The Centers for Medicare & Medicaid Services (CMS) have released the Star Ratings for 2019 Medicare health and drug plans. With the release of the Star Ratings, people with Medicare will have improved access to high-quality health choices for their Medicare coverage in 2019.
“Medicare is committed to empowering seniors to choose high-quality health and drug plans that fit their needs and the needs of their families,” said CMS Administrator Seema Verma. “More high-quality choices mean improved quality care and better customer service at lower cost.”
In 2019, people with Medicare will have more choices and options for their Medicare coverage. Access to the Medicare Advantage program remains strong. The number of Medicare Advantage plans available to individuals to choose from across the country is increasing from about 2,700 to more than 3,100 – and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans.
Most areas across the country have Medicare Advantage and Part D plans with four or more stars. In 2019, approximately 73 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars. Compared to 2017, approximately 69 percent of these enrollees were in four and five star plans. Approximately 44 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2019.
Medicare Part D prescription drug plan enrollees are also benefiting from improved access to high-quality plans. In 2019, approximately 47 percent of enrollees in stand-alone prescription drug plans will be in plans with four and five stars. Approximately 52 percent of stand-alone prescription drug plans will have a rating of four stars or higher in 2019.

The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered. Medicare health and drug plans are given a rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. People with Medicare can compare health coverage choices and the Star Ratings through the online Medicare Plan Finder tool available at Medicare.gov.

Non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday, April 2nd, 2018.

The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance and custodial care in Medicare Advantage.

“CMS is expanding the definition of ‘primarily health related,” the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

The rule was originally proposed in February and was met with enthusiasm from the home health and private duty home care industries. Home health care providers have already made great strides as partners in MA contracts, and adding non-skilled services opens the door to the growing MA population even further.

“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group ElevatingHome, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibilities than the fee-for-service providers do. They don’t have a homebound requriement in many cases. So they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”

In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.

Even before this week’s final rule, some providers have been positioning themselves to take on more personal care, with an eye toward MA trends.

“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve had a great relationship for skilled home health and hospice for quite a while,” said Keith Myers, CEO of LHC Group. “In the last few years, they’re starting to focus more on a dual-eligible population and have needed us to have a bigger commitment in personal services.”

• Forty-seven percent of adults ages 50 and above could not pass a simple Social Security quiz.
  
• Two topics that particularly confused quiz takers: full retirement age and spousal benefits.
• Not fully understanding Social Security strategies can result in big losses for retirees if they make a mistake when claiming benefits.

If you can't pass a simple five-question quiz on Social Security retirement benefits, you're not alone.
Almost half of adults ages 50 and above — 47 percent — failed the quiz that mutual life insurance company MassMutual recently sent out in an online survey.
"The good news is we're making progress," said David Freitag, a financial planning consultant and Social Security expert at MassMutual. "The bad news is we have a long way to go."
Two topics that stumped quiz takers were the ideal age for claiming Social Security and spousal eligibility to receive retirement benefits.
When asked to answer true or false to the statement, "Under current Social Security law, my benefits will not be reduced if I claim them at age 65," only 49 percent answered the correct answer, "False."
Most individuals who reach retirement today can receive their full benefits at age 66 or 67, depending on the year in which they were born.
This is what is known as full retirement age, which is often confused with the age by which you typically must sign up for Medicare — 65.
"You are going to be taking a reduction in benefits if you don't fully understand your full retirement age," Freitag said.
The next question that stumped respondents asked them to answer true or false to the statement, "My spouse is eligible to receive Social Security retirement benefits, even if he or she has no individual earnings history."
Just 54 percent of respondents responded with the correct answer, which is "True."
Another key finding of MassMutual's research found that 86 percent of respondents ages 50 to 59 have not set up an online account with the Social Security Administration.
Setting up a My Social Security account not only helps you protect your benefits from getting stolen, it also helps you double check your earnings record upon which those benefits are based.
Mistakes, which can be prompted by job changes or misprocessed 1099 forms, are common, according to Freitag. If you have 30 people in one room, 10 percent of them will likely have an error on their Social Security record, he said.
Making sure those records are accurate is crucial, as the Social Security Administration takes your highest 35 years of earnings to calculate your benefits.
"People need to be aware of how much they're contributing to the Social Security system," Freitag said.
Now, here’s the quiz:
Quiz questions (Answers = True or False)
1. Under current Social Security law, my benefits will not be reduced if I claim them at age 65. FALSE
2. My spouse is eligible to receive Social Security retirement benefits, even if he or she has no individual earnings history. TRUE
3. If my spouse dies, I will continue to receive both my own benefit and my deceased spouse's benefit; the total Social Security benefits I receive will not change. FALSE
4. Social Security retirement benefits are based on my earnings history; I'll receive the same monthly benefit amount whether I start collecting before or after my full retirement age. FALSE
5. If I am still working when I claim my Social Security, my benefit might be reduced, depending on my earnings and my age. TRUE

The Trump administration is considering expanding Medicare's ability to negotiate the cost of drugs by giving private payers a role in setting the price of medicines administered in hospitals and doctors' offices, Health and Human Services Secretary Alex Azar said.

Azar's comments provided more details on the plan announced by President Donald Trump to lower prescription drug costs for Americans.

While Trump has vowed to tackle rising prices since running for office, his plan spared the pharmaceutical industry from direct government negotiations to control costs. Drugmaker shares rose as Wall Street analysts said the new policies should not hurt industry profits.

Medicare is the national health insurance plan run by the federal government for Americans over the age of 65.

Azar said that Trump views tougher negotiation as key to the plan, and that his agency will consider an alternative system for buying Medicare Part B drugs, which are administered by a healthcare provider and covered directly by the government.

Instead, the administration would seek to allow private sector payers to negotiate the price of those medicines, as they do in Medicare Part D, which covers drugs that patients pick up at the pharmacy.

"We believe there are more private sector entities equipped to negotiate these better deals in Part B, and we want to let them do it," Azar said in prepared remarks. "More broadly, the President has called for me to merge Medicare Part B into Part D, where negotiation has been so successful.
 

The Home Equity Conversion Mortgage (HECM) is FHA's reverse mortgage program, which enables you to withdraw some of the equity in your home.  The HECM is a safe plan that can give older Americans greater financial security. Many seniors use it to supplement Social Security, meet unexpected medical expenses, make home improvements and more.  You can receive additional free information about reverse mortgages in general by contacting the National Council on Aging at (800) 510-0301. It is smart to know more about reverse mortgages and decide if one is right for you!

1. What is a reverse mortgage?
A reverse mortgage is a special type of home loan that lets you convert a portion of the equity in your home into cash. The equity that you built up over years of making mortgage payments can be paid to you.  However, unlike a traditional home equity loan or second mortgage, HECM borrowers do not have to repay the HECM loan until the borrowers no longer use the home as their principal residence or fail to meet the obligations of the mortgage.  You can also use a HECM to purchase a primary residence if you are able to use cash on hand to pay the difference between the HECM proceeds and the sales price plus closing costs for the property you are purchasing.

2. Can I qualify for FHA's HECM reverse mortgage?
To be eligible for a FHA HECM, the FHA requires that you be a homeowner 62 years of age or older, own your home outright, or have a low mortgage balance that can be paid off at closing with proceeds from the reverse loan, have the financial resources to pay ongoing property charges including taxes and insurance, and you must live in the home. You are also required to receive consumer information free or at very low cost from a HECM counselor prior to obtaining the loan. You can find a HECM counselor online or by phoning (800) 569-4287.

3. Can I apply for a HECM even if I did not buy my present house with FHA mortgage insurance?
Yes.  You may apply for a HECM regardless of whether or not you purchased your home with an FHA-insured mortgage. 

4. What types of homes are eligible?
To be eligible for the FHA HECM, your home must be a single family home or a 2-4 unit home with one unit occupied by the borrower. HUD-approved condominiums and manufactured homes that meet FHA requirements are also eligible.

5. What are the differences between a reverse mortgage and a home equity loan?
With a second mortgage, or a home equity line of credit, borrowers must make monthly payments on the principal and interest.  A reverse mortgage is different, because it pays you – there are no monthly principal and interest payments.  With a reverse mortgage, you are required to pay real estate taxes, utilities, and hazard and flood insurance premiums.

6. Will we have an estate that we can leave to heirs?
When the home is sold or no longer used as a primary residence, the cash, interest, and other HECM finance charges must be repaid.  All proceeds beyond the amount owed belong to your spouse or estate. This means any remaining equity can be transferred to heirs.  No debt is passed along to the estate or heirs.

7. How much money can I get from my home?
The amount varies by borrower and depends on:

• Age of the youngest borrower or eligible non-borrowing spouse
• Current interest rate; and
• Lesser of appraised value or the HECM FHA mortgage limit of $679,650 or the sales price

If there is more than one borrower and no eligible non-borrowing spouse, the age of the youngest borrower is used to determine the amount you can borrow. 

8. Should I use an estate planning service to find a reverse mortgage lender?
FHA does NOT recommend using any service that charges a fee for referring a borrower to an FHA-approved lender.  You can locate a FHA-approved lender by searching online at www.hud.gov or by contacting a HECM counselor for a listing.   Services rendered by HECM counselors are free or at a low cost.  To locate a HECM counselor Search online or call (800) 569-4287 toll-free, for the name and location of a HUD-approved housing counseling agency near you.

9. How do I receive my payments?
For adjustable interest rate mortgages, you can select one of the following payment plans:

• Tenure- equal monthly payments as long as at least one borrower lives and continues to occupy the property as a principal residence.
• Term- equal monthly payments for a fixed period of months selected.
• Line of Credit- unscheduled payments or in installments, at times and in an amount of your choosing until the line of credit is exhausted.
• Modified Tenure- combination of line of credit and scheduled monthly payments for as long as you remain in the home.
• Modified Term- combination of line of credit plus monthly payments for a fixed period of months selected by the borrower.

For fixed interest rate mortgages, you will receive the Single Disbursement Lump Sum payment plan.

• Single Disbursement Lump Sum - a single lump sum disbursement at mortgage closing.

 10. What if I change my mind and no longer want the loan after I go to closing?  How do I do this?
By law, you have three calendar days to change your mind and cancel the loan.  This is called a three day right of rescission.  The process of canceling the loan should be explained at loan closing.  Be sure to ask the lender for instructions on this process.  Mortgage lenders differ in the process of canceling a loan.  You should ask for the names of the appropriate people, phone numbers, fax numbers, addresses, or written instructions on whatever process the company has in place.  In most cases, the right of rescission will not be applicable to HECM for purchase transactions.

With the possibilities of a hurricane coming to the Southeast, now is a good time to review your plans for helping older neighbors and relatives. Bear in mind that these special individuals may be reluctant to evacuate, choosing to just stay home and ride out the storm.

If you have a loved one in a mandatory evacuation zone, please either go pick up this person and bring them to a safe area or alert authorities in that area if you can't physically get there yourself. Considerations for the elderly who may evacuate include: taking any specialized medical equipment, such as oxygen; making sure an adequate supply of medication is available and packed, important papers are gathered (insurance, medical IDs, wills, etc.); as well as comfort items, such as bedding, clothing, snacks, etc.

If a senior has medically necessary equipment running that requires electricity, make sure that they know about the possibility of power outages during and after a storm. It may be much better to take the equipment and evacuate for a short time, instead of being without a needed or critical device in a crisis situation.

There are shelters set up for those with special needs. Check out the South Carolina Emergency Management Division's website by clicking here. They have important information regarding any emergency declarations, shelter locations, business and government closings and more.

When it comes to signing up for Medicare, there's plenty of confusion. Which part of the four-part program covers hospital stays? Do all parts help pay for prescription drugs? What's the difference between Original Medicare, Medicare Advantage and Medicare Supplement Insurance?

Medicare itself has four parts. Part A (hospital insurance) and Part B (health insurance) come standard in every Original Medicare Plan. Part C is called Medicare Advantage, and it's an alternative to a standard Medicare Plan that offers some additional benefits like prescription drug coverage. Stand-alone prescription drug plans, or Part D, cover prescription drugs for those who want to keep their Original Medicare plans. And then there is Medigap.

Medicare Supplement Insurance plans are private health insurance that can help you pay for the "gaps" in your traditional Medicare policy – such as copayments at a doctor's office, coinsurance at skilled nursing facilities and out-of-pocket hospital costs not covered by Medicare Part A. There are 10 different types of Medicare Supplement Insurance plans, each designated by a letter of the alphabet (you can find details about all 10 plans at Medicare.gov). In most states, the benefits are the same no matter what insurance company you purchase the plan from, though each plan covers different things. Premium prices for each of the 10 Medigap plans varies depending on the benefits offered, and the premiums are separate from your regular Medicare premiums.

To be eligible for a Medicare Supplement Insurance plan, you must already have Medicare parts A and B. The most comprehensive Medicare Supplement Insurance plan is Plan F, which covers all available benefits. Plan C, which covers everything except excess health insurance costs, and Plan F are the most popular plans. 
 
The advantage of a Medicare Supplement Insurance plan is that you will have a larger network of providers from which to choose. If you have a health condition, a Medicare Supplement Insurance plan may also provide better ways to pay for medical expenses. If you can afford to spend a bit more, a Medicare Supplement Insurance plan may be a wiser choice. It may save you a lot of money in the long run if you need extensive medical services or treatments.

Nearly half (47%) of adults in the 40s and 50s have a parent aged 65 or older and are either raising a young child or financially supporting a grown child, aged 18 or older.
 
What IS the sandwich generation? In a nutshell, it’s taking care of both elder care and childcare or supporting a grown child at the same time. You’re “sandwiched” in the middle of both circumstances.
 
Family members, predominantly female family members, have provided the majority of care to their aging loved ones. Today, there’s a generation of middle-aged adults known as the Sandwich Generation, who are caught in the middle of child rearing or support and providing care to aging parents for these reasons:

1. Delayed parenting – a new norm in society is couples starting families in their middle to late 30s instead of earlier in life.
2. Increased life span: people are living longer as a result of better healthcare and technology.
 
The sandwich generation can be further defined:
•Traditional: those sandwiched between aging parents who need care and/or help and their own children.
 
•Club sandwich: those in their 50s or 60s sandwiched between aging parents, adult children and grandchildren or those in their 30s and 40s with young children, aging parents and grandparents.
 
•Open faced sandwich: anyone else involved in elder care.
 
•Interesting fact: Most of the sandwich generation were baby boomers until 2005. As of 2014, boomers became grandparents and started transitioning into the aging population while their children took their places and moved into the sandwich generation.

Rehabilitation hospitals say a proposed change to how Medicare will reimburse them for care could lead to inaccurate payments as new system pulls patient data from a new source.

In the 2019 inpatient rehabilitation proposed pay rule, Medicare proposed to retire the current patient assessment tool that helps categorize the level of care needed by a patient. The current tool has been used since 2002 to help determine the amount of care reimbursement. But now the agency wants to switch to a new patient assessment tool that's similar to one in place for other post-acute care settings to create a more uniform evaluation for patients' care needs. The change will kick in on Oct. 1, 2019 if it's finalized.

Clinicians use the tool in question to rank the severity of the patients care needs and develop a treatment plan.

The new assessment tool was introduced last year and it's unclear if it tracks patient needs sensitively enough to determine reimbursement accurately. "The limited analysis CMS has made available to stakeholders is insufficient evidence as to the data's validity or reliability as a basis for payment purposes," Richard Kathrins, chair of American Medical Rehabilitation Providers Association's board of directors, said.

Providers are worried about whether the new tool asks the right questions and helps them evaluate patients as thoroughly as the assessment method they've been using for years. The tool is still too new to answer those questions, according to rehab providers.

"Too little is known about the accuracy, consistency and clinical efficacy of the new clinical data and information that CMS is proposing to utilize," Mark Tarr, president and CEO of Encompass Health, one of the largest providers of rehab hospital services in the nation said. "These clinical data and information have not been sufficiently studied, understood or validated to determine payment or patient care implications for rehabilitation hospital services."

The Kentucky Hospital Association suggested Medicare should study and evaluate the accuracy and reliability of the new data source as well as its implications before changing the reimbursement model.