Does Medicare Coverage Apply to COVID-19 Treatment?

The federal government has announced that the treatment will be available with no cost-sharing for patients. Understand current Medicare coverage, and how it applies to COVID-19 treatment payments.

Money Talks News’s recent article entitled “Medicare to Cover New Coronavirus Treatment” says that treatments in settings such as a doctor’s office, nursing home, or infusion center will now be covered without cost-sharing for those with Medicare, the federal health insurance program for seniors and people with certain disabilities.

This COVID-19 coverage (which started on November 10) is for monoclonal antibody infusions in facilities where “safety precautions can be met,” according to the Centers for Medicare & Medicaid Services, or CMS.

This coverage includes having access to medications that can treat anaphylaxis and other severe infusion reactions.

The day before the CMS announcement, the FDA issued an emergency use authorization for an investigational monoclonal antibody therapy for the treatment of mild to moderate cases of COVID-19 in patients at high risk for becoming severely ill, and/or who are likely to require hospitalization. It’s called bamlanivimab.

The CMS announcement is the most recent expansion of Medicare coverage to help treat the disease.

Medicare and private insurance will also pay for any coronavirus vaccine that is approved early.

Medicare is a federal program that provides health insurance to Americans. It’s frequently called Original Medicare. It has two parts—Part A and Part B. Part A covers inpatient hospital and skilled nursing care, and Part B covers doctor visits and outpatient care.

Private Medicare plans are optional and provide more coverage. Medicare Advantage plans (also known as Part C) combine Part A and Part B coverage and may have drug coverage and other benefits you don’t receive with Original Medicare.

Medicare prescription drug plans (Part D) help pay for medications. Seniors can buy a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.

Medicare supplement insurance or “Medigap” helps pay some or all costs not paid by Original Medicare, such as deductibles, copays and coinsurance.

Reference: Money Talks News (Nov. 12, 2020) “Medicare to Cover New Coronavirus Treatment”

You Need a Trust Even When You Aren’t a Billionaire

Trusts are used to solve problems in estate planning, giving great flexibility in how assets are divided after your death, no matter how modest or massive the size of your estate, according to an article titled “3 Reasons a trust may make sense for your family even though your name isn’t Trump, Gates or Rockefeller” from Market Watch. Don’t worry about anyone thinking your children are “trust fund babies.” You need a trust in your estate planning toolkit. Using trusts in your estate plan is a smart move, for many reasons.

There are two basic types of trust. A Revocable Trust is flexible and can be changed at any time by the person who creates the trust, known as the “grantor.” These are commonly used because they allow a high degree of control, while you are living. It’s as if you owned the asset, but you don’t—the trust does.

Once the trust is created, homes, bank and investment accounts and any other asset you want to be owned by the trust are retitled in the name of the trust. This is a step that sometimes gets forgotten, with terrible consequences. Once that’s done, then any documents that need to be signed regarding the trust are signed by you as the trustee, not as yourself. You can continue to sell or manage the assets as you did before they were moved into the trust.

There are many kinds of trusts for particular situations. A Special Needs Trust, or “SNT,” is used to help a disabled person, without making them ineligible for government benefits. A Charitable Trust is used to leave money to a favorite charity, while providing income to a family member during their lifetime. A real estate trust can be used for real property.

Assets that are placed in trusts do not go through the probate process and can control how your assets are distributed to heirs, both in timing and conditions.

An Irrevocable Trust is permanent and once created, cannot be changed. This type of trust is often used to save on estate taxes, by taking the asset out of your taxable estate. Funds you want to take out of your estate and bequeath to grandchildren are often placed in an irrevocable trust.

If you have relationships, properties or goals that are not straightforward, talk with your estate planning attorney about how trusts might benefit you and your family. Here’s why this makes sense:

Reducing estate taxes. While the federal exemption is $11.58 million in 2020 and $11.7 million in 2021, state estate tax exemptions are far lower. New York excludes $6 million, but Massachusetts exempts $1 million. An estate planning attorney in your state will know what your state’s estate taxes are. You need a trust to to protect your assets.

If you own property in a second or third state, your heirs will face a second or third round of probate and estate taxes. If the properties are placed in a trust, there’s less management, paperwork and costs to settling your estate.

Avoiding family battles. Families are a bit more complicated now than in the past. There are second and third marriages, children born to parents who don’t feel the need to marry and long-term relationships that serve couples without being married. Trusts can be established for estate planning goals in a way that traditional wills do not. For instance, stepchildren do not enjoy any legal protection when it comes to estate law. If you die when your children are young, a trust can be set up so your children will receive income and/or principal at whatever age you determine. Otherwise, with a will, the child will receive their full inheritance when they reach the legal age set by the state. An 18- or 21-year-old is rarely mature enough to manage a sudden influx of money. If you want to control how the money is distributed, you will need a trust.

Protect your assets while you are living. Having a trust in place prepares you and your family for the changes that often accompany aging, like Alzheimer’s disease. A trust also protects aging adults from predators who seek to take advantage of them. Elder financial abuse is an enormous problem, when trusting adults give money to unscrupulous people—even family members.

Talk with an estate planning attorney about your wishes and your worries. They will be able to create an estate plan and trusts that will protect you, your family and your legacy.

Reference: Market Watch (Dec. 4, 2020) “3 Reasons a trust may make sense for your family even though your name isn’t Trump, Gates or Rockefeller”

What Percentage of Assisted Living Communities Don’t Provide Mental Health Services?

Assisted living communities and other residential care communities are more and more becoming the setting for care of older adults with Alzheimer’s disease and other dementias, according to a new report. More so, these communities struggle with suitable access to mental health services.

That report is based on data from the 2016 wave of the biennial National Study of Long-Term Care Providers.

McKnight’s Senior Living’s recent article entitled “More than 40 percent of assisted living communities do not provide mental health services: CDC” reports that in 2016, 41.9% of assisted living community residents had diagnosed dementia, according to the authors. A total of 30.9% of assisted living residents had depression.

Mental health services are not provided at nearly half of communities (49.4%) where more than 75% of residents have been diagnosed with dementia. In addition, in 42.6% of communities there are 25% to 75% of residents who have been diagnosed with dementia, and 44.5% of communities where less than 25% of residents have been diagnosed dementia, the authors said.

In a quarter of assisted living communities across the country, over 75% of residents had diagnosed Alzheimer’s disease or other dementias. Most of those communities (90.5%) were found in metro areas, compared with communities with lower percentages of residents with dementia.

Communities where more than 75% of residents had dementia were most likely to have four to 25 beds (77.5%) compared with 26 to 50 beds (11%) or more than 50 beds (11.6%).

Residents in communities where more than three-quarters of residents had dementia saw an average of 33 more minutes of aide time and 10 more minutes of activities staff time, compared with communities where fewer of the patients suffered from dementia.

However, assisted living communities with the highest prevalence of dementia also had the highest prevalence of depression (38.7%).

However, the rate of depression was 32.3% in communities where 25% to 75% of residents had dementia and was the lowest, 25.3%, in communities where dementia was diagnosed in less than 25% of residents.

A few of the organizational and staffing characteristics vary based upon the prevalence of residents with dementia, which may help give providers, policymakers, researchers and consumer advocates data concerning the differences among assisted living communities. Understanding these unfortunate realities may pave the way for improvements to be made.

Reference: McKnight’s Senior Living (Dec. 7, 2020) “More than 40 percent of assisted living communities do not provide mental health services: CDC”

Talk to a Parent Suffering from Dementia during the Pandemic

If you have a parent living in an assisted living facility or a nursing home, or they’re at home, caregivers need to know how to explain the current coronavirus pandemic in an appropriate and clear manner—and in a way that protects and cares for your own personal health. With the busy holiday season behind us, you may have noticed new struggles with your parents.

Long Island Weekly’s recent article entitled “Caregiving During The Coronavirus” explains that older adults often have more health complications, like heart disease, diabetes and hypertension. As a result, they’re more susceptible to the complications of the coronavirus. Review the recommendations of the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) for protecting you and your family, especially your elder parents, from exposure.

And although some people suffering from Alzheimer’s or dementia may not fully understand the complexity and severity that the COVID-19 pandemic is having on our communities, they can sense what’s happening. They can read your personal energy and can sense your stress. This may cause them to show more symptoms of anxiety, agitation, cognitive decline and confusion. Communicate as best you can to your parent frequently and clearly about what’s happening. While they may not need to have all the details, let them know that there’s a virus spreading within the community and that we need to wash our hands thoroughly and stay indoors.

For those still being cared for at home, take the necessary precautions as you’d do for yourself. Modify your grocery shopping trips, since stores are adding special senior hours, reschedule unnecessary doctor visits, stock up on needed medications and talk to your doctors about any concerns.

For those in a facility, understand the visitation policies, because many have adjusted their policies to limit or prohibit personal visitation. Ask the administration about visitation and what your parent’s care facility is doing to ensure for proper care.

Although you might be frustrated that your parent’s facility is limiting or cancelling visitation, remember that the new rules are designed to protect the residents. You may be able to schedule a time to speak with your mother or father on the phone every few days, or you can deliver food or items, like photos albums or other gifts to stay connected. Try to be reasonable and understand that these facilities may be understaffed.

Here are a few key points that may be helpful to get through this crisis:

  • Have a talk with your parent and with the facilities in which they’re living, so they can understand the new policies.
  • Be careful yourself. Take reasonable precautions for yourself and your family member.
  • Avoid public spaces. This includes routine, or non-essential doctor visits, grocery shopping and other visits.
  • Stay upbeat. Know the latest news and guidelines but try to remain calm, because your parent may sense your stress and reflect that.

Be reasonable and understanding and try your best in these uncertain times—for yourself and your parents.

Reference: Long Island Weekly (April 12, 2020) “Caregiving During The Coronavirus”

Will the Pandemic Affect My Social Security?

Kiplinger’s recent article entitled “Social Security Shocker: Pandemic to Reduce Benefits by 9% for Americans Turning 60 in 2020” explains that retirees can mitigate some of the damage, by waiting to claim their benefits. For every year you delay benefits past your full retirement age until age 70, you’ll receive an increased benefit of about 8%.

Eligibility for Social Security benefits requires a senior to have earned no less than 40 “credits.” You can earn up to four credits a year, so it takes 10 years of work to qualify for Social Security benefits. In 2020, you have to earn $1,410 to get one Social Security work credit and $5,640 to get the maximum four credits for the year.

Your benefit is based on the 35 years in which you earned the most amount of money. If you have fewer than 35 years of earnings, each year with no earnings is calculated as a zero. You can increase your benefit by swapping out those zero years, by working longer, even if it’s only part-time. However, don’t worry about a low-earning year replacing a higher-earning year. It won’t happen. The benefit isn’t based on 35 consecutive years of work, it’s based on your highest-earning 35 years. As a result, if you decide to ease into retirement by working part-time, you won’t wreck the amount of your Social Security benefit at all, if you have 35 years of higher earnings. If you earn more money, however, your benefit will be adjusted upward—despite the fact that you’re still working while taking your benefit.

There is a maximum benefit amount you can get. However, it depends on your age when you retire. If you retire at full retirement age this year, the maximum monthly benefit is $3,790.

In the past, a great perk of Social Security benefits was that every year, the government would adjust the benefit for inflation. This is called a cost-of-living adjustment, or “COLA.” It’s an inflation protection to help seniors keep up with rising living expenses during retirement.

The COLA is automatic and is quite valuable because purchasing inflation protection on a private annuity can be expensive.

The COLA is calculated based on changes in a federal consumer price index (CPI). The amount of the COLA depends largely on broad inflation levels determined by the federal government.

For 2021, Kiplinger anticipates that there won’t be a Social Security cost of living adjustment. That is due to the COVID-19 pandemic.

Reference: Kiplinger (July 30, 2020) “Social Security Shocker: Pandemic to Reduce Benefits by 9% for Americans Turning 60 in 2020”

What are Young People Doing to Help Seniors in Isolation?

With the pandemic continuing to be a part of our world, family caregivers are increasingly concerned about loved ones isolated at home or in facilities.

Many seniors and their family caregivers have little human interaction in “normal” times, and the pandemic makes it even worse.

Research shows that isolation and loneliness are as detrimental to health as smoking 15 cigarettes a day, says AARP’s recent article entitled “Teens Reach Out to Isolated Older Americans Through Online Programs.”

However, some new programs and approaches that have come about in the coronavirus quarantine can have a positive impact far beyond the pandemic. Young people have become pivotal in helping alleviate the lonesome burden for our seniors. Let’s look at three virtual intergenerational programs that bring hope for the future.

Music and Games to Brighten Spirits. Fifteen-year-old Maya Joshi and her twin sister, Riya, started daily video calls with their grandparents when the pandemic took hold. Seeing how much their grandparents enjoyed it, Maya decided to do something to help other isolated older adults. She launched Lifting Hearts with the Arts in April. The intergenerational program involves young teen volunteers connecting online with senior residents in 17 Illinois nursing homes and assisted living facilities. They present musical performances, games and 1:1 video chats.

These virtual activities are making a significant impact and are improving the senior residents’ moods, said the director of programming at a nursing home in Springfield, Illinois. After one resident grew more comfortable with the technology, she began initiating video calls with her friends and family. These seniors now have something to look forward to and they like seeing young smiles on the screen.

Meals and conversation To Eliminate Loneliness. The Los Angeles-based Youth Movement Against Alzheimer’s (YMAA) YouthCare program, in partnership with the University of Southern California, has been training their young students to provide in-home nonmedical respite and cognitively stimulating activities for people living with dementia.

The program was suspended when the COVID-19 lockdown began. As a rapid response to the pandemic, YMAA reached out to their chapters in high schools and college campuses across the country to create Meals Together. It’s a program where young students have virtual visits during mealtime with those in early stages of dementia and their caregivers.

In only three months, 39 YMAA chapters are participating in the expanding program. They now serve 175 senior users. They partner with nonprofits, like Meals on Wheels and assisted living facilities, to identify older participants. Seniors can also sign up on their own.

Natashia Townsend, YMAA’s director of caregiving programs, says they describe the program to participants in early stages of dementia as a way to help the students as they prepare for their careers. “It makes them feel empowered to help someone else,” Townsend explains. The youth volunteers also find it rewarding. “It’s just a great way to connect, and a lot of our seniors are feeling lonely at this time; they just want to feel like they have a friend,” she says.

Reference: AARP (July 27, 2020) “Teens Reach Out to Isolated Older Americans Through Online Programs”

Does a ‘Senior Moment’ Mean Alzheimer’s?

When your memory starts to waver, its easy to assume the worst, even Alzheimer’s disease. Considerable’s recent article entitled “What it means when you can’t remember a word” says on its own, sometimes forgetting a word is a completely normal part of life. Whew! Psychologists call this experience “tip of the tongue” state. When you forget a word, it hasn’t disappeared from memory. Actually, it is still there, but in the moment of speaking something is preventing it from being fully accessed.

What prevents the retrieval of a word? A word is a collection of features: it has a meaning and associated meanings and images. It has a form, which includes its pronunciation, a written representation and a syllable and stress pattern. Psychologists also say it leaves traces in neural connections of how frequently or recently it’s been used. Word retrieval might be disrupted by an issue in activating one or just a few of those features. Stress, fatigue and distraction can also all result in insufficient activation for retrieval.

More serious issues that damage or slow the necessary neural connections can also cause problems for word retrieval, most notable Alzheimer’s disease. The inability to find words can also signal brain injury or infection, strokes and degenerative diseases. However, in those cases, word-forgetting will be only one of many symptoms. By itself, forgetting a word once in a while is a completely normal part of life.

Forgetting a word can be annoying. However, the situation usually resolves itself quickly.

Word-forgetting can cause seniors a special kind of distress. That’s due to the fact that they worry more about what it means about the health of their memory.

Some memory functions do decline with age and are signals of Alzheimer’s or other problems. However, tip of the tongue states are independent of that type of cognitive decline.

In a study of age-related increases of tip-of-the-tongue states showed that “even though increased age is associated with lower levels of episodic memory and with more frequent TOTs [tip of the tongue states], which can be viewed as failures to access information from memory, the two phenomena seem to be largely independent of one another.”

In other words, your failure to remember a word isn’t a general memory problem in most cases. It is just a failure to remember a word.

Regardless whether your memory and mental state is in tact or wavering, prepare for whatever the future holds with careful estate planning and elder care considerations.

Reference: Considerable (July 13, 2020) “What it means when you can’t remember a word”

What’s Involved in the Probate Process?

SWAAY’s recent article entitled “What is the Probate Process in Florida?” says that while every state has its own laws, the probate process can be fairly similar. Here are the basic steps in the probate process:

The family consults with an experienced probate attorney. Those mentioned in the decedent’s will should meet with a probate lawyer. During the meeting, all relevant documentation like the list of debts, life insurance policies, financial statements, real estate title deeds, and the will should be available.

Filing the petition. The process would be in initiated by the executor or personal representative named in the will. He or she is in charge of distributing the estate’s assets. If there’s no will, you can ask an estate planning attorney to petition a court to appoint an executor. When the court approves the estate representative, the Letters of Administration are issued as evidence of legal authority to act as the executor. The executor will pay state taxes, funeral costs, and creditor claims on behalf of the decedent. He or she will also notice creditors and beneficiaries, coordinate the asset distribution and then close the probate estate.

Noticing beneficiaries and creditors. The executor must notify all beneficiaries of trust estates, the surviving spouse and all parties that have the rights of inheritance. Creditors of the deceased will also want to be paid and will make a claim on the estate.

Obtaining the letters of administration (letters testamentary) obtained from the probate court. After the executor obtains the letter, he or she will open the estate account at a bank. Statements and assets that were in the deceased name will be liquidated and sold, if there’s a need. Proceeds obtained from the sale of property are kept in the estate account and are later distributed.

Settling all expenses, taxes, and estate debts. By law, the decedent’s debts must typically be settled prior to any distributions to the heirs. The executor will also prepare a final income tax return for the estate. Note that life insurance policies and retirement savings are distributed to heirs despite the debts owed, as they transfer by beneficiary designation outside of the will and probate.

Conducting an inventory of the estate. The executor will have conducted a final account of the remaining estate. This accounting will include the fees paid to the executor, probate expenses, cost of assets and the charges incurred when settling debts.

Distributing the assets. After the creditor claims have been settled, the executor will ask the court to transfer all assets to successors in compliance with state law or the provisions of the will. The court will issue an order to move the assets. If there’s no will, the state probate succession laws will decide who is entitled to receive a share of the property.

Finalizing the probate estate. The last step is for the executor to formally close the estate. The includes payment to creditors and distribution of assets, preparing a final distribution document and a closing affidavit that states that the assets were adequately distributed to all heirs.

Reference: SWAAY (Aug. 24, 2020) “What is the Probate Process in Florida?”

Estate Planning for a Second Marriage

It takes a certain kind of courage to embark on a second marriage, even when there are no children from prior marriages. Regardless of how many times you walk down the aisle, the recent article “Establishing assets, goals when planning for a second marriage” from the Times Herald-Record advises couples to take care of the business side of their lives before saying “I do” in a second marriage. Changing the dynamic of your family calls for changes to your estate plan.

Full disclosure of each other’s assets, overall estate planning goals and plans for protecting assets from the cost of long-term care should happen before a second marriage. The discussion may not be easy, but it’s necessary: are they leaving assets to each other, or to children from a prior marriage? What if one wants to leave a substantial portion of their wealth to a charitable organization?

The first step recommended with remarriage is a prenuptial or prenup, a contract that the couple signs before getting married, to clarify what happens if they should divorce and what happens on death. The prenup typically lists all of each spouses’ assets and often a “Waiver of the Right of Election,” meaning they willingly give up any inheritance rights.

If the couple does not wish to have a prenup, they can use a Postnuptial Agreement (postnup). This document has the same intent and provisions as a prenup but is signed after they are legally wed. Over time, spouses may decide to leave assets to each other through trusts, owning assets together or naming each other as beneficiaries on various assets, including life insurance or investment accounts.

Without a pre-or postnup, assets will go to the surviving spouse upon death, with little or possibly nothing going to the children.

The couple should also talk about long-term care costs, which can decimate a family’s finances. Plan A is to have long-term care insurance. If either of the spouses has not secured this insurance and cannot get a policy, an alternate is to have their estate planning attorney create a Medicaid Asset Protection Trust (MAPT). Once assets have been inside the trust for five years for nursing home costs and two-and-a-half years for home care paid by Medicaid, they are protected from long-term care costs.

When applying for Medicaid, the assets of both spouses are at risk, regardless of pre- or postnup documents.

Discuss the use of trusts with your estate planning attorney. A will conveys property, but assets must go through probate, which can be costly, time-consuming and leave your assets open to court battles between heirs. Trusts avoid probate, maintain privacy and deflect family squabbles.

Creating a trust and placing the joint home and any assets, including cash and investments, inside the trust is a common estate planning strategy. When the first spouse dies, a co-trustee who serves with the surviving spouse can prevent the surviving spouse from changing the trust and by doing so, protect the children’s inheritance. Let’s say one of the couple suffers from dementia, remarries or is influenced by others—a new will could leave the children of the deceased spouse with nothing.

Many things can very easily go wrong in second marriages. Prior planning with an experienced estate planning attorney can protect the couple and their children and provide peace of mind for all concerned.

Reference: Times Herald-Record (Sep. 21, 2020) “Establishing assets, goals when planning for a second marriage”

Can I Afford In-Home Elderly Care?

Staying in-home long-term isn’t always affordable, according to a recent US News and World Report article. The article, entitled “Can You Afford In-Home Elderly Care?”, says about 80% of seniors are concerned about being able to afford in-home health care costs, based on a 2019 SCAN Health Plan survey. Paying for personalized in-home elderly care can add up quickly and isn’t always easy on a senior’s tight income.

If you’re thinking about in-home elderly care, review these criteria to determine what costs to expect and the different payment options available for this type of care.

Find Out the Services Included in In-Home Care for the Elderly. In-home care can vary a lot, depending on your health conditions and needs. You might get helpers if you’re recovering at home from an illness or injury, and you could also have home care workers help you with daily activities, such as preparing meals and personal hygiene. Home care services often include rides to and from appointments, monitoring heart rate and blood pressure and in-home physical and cognitive therapy sessions.

Think about the Level of Care Needed. If you can do most daily activities on your own, but could use help with certain activities, such as cooking or cleaning, home care might be a wise option. In-home care is focused on the service, and it’s supposed to help those who are living on their own as long as possible. When more care is required, moving to a place with more health support may be necessary. Elderly persons who have significant needs may often look to assisted living as an alternative. Assisted living facilities offer more services, like 24-hour emergency care and ongoing supervision for seniors with Alzheimer’s, dementia, or other disabilities.

Check Out the Cost of In-Home Senior Care. Homemaker services cost about $22.50 per hour on average and include tasks to help a person with daily duties like laundry, grocery shopping and light housework. An in-home health aide charges an average of $23 per hour, and may help with administering medicine at scheduled times, supervising and monitoring chronic illnesses and helping with walking aids. Of course, the exact cost of these services depends on where you live and the amount of help you need. The monthly cost for in-home care ranges from $4,290 for homemaker services to $4,385 for home health aide care. This typically costs more than the monthly median cost for an assisted living facility—but less than the median cost per month for a room at a nursing home facility.

Know Your Insurance Coverage. If you’re on Medicare, you may be able to get coverage for some short-term home services. To do so, a doctor will need to indicate that skilled nursing care is needed for a short period of time. Medicare will cover speech therapy, occupational therapy, or physical therapy. You can also use it to help with the purchase of durable medical equipment and safety additions to your home. However, Medicare won’t typically cover long-term in-home care services.

Medicaid will cover some health services at home, like cleaning and meal preparation, rides to and from medical visits and personal care. The Programs of All-Inclusive Care for the Elderly (PACE) is available in some states, if you have Medicare or Medicaid. It provides some care and services in the home to elderly persons who need a nursing home level of care. If you have long-term care insurance, some in-home services may be covered by your policy.

Look at Other Payment Methods. If your insurance won’t cover in-home care, you might have to pay out-of-pocket. One way to lower costs, is by asking family members to help. If you need to hire more help over time, the cost for services will increase accordingly. If that doesn’t work, they may help pay for in-home elderly care. You can also look at a reverse mortgage, which lets you borrow against your home’s value.

Reference: US News and World Report (June 10, 2020) “Can You Afford In-Home Elderly Care?”