As I am writing this there is hot debate on whether the Immigration Reform Bill will pass Congress; however, the latest sticking point is when or even if immigrants who are granted permanent status would be granted health benefits. Senate Republicans are advocating that immigrants would be ineligible for federal health subsidies for five years after they become legal residents and House Republicans are advocating that they be required to purchase private health insurance, without access to Federal money. At the same time, many border-state governors are rejecting the implementation of ACA altogether, the effects of which remain uncertain. One thing that is clear is that neither the Senate nor House Immigration Bill will help the uninsured illegal immigrants get health insurance.

Another related Immigration Bill concern is the usage of a National Identification Card, which can be used for identification, medical records retrieval, healthcare monitoring and is tied to the Department of Homeland Security nationwide computer. This is causing both sides to discuss not only the security issue, but the privacy of healthcare information and who will have access. I am not sure if we are quite prepared to turn over our private healthcare information to the government, who will be monitoring our healthcare, could very well be a conflict.

Once again, I say to all of you out there, healthcare certainly affects every part of our life and shapes the national debates in one way or another.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.

The slowing healthcare costs can be attributed, at least in part to, the Affordable Care Act, new policy limitations on the Medicare Part C or Medicare Managed Care Plans, reduced hospital re-admissions and payment changes to healthcare facilities. What impact the Affordable Care Act, which goes into full swing on January 1, 2014, remains to be seen.

Although, this was certainly good news, the Trustees cautioned there is still significant work to be done with respect to Medicare and Social Security, the federally funded programs.  It is well known that the programs are not sustainable in their current forms, especially since there are approximately 10,000 people retiring each day. In even more alarming developments, the Social Security Disability Trust Fund is scheduled to become depleted in 2016. 

If the retirement fund become depleted, it is not likely that benefits will stop completely; Medicare will pay less and less of the projected benefit, based on what is contributed. To fix the Medicare and Social Security Disability solvency issues would include raising the payroll tax or decreasing benefits, two very unpopular political moves that all sides appear reluctant to promote.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, LLP, practicing elder law/probate/disability/wills, trusts and estates, healthcare regulatory, Medicare sppeals, Social Security and general legal practice in both New York and Connecticut.  Email: Mlamagna@hhrls.com, phone: 914-437-5955 www.HHRLS.com for more information.     

What we can expect is TV ads, door-to-door interaction and newspaper advertisements touting the benefits of signing up for the mostly unknown benefits and with healthcare exchanges, which are mostly unknown as well. This can be especially challenging as more than 4 in 10 Americans do not even recognize the law as surviving the Supreme Court. In addition, the success of the program depends on at least 7 million people signing up in the first year, with a majority of those people being younger and well. If more chronically ill people sign up, there can be enormous fiscal implications.

Even more troubling is the impact of the states that haven't fully accepted the law and those ill-equipped to implement. Will people migrate from state to state to obtain insurance, and what would be the eligibility requirements, much like Medicaid eligibility requirements are state based. The good news is that we have the summer to answer some of our questions and come up with a few more.

I would like to know what you think about the advertisement blitz and its effectiveness and your thoughts about people calling and visiting your homes.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing elder law/probate/disability/wills, trusts and estates, health care regulatory, Medicare appeals, Social Security and general legal practice in New York and Connecticut. Contact him at Mlamagna@hhrls.com; 914-437-5955; www.HHRLS.com.

Currently, there are more than 3 million young adults covered under their parent's plans.  Although this group may be covered for comprehensive medical needs, young adults who are covered under their parent's plans find themselves not covered for mental health issues, substance abuse and maternity care, which are common healthcare occurrences in the 26 and under crowd. There may be some hope starting in 2014, health plans will no longer be able to turn people down because they have preexisting medical conditions and with the advent of healthcare exchanges, young people will be free to shop around for individual plans if they don't want to stay on their parent's plan. All non-grandfathered healthcare plans will cover 10 essential health occurrences, including maternity and newborn care, mental health and substance abuse services.

In addition to the comprehensive plans available on the exchanges, young people up to age 30 will have the option of choose a catastrophic plan, which will cover preventive services without any cost sharing and three physician visits after a $6,350 deductible is met.

Of course there are exceptions called grandfathered plans, which you should be aware. Large-group employers are exempt from covering the 10 essential health benefits, which may exempt young people from mental health, substance abuse and maternity care. While Medicaid can be an option for specific care, there are strict income and asset guidelines that must be adhered to, which will make it impossible for most non-disabled working people to qualify.

Even still, many mental health professionals and counselors who provide outpatient services may not take many of the health plans or accept Medicaid. It is vital that you become very familiar with your health plans and know your rights regarding coverage and the appeals process in case you or your children get denied coverage. It is common for bills for these services to be in the tens of thousands of dollars, which many people do not have to pay the hospital bills, especially those 26 and under and their parents.  

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.     

• adult day care costs rose 6.56% to an average daily rate of $65.
• nursing home care private room costs increased 3.6% to $230 per day/ $83,950 per year.
• nursing home care semi-private room rates increased 3.3% to $207 per day/ $75,555 per year.
• home health care costs have remained relatively flat.
• Assisted living care costs increased 4.55% to a national median monthly rate of $3,450.

As you can see the high costs are staggering and increasing each year. It is vital that everyone think about long term care early enough to prepare for the unpredictable future.  Further, long term care insurance is one of many possible solutions; however, it is important to explore each possibility, which also includes utilizing estate and long term care legal and financial planning.  Although, skilled elder lawyers can assist when you are in crisis, i.e. in a facility or hospital, the best plan is to plan early and prepare for the unexpected. 

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, N.Y., on May 16, 2013.

Michael LaMagna is a partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing elder law/probate/disability/wills, trusts and estates, health care regulatory, Medicare appeals, Social Security and general legal practice in both New York and Connecticut.  Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit www.HHRLS.com.     

1. Higher Part B deductibles:  Medicare Part B, which pays for physician and ancillary services, will have an increase of approximately $75, which is a significant increase over the $147 current deductible. This is true despite more than half of Medicare beneficiaries having an annual income of less than $22,500 in 2012;  
2. Home Health Care Visits:  Starting in 2017, new Medicare beneficiaries would be expected to pay $100 for five or more home healthcare visits paid by Medicare if the care was not provided after a hospital or rehabilitation visit;
3. Surcharge for Medigap premiums:  Also starting in 2017, new beneficiaries who purchase the often critical supplemental or Medigap policy, will have a 15% surcharge to discourage over usage;
4. Medicare Part B and Part D premiums to increase for wealthier individuals: Although individuals with incomes above $80,000 and couples who have incomes over $170,000 already pay a larger share of Medicare premiums, the budget calls for higher premiums for those with higher incomes:
5. Doughnut Hole Closing: The good news is that the dreaded doughnut hole would be closing as soon as 2015;
6. Cuts to Healthcare Providers: Hospitals would see the amount of money provided to them because of bad debt slashed by almost two-thirds and the amount paid to teaching hospitals also decreased.

Of course, this is just a snapshot of the proposed budget, but it is vital that all of us take notice of the possible changes and the likelihood that many of these provisions will become enacted and to prepare accordingly.    

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259.  Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut.    Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.     

There are big changes to your Medicare benefit that will assist you to obtain a longer stay at a rehabilitation center or more outpatient therapy. Medicare just settled a lawsuit, Jimmo v Sebelius, which clarifies when a rehabilitation center, home health care or outpatient therapy provider can discontinue services paid by Medicare.

As most readers know, your Medicare Part A benefit pays for rehabilitation after a 3 day hospital stay for a period up to 100 days, day 1 to 20 at 100%, day 21 to 100 at 80% (you are responsible to pay the 20% co-pay of $148/per day or a supplemental plan will cover the daily fee). Prior to the recent settlement of the Jimmo lawsuit, Medicare providers would discharge beneficiaries, thus denying them more services during the 100 days if there wasn't any "Improvement." This rule of thumb "Improvement Standard" meant that the provider would determine that there wasn't any further rehabilitation or restoration potential, leaving the beneficiary to pay privately (at $400 to $500 per day), be discharged or appeal the decision.

Jimmo, which was a class action lawsuit against Medicare based on this very issue, was just settled. Effective immediately, Medicare can no longer deny a claim because of a lack of rehabilitation potential, but is expanded to pay for rehabilitation which prevents or slows further deterioration in a beneficiaries' clinical condition. This new standard will allow many Medicare beneficiaries to continue on with their therapy, even if they do not show restorative potential, but require more time to prevent further physical deterioration. This should save beneficiaries thousands of dollars and more importantly, allow beneficiaries to obtain the therapy they need to prevent them from further harm after discharge.

Therefore, if you are currently obtaining Medicare paid rehabilitation services in a rehabilitation center or at home and you are being discharged because of a lack of improvement, you may be able to stop the discharge by reminding the provider of the new Medicare policy clarification.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

A promissory note allows a nursing home resident to loan a sum of money to another person with specific written repayment terms detailing the interest rate, the amount of principal and interest to be paid each month and the term of the note. This loan must be made in conjunction with a non-exempt transfer or gift of assets which causes a period of ineligibility ("penalty period") for that person. The end result is that the Medicaid applicant should be eligible to receive institutional Medicaid benefits ("Nursing Home Medicaid") upon the expiration of the term of the note and the penalty period, saving almost half of the money they would otherwise be given to the nursing home.

As you can imagine, there have been challenges to this Medicaid loophole. This week a U.S. District Court in Oklahoma upheld a promissory note as a "valid form of Medicaid planning" and the state cannot penalize the applicant for taking advantage of a lawful loophole that Congress has not foreclosed. The result was that the note was not considered a resource and does not subject the Medicaid applicant to a transfer penalty, Lemmons v. Lake (U.S. Dist. Ct., W.D. Okla., No. CIV-12-1075-C, March 21, 2013). I would be happy to explain more about this strategy in a legal consultation.

A better method of preserving assets is to start the Medicaid planning process several years prior to the entrance into a nursing home, however, if you do not have the opportunity to plan ahead, the promissory note is certainly a valid and acceptable Medicaid planning technique, which can save you hundreds of thousands of dollars that would otherwise go to the nursing home.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Health Care Regulatory, Elder Law/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

If you have Medicare, Part A and you are admitted as an inpatient for three overnight stays, on the fourth day your Skilled Nursing Benefit would be active, and if admitted to a nursing facility, Medicare would pay for up to 100 days of rehabilitation and skilled nursing. The benefit period pays 100% of the nursing costs for days 1 to 20 and there is a co-pay of $148 per day from day 21 to 100. This part is relatively uncomplicated; however, this isn't the end of the story.

Whether you are inpatient or outpatient during your stay at the hospital is critical. Although you are staying overnight, that doesn't necessarily mean you are an inpatient, and very often you are considered under Observation, which is outpatient status and not counted toward the three night qualifying stay, thereby costing seniors thousands of dollars for rehabilitation that Medicare would have paid for if the hospital had classified the stay as inpatient. In order to be considered inpatient you must be actually admitted to the hospital with a physician order. You are considered outpatient if your receiving emergency department services, lab tests, x-rays and the physician hasn't written an order to admit.

To protect yourself, you have a right to ask hospital personnel the status of your hospital stay, and if you don't agree, you have a right to appeal any adverse decision; however the appeal time frames are very short, in some cases 48 hours, so make sure you read all the information provided and take notes when talking to hospital staff.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Unfortunately, the disease is quickly growing and a recent report noted the expected number of Alzheimer's cases could triple from 5 million currently to nearly 14 million by 2050, costing an estimated $1.1 trillion. Besides the human toll on the families and the patients, it is an overwhelming cost to the Medicare and Medicaid systems, which pay more than 70% of all related costs. It has been shown that patients with Alzheimer's will spend three times more on healthcare than patients with other types of illnesses. Medicare patients with Alzheimer's and other dementias spend $43,847 on healthcare and long-term care services annually, compared to $13,879 spent by patients without those illnesses. However, that leaves 30% of the overwhelming costs to the individuals.

Because the disease is progressive, early detection is crucial. If you see signs of Alzheimer's, which includes memory loss that disrupts daily life, difficulty completing daily tasks and confusion with time or place, see a physician immediately. In addition, it is critical you get your legal affairs in order, such as the power of attorney and healthcare proxy, so you have the peace of mind that other people are appointed to make decisions even when someone no longer has the capacity to make them. In addition, it is critical to have your finances in order and professionals to assist in obtaining benefits to avoid the overwhelming financial and emotional toll.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Estate Administration/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

The problem arises because the law redefined what employers are responsible to pay for insurance. Under the law, an employer will face a penalty if the premiums are so expensive that a worker would qualify for a subsidy. Subsidies are available for unaffordable coverage, deemed as 9.5% of a worker's household income. The problem is that the benchmark used is cost of an individual policy, not a family policy. Anyone who pays for health insurance knows it is often 3-4 time more expensive for a family policy than an individual, so if you base the calculation on an individual policy, not very many people would qualify for the subsidy and the employers are not responsible to make up the difference.

The numbers certainly are staggering. There are as many as 4 million households, including 500,000 children, affected by this glitch. Using 2011 figures, a family making more than $9,700 per year would be ineligible for a subsidy, while the cost of that plan for a family is actually more than $4,000 per year, far more than most families can afford without some assistance from the employer or the government.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

The new law, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, sets time frames for CMS and Medicare beneficiaries to provide information in cases where a settlement is expected. Under the SMART law, a beneficiary must notify CMS within 120 days of the lawsuit settlement. CMS then has 65 days to tell the parties how much is owed. The agency can request an additional 30 days if necessary. Moreover, if beneficiaries believe the amount posted is wrong, they can provide documentation to CMS, and the agency has 11 days to respond. The law also limits to 3 years the time CMS has to pursue reimbursement.

The previous system not only would cause delays in the settlement process, but affected whether or not a case would even go forward, as most attorney's want the information regarding the Medicare figure prior to taking a case. Moreover, if a case is expected to go to mediation and the mediator doesn't have accurate numbers, a decision cannot be reached.

In addition, the slow reporting process didn't allow for the famous ever-dwindling Medicare Trust Fund to get promptly repaid. In 2011, more than 480,000 new cases were recorded, and CMS realized more than $860 million in payments and savings related to such cases, many months or years longer than they could have. It is expected that the new law will allow for more timely reimbursement. However, with the new time frames, I could foresee a situation where Medicare foregoes its right to be paid back altogether, if they do not pursue reimbursement within 3 years.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder/Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

In early October, CMS settled a class action lawsuit filed by the Center for Medicare Agency and Vermont Legal Aid. According to the settlement, CMS will reverse course and allow Medicare to pay for services "necessary for the performance of a safe and effective maintenance program." In addition, CMS will no longer deny claims because a Medicare beneficiary wouldn't be able to achieve complete independence or because they can no longer return to their prior functioning level.

Under the agreement, CMS will also set up an appeals process, similar to the process currently in place, in which a beneficiary can appeal a denial for a claim, all the up to an impartial Administrative Law Judge. It is expected the new policy revision will enable thousands to gain access to needed skilled care and allows those Medicare providers to continue needed services, in particular, to those with chronic conditions, including Alzheimer's, Parkinson's and multiple sclerosis.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

The premise is that if you increase the age by 2 years, the 3.3 million individuals who would be disqualified would be required to either: 1) pay for coverage out of pocket; 2) go without insurance and pay a fine; 3) rely on employer sponsored insurance; or 4) rely on Medicaid. The proposed result would be a total savings of $5.7 billion; however it is projected to cost the entire healthcare system $11.4 billion dollars in spending.

The spending costs include the cost of seniors paying for replacement plans, fines and costs to employers. The question remains to be seen whether raising the eligibility age would simply shift the costs from the Federal government, who pays for Medicare, to the individuals and ultimately the states (Medicaid costs).

Now, I am not suggesting that raising the age isn't a viable solution; however, I am calling on Washington to carefully consider all of the ramifications of changing the system and ensuring the states will be able to withstand the impact.

Your comments are always appreciated.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

The new Part B cost for the majority of beneficiaries will be $104.90, up from the current $99.90 per month. However, those "high income" beneficiaries, whose income is more than $85,000 for an individual or $170,000 for couples will see an increase of $42 to $230.80 per month. Most beneficiaries will not realize the change because they pay directly from their Social Security check.

In addition, Medicare's hospitalization deductible will increase by $28, to $1,184. The deductible is the amount a person must pay before health insurance kicks in. It is recommended that seniors have supplemental coverage to offset their Medicare hospital deductible.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing health care regulatory, elder /probate/disability/trusts and estates, social security and general legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit www.nyandctlaw.com for more information.