Social Security Beneficiaries Will Receive a 2 Percent Increase in 2018

In 2018, Social Security recipients will get their largest cost of living increase in benefits since 2012, but the additional income will likely be largely eaten up by higher Medicare Part B premiums.

Cost of living increases are tied to the consumer price index, and an upturn in inflation rates and gas prices means recipients get a small boost in 2018, amounting to $27 a month for the typical retiree. The 2 percent increase is higher than last year’s .3 percent rise and the lack of any increase at all in 2016. The cost of living change also affects the maximum amount of earnings subject to the Social Security tax, which will grow from $127,200 to $128,700.

The increase in benefits will likely be consumed by higher Medicare premiums, however. Most elderly and disabled people have their Medicare Part B premiums deducted from their monthly Social Security checks. For these individuals, if Social Security benefits don't rise, Medicare premiums can't either. This “hold harmless” provision does not apply to about 30 percent of Medicare beneficiaries: those enrolled in Medicare but who are not yet receiving Social Security, new Medicare beneficiaries, seniors earning more than $85,000 a year, and “dual eligibles” who get both Medicare and Medicaid benefits. In the past few years, Medicare beneficiaries not subject to the hold harmless provision have been paying higher Medicare premiums while Medicare premiums for those in the hold harmless group remained more or less the same. Now that seniors will be getting an increase in Social Security payments, Medicare will likely hike premiums for the seniors in the hold harmless group. And that increase may eat up the entire raise, at least for some beneficiaries.

For 2018, the monthly federal Supplemental Security Income (SSI) payment standard will be $750 for an individual and $1,125 for a couple.

For more on the 2018 Social Security benefit levels, click here.

Hospital Observation Status & Medicare

All hospitals must now give Medicare recipients notice when they are in the hospital under observation status. The law was intended to prevent surprises after a Medicare beneficiary spends days in a hospital under “observation” and is then admitted to a nursing home. This is important because Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. Many beneficiaries are being transferred to nursing homes only to find that because they were hospital outpatients all along, they must pick up the tab for the subsequent nursing home stay — Medicare will pay none of it. Also, if you do not have Medicare Part B, you may end up having to pay the full hospital bill.

The use of observation status by hospitals is increasing and you need to be aware of this and fight it. The Center for Medicare Advocacy has great information and a toolkit to assist you with this. I strongly advise you review the information on their site devoted to this topic.  http://www.medicareadvocacy.org/medicare-hospital-outpatient-observation-status-toolkit/

Nursing Home Costs Rise Sharply in 2017

The median cost of a private nursing home room in the United States has increased to $97,455 a year, up 5.5 percent from 2016, according to Genworth 2017 Cost of Care survey, which the insurer conducts annually. Genworth reports that the median cost of a semi-private room in a nursing home is $85,775, up 4.44 percent from 2016. The rise in prices is much larger than the 1.24 percent and 2.27 percent gains, respectively, in 2016.

The price rise was slightly less for assisted living facilities, where the median rate rose 3.36 percent, to $3,750 a month. The national median rate for the services of a home health aide was $22 an hour, up from $20 in 2016, and the cost of adult day care, which provides support services in a protective setting during part of the day, rose from $68 to $70 a day.

Alaska continues to be the costliest state for nursing home care, with the median annual cost of a private nursing home room totaling $292,000. Oklahoma again was found to be the most affordable state, with a median annual cost of a private room of $63,510.

The 2017 survey was based on responses from more than 15,000 nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey was conducted by phone during May and June of 2017.

As the survey indicates, nursing home care is growing ever more expensive. Contact your elder law attorney to learn how you can protect some or all of your family’s assets.

For more on Genworth’s 2017 Cost of Care Survey, including costs for your state, see the following link: https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

How Medicare and Employer Coverage Coordinate

Medicare benefits start at age 65, but many people continue working past that age, either by choice or need. It is important to understand how Medicare and employer coverage work together.

Depending on your circumstances, Medicare is either the primary or secondary insurer. The primary insurer pays any medical bills first up to the limits of its coverage. The secondary payer covers costs the primary insurer doesn’t cover (although it may not cover all costs). Knowing whether Medicare is primary or secondary to your current coverage is crucial because it determines whether you need to sign up for Medicare Part B when you first become eligible. If Medicare is the primary insurer and you fail to sign up for Part B, your eventual Medicare Part B premium could start going up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it.

Here are the rules governing whether Medicare coverage will be primary or secondary:

▸ If your employer or your spouse’s employer has 20 or more employees, your employer’s insurance will be the primary insurer and Medicare is the secondary payer. If your employer or your spouse’s employer has fewer than 20 employees, Medicare will be the primary insurer and your employer’s insurance will be the secondary insurer.
▸ If you are retired and still covered by your employer’s group health insurance plan, Medicare pays first and your former employer’s plan pays second.
▸ If you receive both Social Security Disability Insurance and Medicare and your employer has 100 or more employees, your employer’s insurance pays first. Some employers are part of a multi-employer plan and if at least one employer in that plan has 20 employees or more, the employer’s insurance pays first. If your employer has fewer than 100 employees, Medicare will pay first.
▸ If you have end stage renal disease (ESRD) and are in the first 30 months of Medicare coverage of ESRD, your employer’s plan pays first. After the first 30 months, Medicare becomes the primary insurer. It does not matter how many employees your employer has.
▸ If you are self-employed and have a group health plan that covers yourself and at least one other person, Medicare pays first. Note that if you are self-employed, you may be able to deduct Medicare premiums from your income taxes by including the premiums in the self-employed health insurance deduction.

If your employer’s insurance is the primary insurer, the employer must offer you and your spouse the same coverage that it offers to younger employees. It also cannot deny you coverage, cancel your coverage once you become eligible for Medicare, or charge you more for premiums, deductibles, and copays.

New World’s Oldest Woman

I am always amazed when I hear stories of the world’s oldest living persons. Imagine the change in our world that a person has lived through if they are 117 years old. Many years ago when my dad showed me the house where he grew up in east Dayton I was amazed that the houses on that street had no driveways. The reason of course is that there were no cars back then.

A recent news story tells of a woman who is now the world’s oldest living person at age 117. Violet-Mosse Brown, who lives in Jamaica, tells us that there is no secret formula. She says she eats everything but does not drink “rum and those things.” http://www.cnn.com/2017/04/17/health/worlds-oldest-woman-trnd/index.html There is an interesting website and book on “Earth’s Elders” that has many stories on the oldest persons in the world. I recommend the book if you are interested in learning about how persons live so long and want to learn their wisdom. http://www.earthselders.org/

Hospitals Now Must Provide Notice About Observation Status

All hospitals must now give Medicare recipients notice when they are in the hospital under observation status. The notice requirement is part of a law enacted in 2015 but that just took effect.

Signed by President Obama in August 2015, the law was intended to prevent surprises after a Medicare beneficiary spends days in a hospital under “observation” and is then admitted to a nursing home. This is important because Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. Many beneficiaries are being transferred to nursing homes only to find that because they were hospital outpatients all along, they must pick up the tab for the subsequent nursing home stay — Medicare will pay none of it.

The law, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, did not eliminate the practice of placing patients under “observation” for extended periods, but it did require hospitals to notify patients who are under observation for more than 24 hours of their outpatient status within 36 hours, or upon discharge if that occurs sooner. The Act required hospitals to begin giving patients this notice as of March 8, 2017. Some states, including California and New York, already require such notice.

To avoid violating the law, hospitals that accept Medicare patients will now have to explain to patients under observation that because they are receiving outpatient, not inpatient, care, their hospital stay will not count toward the three-day inpatient stay requirement and that they will be subject to Medicare’s outpatient cost-sharing requirements. The law does not make hospital observation stays count towards Medicare’s three-day requirement.

For an article from USA Today about the new requirement, http://www.usatoday.com/story/news/2017/03/09/kaiser-law-hospitals-now-must-tell-medicare-patients-when-care-observation-only/98967470/

SAD: Seasonal Affective Disorder

Winter SADness

Everyone has been sad. It happens, and it’s as much a part of life as happiness is. But beware. There’s a big difference between being “just” sad, and suffering from SAD, the seasonal affective disorder. We’ve previously talked about winter safety measures for you and your senior loved one, but I never once mentioned this less known but equally risky condition. I’ll make up for it now by introducing you to the issue and teaching you about the symptoms and precautions.

What is SAD?

“Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.” — National Institute of Mental Health

Risk factors for SAD include a family history of mental diseases or suffering from depression or bipolar disorder combined with the lack of daylight or feelings of loneliness during the holiday season. The most endangered groups are women of the younger adult age, but SAD occurs in people of all ages.

Why are elderly people at risk?

Especially long-term care residents (but not exclusively) may experience a heavy mood swing due to the weather change and disruption of the body rhythms. Furthermore, elderly people with restricted mobility, people who have recently lost a loved friend or a family member or patients suffering from dementia may be very sensitive to these changes. If you start observing some of the changes listed below, it may be best to consult a psychologist.

What are the symptoms of SAD?

SAD is not a disorder itself, but rather a sub-type of major depression, and as such it is not to be taken lightly. The symptoms are many, but the manifestations don’t always necessarily indicate seasonal affective disorder. However, if several symptoms occur, be cautious and consult a specialist. Here’s a list of what to watch out for, by NIMH:

  • Feeling depressed most of the day, nearly every day
  • Feeling hopeless or worthless
  • Having low energy
  • Losing interest in activities you once enjoyed
  • Having problems with sleep
  • Experiencing changes in your appetite or weight
  • Feeling sluggish or agitated
  • Having difficulty concentrating
  • Having frequent thoughts of death or suicide.

Symptoms of the Winter Pattern of SAD include:

  • Having low energy
  • Hypersomnia
  • Overeating
  • Weight gain
  • Craving for carbohydrates
  • Social withdrawal (feel like “hibernating”)

How to help?

  1. Prevention. Start with dietary supplements including vitamin D. Always consult your doctor before you start taking any pills, even if they’re just vitamins. Other methods of prevention are frequent short walks outside in the daylight, light exercise, enriching your diet (you may find some inspiration in my post on nutrition during the winter months)
  2. See a specialist. If you think that you or your patient or relative may be suffering from SAD, don’t leave it be. The first thing to do is to see your doctor. He will examine the nature of the condition, and the treatment goes from there.
  3. Light therapy. You can purchase a light box that radiates rays of light similar to those coming from natural sunlight. When supervised and regulated according to individual needs, it can be beneficial for symptomatic people by exposing their preceptors to a high intensity light, making the body “forget” the actual dark weather.

The best help and prevention, however, is to be informed about the issue, and keep an eye on your loved ones’ mental state, especially during the winter months.

Winter nutrition tips: learn to eat well during winter & all year long

Nutrition during the winter months

Winter is a demanding season, some parts of our country are drowning in snowstorms, roads are under ice, the temperatures are reaching record lows, and these rapid weather changes and extreme conditions are taking their toll on our physical health. I’ve previously written about how important staying in shape is (not only) for our elderly. Today I’d like to continue that thread by adding some tips on how to eat the right stuff — to get proper nutrition and stay full of energy even during the cold winter months. Read on, eating well during winter is important for all generations.

Fruits & Vegetables

Naturally, the first place on every nutrition list goes to good old fruits and vegetables. Including at least five, but even better seven to thirteen cups of fruits and vegetables in your daily diet will help you enjoy all the benefits including vitamin intake, obesity and heart disease protection and other positive effects. This beautiful article shows you exactly the daily serving sizes of various fruits and veggies. Don’t forget to include pomegranates for cholesterol reduction, citruses for vitamin C for an immune system boost, and dark leafy greens for vitamins A (good eyes and bones) and K (blood clotting prevention, hart disease prevention).

Protein 

Protein is very important stuff that keeps our muscles in a good shape, it helps control blood sugar and energy levels. With insufficient protein intake we’re putting ourselves under risk of muscle atrophy and other physical malfunctions, so let’s make sure we get some every day. The daily Dietary Reference Intake of protein is 0.8 grams per kilogram of body weight, that is on average 45 – 55 grams per person (about 2 ounces). High protein foods include meat (beef, pork, turkey and chicken), fish (cod, tuna, salmon), cheese, tofu, beans, lentils, yogurt, eggs, nuts, and seeds.

Fiber

Fiber is an excellent digestion helper and aids in haemorrhoid prevention. It helps control blood sugar and prevent heart disease and stroke. It also helps fight obesity, as it increases feelings of fullness and slows carbohydrate metabolism. Most people need more than 50 grams of fiber per 1,000 calories consume. Sadly, the majority of Americans get nowhere near this amount. If you want to integrate more fiber into your diet, remember to increase the dose slowly and drink a lot of water as well. Whole-grain products, vegetables, nuts and seeds are great and nutritions sources of fiber.

Vitamin D + calcium

Our body is a pretty efficient vitamin D factory when exposed to 10 minutes of sunlight per day. However, the lack of sun exposure during winter needs to be balanced by eating foods that contain vitamin D and calcium. These two are dependent on each other, as vitamin D enables calcium absorption, so that your bones and joints become and stay healthy. That is important also in the context of winter falls. Aside from that, vitamin D also adds to mood control, helping to ward off depression.

Only a very few foods contain vitamin D naturally, but don’t worry – some foods are fortified with it. Here are some of the natural and fortified ones: salmon, sardines, shrimp, egg yolk, milk (fortified), cereal (fortified), yogurt (fortified), orange juice (fortified). Supplements containing vitamin D are also an option, but don’t forget to take calcium at the same time.

Water

We can’t talk about eating well during winter without mentioning the importance of thorough and regular hydration. It’s generally harder to keep up with water intake during winter, and it’s especially proven to be problematic for elderly people.

“Water makes up most of our body and it is used in the transport of medications, for digestion, for circulation and for our joints and muscles. Water is also essential for our concentration and for our cognitive functioning.  Staying hydrated in winter is important, too! Try adding a soup to your meal, have decaffeinated coffee/tea, herbal teas, vegetables and fruit juices (100% pure) or milk.” — Senior Living

Try to eat all together with the whole family, making food the social event of the day. If you or your loved one struggle with proper nutrition and keeping up with a healthy diet, it may be worth a try to look into moving to a local retirement community or a specialized meal delivery service for seniors.