept. And if not, then asking this question will help you realize how scattered the details are and something can be done to change that. This should include all of the following documents: birth certificate, marriage license, divorce paperwork, copy of driver’s license, social security card and military records, insurance paperwork. You can also download a copy of our BLG Essential Documents Checklist, to help you get started.
  1. If there ever comes a time when you can’t live safely at home, have you thought about where you would choose to live? One of the hardest decisions for families to make occurs when a loved one needs rehabilitation or long-term care. Some parents are willing to explore options ahead of time and can let you know what their wishes are. You can even reserve space prior to need, or get on a waiting list (sometimes up to five years) at a desirable senior apartment complex or assisted living facility. Parents: Sometimes just telling your adult children, “I don’t expect you to take care of me at home” can provide tremendous relief from guilt, if they ever need to choose an assisted living or nursing home on your behalf. And if you can’t say that your loved (or you) would be willing to move out of your own home, then it’s even more important to have your financial affairs in order. There are a variety of supportive services available to help seniors stay at home and independent for as long as possible, and there may even be benefits available to help pay for them.  By planning ahead and sharing financial/legal information with family and caregivers, you can minimize future stress and ensure that you will have the most options for care if/when the time comes.

CLICK HERE to DOWNLOAD a copy of the BLG Essential Documents Checklist to get started today.