Medicare and Medicaid

Medicaid

The Law Offices of Linnea J. Levine, P.C. assists families with the daunting task of planning for Medicaid coverage. Income and asset amounts play a critical role in the ability to qualify for benefits. If an individual's income exceeds a certain amount, alternative planning devices must be implemented in order to qualify for Medicaid. Many legal remedies and solutions are available to overcome the stringent guidelines required for Medicaid eligibility. Our lawyers evaluate and assess each situation in an effort to simplify the application process and preserve assets for the individual's family. We also assist clients with difficult and time-consuming decisions surrounding appropriate placement for family members utilizing Medicaid benefits. We work closely with hospitals, geriatric physicians, and social workers as well as representatives from nursing homes, assisted living facilities, and personal care homes throughout Connecticut and New York. We help families assess which type of facility best suits their loved one's needs, verify that appropriate state licensing is in place, and help obtain services or products necessary for on-going care. Areas of practice include:

• Asset transfers and preservation
• Medicaid eligibility
• Spousal support
• Medicaid applications
• Medicaid hearings and appeals
• Compliance and recertification

The following documents are required for Medicaid

1. Birth Certificate
2. Proof of residential address, e.g. lease or utility bill
3. Social Security cards or annual award letter showing social security number
4. Medicare cards and any other health insurance cards
5. Current Income
   1. Copy of social security and/or pension check
   2. IRAs or Keoghs
   3. Interest earned in 2001
   4. Other income, i.e. rents or mortgages
6. Copies of bank account statements for the last thirty-six (36) months on which applicant's name appears:
   1. Verification of all deposits and withdrawals of $1000.00 or more. Applicant will need to show where the money came from for deposits, and where it was disbursed to for withdrawals.
7. Stocks, bonds, certificates owned by you within the last thirty-six (36) months
8. Life insurance
   1. Policies, or
   2. Last statement from Life Insurance Company(s)
9. Burial plot and funeral plan, if any*
10. Income Tax Returns for the past three (3) years

* Applicant may purchase an irrevocable pre-need funeral agreement with the funeral home of your choice for any amount

Medicare

Medicare is a federal insurance program for people age 65 and older and certain disabled people. Medicare typically covers hospital, skilled nursing facility, home health and hospice care, as well as doctor services, outpatient hospital services, and a number of other medical services and supplies. Medicare also provides limited coverage for preventive services. Medicare is not provided free of charge, and requires cost sharing in the form of premiums, deductibles, and coinsurance. Our law firm assists clients with the following:

• Medicare eligibility
• Medicare appeals
• Medicare claims
• Prescription drug discount provisions

CHANGES IN THE LAW

MEDICARE PART D - THE DRUG PLAN
By Linnea J. Levine, J.D., CELA

As of November 15, 2005, Medicare eligible individuals can enroll in one of many prescription insurance plans subsidized by the federal government.  The plans offered come in two varieties:

1. Stand alone prescription plan (PDP) to supplement existing health insurance - either Medicare or a private insurance.
   
2. Comprehensive health plan such as a health maintenance organization (HMO) or a preferred provider organization (PPO).

The subsidized prescription plans must meet or exceed the basic guidelines below:

Enrollees may be charged:

1. A monthly premium (the average premium appears to be $35.00);
   
2. The first $250.00 for prescriptions;
   
3. 25% of the annual cost from $251.00 to $2,250.00;
   
4. 100% of the cost from $2,251.00 - $5,100.00;
   
5. 5% or less of annual prescription costs above $5,100.00.

Medicaid recipients and low income enrollees may have their premiums and co-pays paid by the government depending upon the plans chosen.  Some plans will cover the gap between $251.00 through $2,250.00, but likely with a higher monthly premium.

In addition to cost, there are serious pitfalls to avoid in selecting a plan:

1. Each plan has its own "formulary" which is the list of drugs covered under the plan.  A cost-savings plan may not cover the most expensive essential drug prescribed to an enrollee;
   
2. Plans which are heavily subsidized by the government may require the enrollee to replace Medicare Part A and B Coverage with enrollment in an HMO.  This is a serious issue because of the medical treatment pre-approval requirements of the HMO and the add-on costs of seeing medical specialists out of the HMO's network;
   
3. Plan enrollment after May 15, 2006 will result in a higher premium.

Some recommendation steps in choosing a plan:

1. Ask your pharmacist for a printout of all of your prescriptions and the uninsured cost of each.
   
2. Bring the prescription list to your treating physicians and ask which prescriptions are essential to your health and which prescriptions can be substituted with either the generic form of the drug, an over the counter substitution, or a less expensive brand.
   
3. Carefully check the formularies offered by the drug plan under consideration to assure all of your prescriptions, or at least your most expensive prescriptions are covered.
   
4. If Medicare is your primary insurance, consider the stand along drug plans first before the drug/HMO plans.
   
5. In computing cost, consider the following:
   • Plan premium amount;
   • Plan deductible and co-pays;
   • Gap coverage for the 100% cost of drugs between $2,251.00 and $5,100.00;
   • Cost of prescriptions;
   • Prescription coverage under your existing health insurer.
     
6. If you have a Medigap policy with drug coverage, see if the drug benefit meets the government guidelines.  If your Medigap plan does not meet the guidelines, you can keep the Medigap medical coverage, but drop the Medigap drug coverage and replace it with a Medicare Part D stand alone plan.
   
7. If you have private health insurance through an employer or through union retiree benefits and are eligible for Medicare as a second insurance, compare your existing prescription plan to the new Medicare Part D plans to see if better drug coverage is available.
   
8. If you are married and your monthly income is less than $1,604.00 or if you are single and your monthly income is less than $1,197.00, you qualify for a low-income subsidy.
   
9. If you are an eligible recipient of state pharmaceutical programs such as EPIC in New York or ConnPace in Connecticut, your state should be notifying you of any change in your prescription benefits.

MEDICARE PART D - SELECTION WEB RESOURCES:

• medicareright.org    - This is the website of the Medicare Rights Center which frequently posts updates on the Medicare Part D program.
• shiptalk.org    - This website lists the contact information for each State Health Insurance Assistance Program which provides one-on-one counseling.
• eldercare.gov   - Lists state and local community based organizations for the elderly.

Connecticut SHIP Provider:

 The Choices Program
 25 Sigourney Street
 10th Floor
 Hartford, CT
 860-424-5322

New York SHIP Provider:

 Contact:  e-mail - rkitazawa@medicarerights.org
     Telephone:  212/689-3850 or 800/333-4114

New York Agency on Aging

 Address:
 2 Empire State Plaza
 5th Floor
 Albany, NY 12223

 e-mail - nysofa@ofa.state.NY.US

The Law Offices of Linnea J. Levine, P.C., serving the elderly and disabled in New York and Connecticut, is available to assist our clients in resolving issues they may have regarding Medicare Part D coverage.  Please contact us at 203-557-0850 or 914-481-5555.

We have helped many people in your situation, and we can help you.

Please contact Medicare and Medicaid eligibility attorney Linnea Levine today. For immediate assistance call us at 203-557-0850 or 914-481-5555.

We welcome clients in Fairfield County, CT and Westchester County, NY, including Stamford, Harrison, White Plains, Greenwich, New Canaan, Darien, Westport, Bedford, Katonah, New Rochelle and Scarsdale.