Finkel & Fernandez, LLP

What are the Medicare Premiums for 2016?

What are the Medicare deductible and coinsurance amounts for 2016?

When can I enroll in, or change, my Medicare Part D coverage?

What is the difference between a "will" and a "trust"?

I am settling a lawsuit and am a recipient of SSI and Medicaid benefits. How can I protect these funds so I do not lose my benefits?

What are the asset and income allowances and differences between Supplemental Security Income [SSI] and Social Security Disability Income [SSDI]?

What is a Geriatric Care Manager, and should I consider hiring one for my parent?

What are the Medicare Premiums for 2016?

Medicare Part A (Hospital Insurance): Most people do not pay a monthly Part A premium because they or their spouse paid Medicare taxes while working. For those who must buy Part A, the monthly premium will be a maximum of $411.00 per month. In most cases, if you choose to buy Part A, you must also have Medicare Part B, and pay monthly premiums for both.

Medicare Part B (Medical Insurance): Most beneficiaries will pay a $104.90 per month premium in 2016. Those beneficiaries for whom the Social Security Administration currently withholds their Part B premium, and have incomes of $85,000 or less [$170,000 or less for joint filers] will pay $121.80 in 2016. If your income is above $85,000 [single] or $170,000 [married filing joint], then your Medicare Part B premium may be higher than $121.80 per month.

What are the Medicare deductible and coinsurance amounts for 2016?

Part A: [Inpatient hospital, skilled nursing facility, and some home health care benefits] During each benefit period, Medicare will pay all Part A covered costs minus the Medicare Part A 2016 deductible of $1,288 for a hospital stay of 1-60 days. For hospital stay days 61 – 90, the coinsurance rate/deductible will be $322 per day. For days 91-150 of a hospital stay, the coinsurance rate/deductible will be $644 per day [lifetime reserve days]. For admission in a skilled nursing facility for skilled nursing care or rehabilitation, the deductible is $161.00 per day for days 21 through 100 each benefit period, with no deductible for days 1-20.

Part B: [Medicare eligible physician services, outpatient hospital services, limited home health services, durable medical equipment]. The deductible in 2010 will be $166.00 per year, with a coinsurance payment of 20% of the Medicare-approved amount for services [after you meet the $166.00 deductible].

When can I enroll in, or change, my Medicare Part D coverage?

October 15 through December 7 is the open enrollment for Medicare Part D.

What is the difference between a "will" and a "trust"?

Both a will and a trust are estate planning tools. The main difference between the two is that a will goes into effect only after you die, while a trust can come into effect after you die or it can be created to take effect during your, or another beneficiaries lifetime.

A will directs who is to receive your property after you die. A will covers only property which is titled in your name alone at your death, and not property held in joint tenancy or in a trust, unless otherwise designated. A will allows you to appoint one [or more] legal representative, known as an “executor or executrix”, to carry out your directions.

A trust, on the other hand, allows you to appoint one or more trustees [persons or an institution, often a bank or financial management firm] to distribute trust property during life, at death or thereafter. A trust is a legal arrangement where the trustee[s] hold legal title to property for the trust beneficiary. Only property that has been transferred to the trust, and is therefore titled in the name of the trust, will be controlled by the terms of the trust.

Another significant difference between a will and a trust is that a will passes through probate after your death. The surrogates court oversees the probate of the will, ensures its validity, and ensures that the property is distributed according to the terms of the will. A will becomes a part of the public record in the county clerk’s office.

By contrast, a trust not established through a will passes outside of probate, in most cases without any court oversight, saving time and expense, and therefore remains private.

There are advantages and disadvantages to both wills and trusts, and together, both can work to create a complete estate plan.

I am settling a lawsuit and am a recipient of SSI and Medicaid benefits. How can I protect these funds so I do not lose my benefits?

If you are a disabled person under age 65 receiving Medicaid and or Supplemental Security [SSI] benefits and you are about to receive a personal injury award, you may lose both Medicaid and SSI benefits unless the settlement proceeds are properly protected by a Special Needs Trust. A First Party/Payback Special Needs Trust [SNT] is established by a parent, grandparent, guardian or the Court and is funded with the settlement proceeds so that you, the disabled person, can continue receiving the monthly [SSI] allowance and or Medicaid health insurance benefits going forward. It is important to know that this type of SNT requires a pay back to Medicaid after the trust beneficiary dies or the trust otherwise terminates. The payback is only for the medical costs that Medicaid has actually paid, without interest, and only to the extent that there are any funds remaining in the trust at that time.

Prior to funding the trust, all monies spent by Medicaid between injury and settlement on medical benefits [the amount of the “Medicaid lien”], but not on lost wages, pain and suffering, must be repaid. Then, the remaining settlement funds are placed into an approved payback SNT. By protecting the proceeds of a personal injury or malpractice settlement with an SNT, you, the beneficiary, retain your future Medicaid and SSI benefits. The SNT assets must only be used to supplement, not supplant, the benefits provided to you by Medicaid and SSI, must be for your sole use and benefit, and are reviewed by the Department of Social Services annually. Allowed SNT expenses include payments for your education, entertainment, medical providers who don’t accept Medicaid, travel, clothing, transportation, computers, technology, food, shelter, and many other items. If you are also receiving SSI benefits, payment for food and shelter will reduce your SSI benefits by up to one third of the benefit amount. There is no similar reduction for Medicaid.

To determine if you need a SNT you must make certain whether you get SSDI or SSI. If you are not certain, you should get written documentation by requesting a proof of income letter from the Social Security Administration. Unlike clients on SSI, clients who get Social Security Disability Income [SSDI] do not need a SNT when they obtain a personal injury or similar settlements to protect their SSDI benefits.

What are the asset and income allowances and differences between Supplemental Security Income [SSI] and Social Security Disability Income [SSDI]?

Supplemental Security Income [SSI] is a public benefits program which limits income to $733 per month [2016 Federal level].

Social Security Disability Income [SSDI] is an entitlement program for workers who have paid into Social Security for at least 40 quarters [10 years]) and, unlike SSI, has no income limit. Monthly income payments from the SSDI program is based on a worker’s lifetime contributions to Social Security, and acts as an insurance benefit paid to medically qualified people regardless of financial need.

Supplemental Security Income [SSI] beneficiaries may not have cash assets and accounts greater than $2,000. All disabled people receiving SSI are eligible to receive Medicaid.

Social Security Disability Income [SSDI] beneficiaries, unlike SSI recipients, have no asset limit and can receive benefits, if eligible, regardless of the assets they own. All SSDI disabled workers can receive Medicare insurance after a 24 month waiting period.

What is a Geriatric Care Manager, and should I consider hiring one for my parent?

Geriatric Care Managers [GCMs] are elder care specialists who are typically licensed professional social workers, nurses or therapists. GCMs are trained to provide an objective, comprehensive assessment of the senior in his/her home environment in order to provide a plan of care in order to assist the person and family in improving the person’s safety, socialization, medical care, living situation, support network and quality of life. GCMS are trained to evaluate and assess the senior’s capabilities, functionality, home and social environments. The GCM’s goal is to create an individualized plan to address the needs of the particular person so as to enrich his/her life as well as to fill in any gaps in the senior’s ability to meet his/her needs and activities of daily living. An assessment of the person in their home environment is done, safety measures and changes recommended, programs and resources discussed, and a comprehensive plan devised to provide an understanding of what is required to help the senior remain as safe and independent as possible in the home environment, if possible. GCMs should be knowledgeable about the available community resources that address the social, financial and medical needs of the senior population and should be able to make appropriate referrals to fill the senior’s needs. After an initial assessment, GCMs can be hired to help arrange for any necessary services as well as to monitor on-going and often changing needs.