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ElderLaw News

ElderLaw News is a weekly e-newsletter that brings you reports of legal developments and other trends of vital interest to seniors and their advocates. This newsletter is brought to you by The Estate Planning & Elder Law Firm, P.C., William S. Fralin, Esq., President.

The Pitfalls of Medicare

Medicare can be a wonderful benefit for those 65 and older. However, Medicare eligibility rules can be very complicated, and you may feel that you're in a trap more complicated than running the gauntlet in medieval times.

There are many factors which influence Medicare eligibility, such as: "whether or not you have medical coverage from a current employer, are covered by a spouse's plan, or have retiree health coverage from a former employer." (Ellen Schultz, "How to Avoid Medicare Land Mines," The Wall Street Journal, July 13, 2012).

So how can one best avoid these pitfalls? Careful planning, as with most things, is the answer. Medicare does provide a website which may help to answer some questions, but there are so many variables that it is really best to seek help from someone with expertise in the field, like an attorney or benefits specialist. In any case, here are some things to consider.

1) If you are already receiving Social Security, you will automatically be enrolled in Medicare Part A and Part B when you turn 65. If you aren't yet receiving Social Security, you will have to apply for coverage, which can be done online. Part A, is hospital insurance, which is has no monthly fee, but does have certain expenses like a deductible of $1,156 for hospital stays of up to 60 days, copayments of $289 per day for days 61-90, and copayments of $578 per day for days 91-150 days. (E.Schultz, see above)

2) Part B is medical insurance that pays doctors' bills, lab tests and outpatient care. It is optional. The basic cost is $99.90 per month, although it can be as high as $319.70 if the individual is earning $214,000 or more a year. The annual deductible is $140 a year. Copayments are 20% of Medicare-approved amounts.(E.Schultz, see above)

3) Part D covers prescription drugs. The basic cost is $32.34 per month, but those in high-income brackets pay more. Copayments and deductibles vary according to the plan that the individual has selected. But thanks to the Affordable Care Act, Part D's "doughnut hole" is being phased out. But take note: THE ENROLLEMNT PERIOD FOR PARTS B AND D BEGINS 3 MONTHS BEFORE ONE TURNS 65 AND LASTS SEVEN MONTHS. If you miss the enrollment period, your coverage will be delayed, and your premiums will cost you more. (E.Schultz, see above)

Now you can see why this is such a complicated matter. There are different conditions depending if your current employer has 20 or more employees, less than 20 employees, you have retiree health insurance from a former employer, or if you are self-employed and currently have no health insurance. Your best plan is to seek advice from a Certified Elder Law Attorney or a Certified Financial Planner.


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The Estate Planning & Elder Law Firm, P.C. is an elder law firm. We represent older persons, disabled persons, their families, and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships, and public entitlements such as Medicaid, Medicare, Social Security, and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information about The Estate Planning & Elder Law Firm, P.C., please visit our website at http://www.chroniccareadvocacy.com.

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