Medicare Part D Enrollment Deadline Quickly Approaching

 

Written By: Lisa Barner, Planning Specialist

 Medicare Part D prescription drug benefits became available to Medicare beneficiaries on January 1, 2006 .  Those eligible to sign up for a Part D plan can do so until May 15, 2006 without incurring a penalty.  After that date, the annual enrollment period will be from November 15^th - December 31^st of each year for most beneficiaries. Most enrollees will have to pay a monthly premium for this coverage. The premium will vary depending on the plan chosen. Enrollment is voluntary. However, beneficiaries who choose not to join a Medicare Part D plan during their initial enrollment period ( November 15, 2005 - May 15, 2006 ), may be subject to a penalty if they later decide to enroll. The penalty will be approximately 1% for each month of delayed enrollment. Therefore, someone who delays their enrollment for 4 years will have to pay 48% more in premiums each month.

There is an exception to this penalty. There will be no penalty for delayed enrollment if the beneficiary did not enroll because they had some type of "creditable coverage." Creditable coverage is coverage provided by a private insurer that is considered to be at least "as good as" the Medicare Part D standard benefit.

 There are generally three enrollment times:

1) Initial Enrollment - This period begins when you are first eligible for Medicare.  The initial enrollment period begins 3 months before you turn 65, the month of your 65^th birthday, and three months after you turn 65.

 2) Annual Enrollment - This period is from November 15^th - December 31^st of each year.

 3) Special Enrollment - This period applies to those with special circumstances such as a move to or from a long term care facility, involuntary loss of creditable coverage, a move out of your plan's geographic area, and those that are considered to be "dual eligibles."

 There is also extra help for those Medicare beneficiaries with low incomes and resources.  In 2006, if your income is less than $14,355 (for an individual) and $19,245 (for a couple) and your resources are less than $10,000 (for an individual) and $20,000 (for a couple), you may qualify for some of this extra help.  You could qualify for a smaller or no premium plan, a smaller or no deductible plan, or a smaller or no co-payment plan.  To apply for one of the low income subsidies, you should contact the Social Security Administration, County Assistance Office, or Medicare. 

 What Should You Do If You Have.

 Pace?  Pace is considered to be creditable coverage.  Therefore, you could keep your Pace coverage and if you would later choose to enroll in a Part D Plan, you should not be subject to the penalty in the premiums.  However, if you would qualify for regular Pace benefits, you may qualify for one of the low income subsidies offered through Medicare Part D.  (This might be worth looking into as your costs may be lower with Part D rather than Pace.)

 Pace Net?  If your income is too high to qualify for Pace, but you qualify for Pace Net, you should continue with Pace Net coverage.  If you qualify for Pace Net, your income would exceed the limits for any of the Part D subsidies.  Your cost with Pace Net will most likely be less than it would be with a Part D plan.  Pace Net is considered to be creditable coverage, therefore, if you would choose to enroll in a part D plan later, you should not be subject to the penalty in the premium as a result of delayed enrollment.

 Veterans' Prescription Coverage? This is also creditable coverage.  Therefore, there should be no need to enroll in a Medicare prescription drug plan.

 Employer/Retiree Benefit Plans? First, determine if your coverage is considered to be creditable.  You should have received notification of this from your plan administrator.  If you have not, you should contact them.  If your coverage is deemed creditable, you should not be subject to the penalty in the premium due to delayed enrollment.

 Medicare Supplement Plans H, I, or J? This coverage is most likely not creditable.  Therefore, if you would later enroll in a Part D plan, you would be subject to the penalty in premiums.  Also, if you do enroll in a Medicare Part D plan, you will need to obtain a different Medicare supplement policy. 

 Medicare Advantage Plans? If you have a Medicare Advantage plan (Medicare HMO) and you are going to enroll in a Part D plan, you have to enroll in the plan offered by your Medicare Advantage Plan.  If you choose to enroll in a plan offered by another company, you could jeopardize your health insurance coverage. 

 Dual Eligible? These are recipients eligible for both Medicare and Medicaid benefits.  If you are a "dual eligible" you should have been automatically enrolled in a plan by now.

 If you need help in making a decision about Medicare's new prescription drug coverage, resources are available:

▪ 1-800-MEDICARE

▪ www.medicare.gov

▪ Social Security Administration

▪ Local County Assistance Office

▪ PACE (www.aging.state.pa.us) or 1-800-225-7223

▪  www.paelderlaw.com  

Lisa can be contacted at webmail@paelderlaw.com or at 1-800-401-4552  

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Register for Marshall , Parker & Associates' 10^th Annual Professional Update

 Written By: Melissa Bottorf, Director of Marketing & Public Education

Marshall, Parker & Associates' 10^th Annual Elder Law Update has been slated for Wednesday, May 10^th at the Holiday Inn Downtown in Williamsport and Thursday, May 11^th at the Woodlands in Wilkes-Barre .  Each session begins with breakfast & registration at 7:30 AM .

This will be your opportunity to get the latest information on changes that are of critical importance to seniors and to those of us who provide services to them.  A brochure and agenda are available at www.paelderlaw.com/registration.asp .

The Deficit Reduction Act of 2005 has complicated and limited the transfer of assets by seniors. It is the most significant new development in elder law in over a decade.  Matt Parker, a certified elder law attorney with Marshall, Parker & Associates, will give you an expert overview of the new Act and describe how it will affect Medicaid and estate planning.  Tom Lilly , from Futurecare Associates in Pittsburgh will discuss how the Deficit Reduction Act will increase the importance of long term care insurance as a planning option.

Pennsylvania is also undergoing some new initiatives to provide enhanced services to our seniors.  Kathleen Spacht of PACE, First Health will talk about the state's drug coverage program and the Governor's proposal for PACE Plus Medicare, a program that will work with the Federal prescription drug program to provide even more seniors coverage at about half the price of the current program.

Jim Pezzuti, Director of the Division of Long Term Care Services at the Department of Public Welfare will talk about the Living Independently for Elders Program (LIFE) and how it works at the state level.  The LIFE program will offer seniors age 60 years of age and over who are Medicare & Medicaid eligible comprehensive medical, health & social services. Local representatives of the LIFE program, Shaun Smith from Albright Care Services and Amy Minnich and Maria Hastie from LIFE Geisinger will also be on hand to talk about how the program will be implemented at new local centers in Lycoming and Lackawanna Counties .

The Update is FREE and intended for professionals in the elder care and elder services network such as individuals working in nursing homes, hospitals, assisted living and personal care facilities, area agencies on aging, and county assistance offices.  It will also be of great interest to social workers, insurance and financial planners, accountants, lawyers, and trust officers who work with seniors.

The Northcentral Pennsylvania Estate Planners Council has applied for 3 continuing education credits for attorneys and accountants.

The Professional Update is a DPW-approved training institution for Personal Care Home Administrators.  Please check DPW's website for more information.

The Williamsport session's breakfast is being sponsored by Citizens & Northern Trust & Financial Management Group.  Other sponsors include Outlook Pointe at Loyalsock, LIFE Geisinger, and ManorCare in Williamsport , Sunbury and Jersey Shore .

Register online at www.paelderlaw.com/registration.asp or call

1-800-401-4552.

Melissa can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

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Organ & Body Donations - You Have a Choice

 Written By: Jody A. Lose , Estate Planning Paralegal

Most people already have some knowledge of organ donations.  When you apply for or renew your driver's license or photo ID you are asked if you want to be an organ donor.  Anyone can decide to be a donor.  If you are under age 18, however, you will need the signature of a parent or guardian to have the donor designation placed on your driver's license or photo ID.  You can obtain a separate donor card by calling Gift of Life in Philadelphia toll-free at 1-877-DONORPA (366-6772) or you can go online to www.donatelife-pa.org to obtain more information. They will be offering a secure online donor registration service linked to PennDot starting July 1, 2006 .

 For people who are interested in contributing to scientific study or teaching to promote medical science, your entire body can be donated to the Humanity Gifts Registry in Philadelphia .  The Humanity Gifts Registry is a non-profit agency in the Commonwealth of Pennsylvania that handles receipt and distribution of entire bodies donated to medical and dental schools in the state for teaching purposes.  For more information or to request Uniform Donor Cards you can contact the Registry at 1-215-922-4440.

We are often asked about placing donor information in a person's Last Will and Testament.  This is not the best choice for designating your wishes for organ, tissue and/or body donations since your will may not be reviewed until days or even weeks after you have passed away.  Organ, tissue and/or body donations can be placed in your health care power of attorney, but it is important to discuss with your family members and agents designated in your health care power of attorney what your wishes are for any of these donations.

 People of all ages and medical histories should consider becoming potential donors.  Qualified medical personnel will review the donor's medical and social history to determine what organs and tissues may be able to be donated.  The Registry will make a determination at death for acceptance of remains.  It is only under the most unusual of circumstances that a donor's body would be rejected.

 For more information on the Gift of Life Donor Program, located at 401 N. Third Street , Philadelphia , PA 19123 , call 1-800-DONORS-1 (366-6771) or visit their website at www.donors1.org  

Jody can be contacted at webmail@paelderlaw.com or at 1-800-401-4552  

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What is Sundowning?

Written By: Josephine Reviello , BSW, LPN, Planning Specialist

You may have heard this term used by medical staff in a nursing home or a hospital to describe an elderly resident or patient who is showing increased behavior problems such as agitation, suspicion, disorientation, confusion, wandering, and restlessness, during the evening hours and into the night (hence the term "Sundowning").  These behaviors can be worse or more intense in some people than in others.  Sundowning is not a disease but a symptom that usually occurs in people who have dementia, such as Alzheimer's. According to the Alzheimer's Association, Sundowning is defined as unsettled behavior evident in the late afternoon or early evening.

 

Although, Sundowning seems to result from brain disease, no one is really sure what causes it or why it occurs during the late afternoon and evening hours. However, experts suspect the problem may be due to some of the following factors:

            -Lack of sensory stimulation - the sun is going down and it is becoming darker; the routine daytime activities have slowed down or ceased; there are fewer cues in the environment, with dim lighting and absence of noises from routine daytime activities; things that were familiar appear changed and different.  

            -Lack of a sense of familiarity and security - the understanding of what is happening around them when the evening and night hours approach may cause the person with dementia to become frantic in trying to restore their sense of familiarity and security.  This could be part of the reason why the person would repeatedly ask about "going home" or "finding mother", which may indicate a need for protection or security.

            -Sleep pattern disturbance - The person may sleep all or most of the day, usually in chairs near the nurse's station. This could result from side effects of medication or because it is in the day that they feel secure and safe, so they are able to rest. The person may not be able to distinguish whether it is day or night if there is a disturbance in his/her "biological clock." In contrast, the person may be fatigued and tires at the end of the day and therefore is less able to cope with stress.

The person may be hungry, thirsty, uncomfortable, in pain, or needing to go to the toilet, all of which can only be expressed with agitation and restlessness. 

So, what can you do to lessen or relieve some of these symptoms? Basically, you may have to try several different tactics to find out which ones provide the best response.  Some things you may want to try are:

                    -Keeping the person active in the morning and encourage a rest after lunch. If fatigue is making the Sundowning worse, an early afternoon rest might help.

                    -Don't physically restrain the person. Let them pace where they are safe. A walk outdoors can help reduce restlessness.

                    -Some people are comforted by stuffed animals, pets, hearing familiar tunes or an opportunity to do a favorite pastime.

                    -Consider the effect of bright lights and noise from television and radios.

                    -If late afternoon baths or showers seem to upset the person, try doing these activities during the day.  Unless, the person is calmed by a hot bath before bed.

                    -Nightlights or a radio playing softly may help the person sleep. Some people find warm milk, a backrub or music calming.

-Some may need medication. This will need to be discussed with a doctor.  

Josephine can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

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Richard "Doug" Lane Joins Marshall, Parker & Associates' Staff

Written By: Melissa Bottorf, Director of Marketing & Public Ed ucation  

Marshall , Parker & Associates is pleased to announce the addition of Doug Lane to our staff as a Medicaid Application Specialist.  Doug will primarily be responsible for filing Medicaid applications, collecting the necessary information to accompany the application and overseeing the eligibility process.  

Doug attended the former Lock Haven State College and was active duty in the United States Marine Corps from 1969-1971. Prior to joining Marshall , Parker & Associates, Doug worked as a caseworker at the Lycoming County Assistance Office for twenty-eight years. Fourteen of those twenty-eight years, he specialized in nursing home caseloads.  

 Melissa can be contacted at webmail@paelderlaw.com or at 1-800-401-4552  

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*Attorneys Marshall and Parker are certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.