Unknown Speaker  00:10
Got noisy, noisy. Just wanted to welcome everybody supported myself we both love what we do. Attorney dermatologist cases, both expertise, both being able to share the information. So it's a heavy talk in this respect. So take it home with us. If you have any questions for either one of us, don't hesitate

Unknown Speaker  00:57
to do so without further ado. Briefly it's really very informal. Can I see some questions? Please just ask questions. If there's something that comes up and you feel things to relation that he's better at answering great

Unknown Speaker  01:35
particularly for Scott, because I know he's not on Medicare are people here that aren't on Medicare. I'd like to explain a little bit of that. Medicare is a federally funded program that as of today, comes to people when they turn 65 Or are disabled for a period of time. Medicaid consists of two parts. Medicare Part A, which is your hospital insurance. There's no charge for that is either you are a spouse contributing to the FICA system. The system contributes more to insurance and Medicare Part B, which is your physicians, physician services, durable medical equipment, outpatient services, Medicare Part B, there is a fee for this year, it's $42.50. That's usually deducted from your Social Security check. People can delay taking Medicare Part B, if they are employed. Or if your spouse is employed with an employer of more than 20. Then you can delay for free until you retire or your spouse or your job. And you can apply for Part B at that time and immediately obtain Part B at that time. If for any reason someone goes onto Medicare and inclines Part B. Without those two reasons, then should they apply for Part B at another time, the government only sells to you at a period of time from January 1 to march 31, beginning of the year, and it does not become effective until July of that year. And there are penalties associated with it. It's usually 10% a year for each year. The premium can significantly increase if you don't apply for it at the time. Yes. Only if only if they're working, should they decline it and if they have insurance through their employer or a spouse that that insurance is then primary and Medicare is secondary.

Unknown Speaker  04:01
Yes, you did not have to accept four years ago when they send you your notification of Medicare, they send you your Part A and Part B but many people didn't understand that they did not apply for it at the time penalize. Now when you get a notice from Social Security automatically enrolls your a and b indicates if you don't want being let us know. People that are turning 65 should always notify Social Security at least three months prior to turning 65 Making sure they're in the system. You wouldn't be surprised how many people are not in the system do not get notice protection in a timely fashion. For people that are working. You should be aware that you should check your Social Security earnings every three years. Three years at certain times. Some days to check if your earnings reported properly. And if you wait past that period of time and they've been recorded improperly, then you lose out on some benefits. So that's Medicare Part A, Part B also hasn't been done yet.

Unknown Speaker  05:20
A GPS if you're if but you will get you will automatically get a with no charge for you. Okay, that's not a charge. That's correct. And when you stop working, we get a letter from your employer indicating your date of termination and

Unknown Speaker  05:44
Part B has a yearly deductible of $100. And then the rate of reimbursement for Part D is 80%. of the Medicare approved amount, so that you are liable for the 20% that was approved by Medicare, as well as the excess charges that will be charged by a physician. In New York State the excess charges cannot exceed 5% of what was approved. Should you be overcharged, you have recourse you have healthcare financing to address those issues with and you have Medicare beneficiary defense fund to help you with issues. If you're up to charge that's on your Part B. On your Part A you have a deduction. All of this is written down in your material you don't want to write you don't have to install them. On your Part A you have a deductible that applies per benefit period. Not clearly, it's a 60 day benefit period. Should you go to the hospital, be discharged from the hospital and be out of the hospital for more than 60 days. When you go back and should you go back to the hospital then you have to pay another deductible and I believe it's $739 a day for the deductible. Now, in addition to which you have coinsurance is should you stay longer in the hospital. over a certain period of time, you have to pay some phone insurance, and Medicare many people do not realize that Medicare does not cover you for nursing home long term nursing homes stay. Medicare will only cover you for a short period of time in the nursing home. After you've had either had an illness or surgery requiring some rehabilitation in a skilled nursing facility. Not in a facility where you would need to go to for assisted living or because you need somebody to help you cook for someone to help you bathe, you have to have a skill to go into nursing home on to Medicare. The first 20 days in the nursing home are paid for through Medicare and total days 21 through 100 are partially paid, leaving you with an expense of approximately I think it's $89 a day now should you stay in the nursing home up to 100 days after that the cost of the nursing home is entirely up to you. So there were reasons there. Medicare does not fully pay for everything. Therefore you need to look at a Medicare supplemental plan to supplement with Medicare is not pay. Federal war regulated all plans that are sold. Would you like some water?

Unknown Speaker  08:53
There are regulations for the Medicare supplemental plan that were issued in about three years ago, the federal government regulated the Medicare industry medicare supplement industry. Firms that sell Medicare supplemental insurance can no longer call them super duper, wonderful, extraordinary plans and convinced a senior that they need to have three four or five plans. It actually is a federal offense for a an agent to sell more than one plan to a person and that agent can lose their insurance license for introducing another plan to someone who already has a supplemental plan. All of the supplemental plans are alphabetized from A through J so that if you would apply Plan A from Marion who's an insurance company and from Scotland from myself, Plan A would be the exact same plan from whatever insurance company you're looking at. However, insurance companies can charge you different premiums for the same plan based upon their past experience of running the insurance and based upon the services that they provide to the beneficiaries of plan. So that when you buy a plan, you should look at the cost of it. What plan meets your needs? Each plan is different? And do you need additional services from a brokerage house that may be able to help you with all of your bills, filing everything for you tracking everything for you? Or can you handle everything yourself? Do you want to deal with an 800 number out of town and people that you don't know? What do you want to deal with someone locally that you can develop a relationship with and have them help you with? Those are your choices but know that all of the plans are the same? Regardless of what company you buy from? Do you have any questions? Yes, Medigap supplement. Are there any questions about Medicare at this time or Medigap insurance, you should know that there's a very big difference between Medicare and Medicaid. Martin will address many of the issues by talk a little faster, which but there's a very big difference between Medicare and Medicaid, Medicare comes to you regardless of your income. Regardless of how much money you have, you are entitled to it under the government. Medicaid is a means tested. It's for people who have less than a certain income and less than certain resources. In that case, Medicaid provides you with all of the supplements that you may need that would include food stamps, insurance, dental insurance, transportation to the hospitals, doctors, etc. That would be your Medicaid. Medicaid is the plan that is frequently used when people have become impoverished and are then into nursing homes. And most people upon entering a nursing home, the average person's resources will be depleted in three months, I've entered my right. Three months of entering a nursing home. The cost for nursing home here in the New York area, well over $100,000 Now between 80 and $125,000. Depending upon where you live, your costs will be different. Yes.

Unknown Speaker  12:47
Many people that are on Medicare now are being introduced to plans that have both HMOs. Oxford, US health, we need to know what those health maintenance plans are about. If you should decide to join a health maintenance organization, be aware that you are severely limiting your freedom of choice. You will be restricted to the doctors that are on their panel, you need to select the physician who is known as the gatekeeper. He will make all referrals to any specialists that you need to see and decide if you should see a specialist. And you can only go to hospitals that have been contracted with the HMO for the care that you need. The only time that there's any difference that you can be in another hospital is should there be an emergency and you enter the hospital but you're obligated to let them know within 24 hours, or they are under no obligation to pay for your hospital and emergency care. Nor will the federal government paid for you under your Medicare card because you have now relinquished the right of using your Medicare Part When you join the health maintenance organization. When you go on to Medicare, the government arbitrarily decides depending upon what area of the country you live in, they will deposit so to speak. Let's say $500 a person into a bank for your medical care. So that when you are on the traditional Medicare program and you see a physician or go to the hospital, monies are taken out of this bank account to pay for your care. When you join a health maintenance organization, that money is given to the Health Maintenance Organization for your care, it now becomes the responsibility of the health maintenance organization to give you all of the care that you need within the monies that they receive. So it's in their best interest to restrict the care that you need, so that they will be more profitable when In a physician joins a health maintenance organization, they are put into two pools, they're put into a physician referral pool and a hospital referral pool, the least they use those referral mechanisms to have someone see either another specialist or go into the hospital than the more they share in the profits at the end of the year. So be aware, if you are joining in health maintenance organization of the restrictions that you may be looking at, it sounds great, you don't have to pay, you're gonna get your medications, you'll get your eyeglasses, but be very aware that it's very restrictive, and you need to know what you're getting into. Doctors will frequently join the plan and leave the panel, if you have selected him as your primary care physician, then you've got to find another position. So it's not an easy thing. It's not all that it's cracked up to be. And there are several different HMO plans, you've got staff models, you've got individual physicians, a staff model would be something like hip where you would go to a center, the individual physician model is where you go into the physician's office and you're treated in the physician's office.

Unknown Speaker  16:18
I briefly want to touch on long term care insurance, and then allow more room to talk to you about some of the issues that are relevant to what we're talking about. Yes, we're gonna move on. Absolutely. advise your clients not to. I'm very biased. I was the first Medicare director for the first federally qualified HMO here on the East Coast, I saw how it you know, it's almost like working in a kitchen you never want to eat in a restaurant. I'm very biased because I saw the difficulties that people had in accessing the services if someone is severely restricted with money, and there are many women, unfortunately, who live at the poverty level, and who truly cannot afford the supplemental insurance, if you're looking at a good supplemental insurance, you're looking at about $1,300 a year for plan that will pay you 100 give you 100% coverage. That is frequently that's too much for a person, if we can't look at a plan that they can afford at about $65 a month, if that is still too much, then I will help them in selecting a health maintenance organization. And I will show them what they need to do and give them all of the tools that they need, should they have any problems with it. So I do have a bias. And unfortunately, we live in a society where if you have the money, then you're going to be able to buy the services that will maintain your health. If you don't have the money and you have to go into health maintenance organization, you have to have the tools to know how to fight them. You have to know what letters you have to write to them. You have to know how to investigate a physician, you have to determine what positions are right for you. And you have to know when to speak up. You have to truly be an advocate for yourself in a health maintenance organization. When you're

Unknown Speaker  18:26
a woman and she just doesn't have what it takes to argue with the stuff. She's had breast cancer. She's laid on getting a mammogram and he's not having heard from them. Because it cost them they're saving themselves.

Unknown Speaker  18:51
I also realize I'm not HMOs little experience that I've had clients, very even clients who aren't that comfortable financially and who are pressed to spend the money for the Medigap policy. I remind them that with their Medicare card, they can go to virtually any doctor in the country, any hospital and get care what a luxury. Most of us now in work situations are finding ourselves locked into HMOs. While the seniors still have the option they can afford it to privately to pay for their supplemental insurance and have access to virtually any doctor in the country. The HMOs have other great disadvantages. There's a geographical limitation. I go I'm a Medicare beneficiary. I belong to hip HMO, but I go to Florida three one side of the year. I am really not covered in Florida. There may be some, some link up to Florida now, but I'm not sure you know, I presume. But nevertheless, it means getting that hook up into Florida. If I'm just a straight Medicare patients, I don't have to deal with them. I've had experiences when I was at the Congress of the Ag when the Medicare HMOs first came into effect, that were really very, very, very, very difficult. And what happened was people would elderly people would be kind of railroaded into buying into the HMOs. This was going on last summer as well. There was a great scandal about it. Clients were railroaded into the HMO. But they didn't quite understand that the Medicare HMO means they can no longer used the Medicare. Well, they would get sick, they would go to the hospital, they would run up bills in the hospital. And then they were told you're part of hip HMO Medicare and the hospital stay is not covered. So I had 90 year old clients who were blocked who were put into these HMOs who then ran up bills in hospitals. And were then told you owe 20 $30,000 to such and such as them. The reason my client joined the HMO was he didn't have the so it was what we had to do once we have to have him retro disenroll he really shouldn't ever been in that HMO. Medicare's Okay Will retroactively disenrolled you will retro actively enrolled you back into the system. And everything's class action. They did it because they want these HMOs. And they didn't want the bad press. Because it wasn't just this 190 year old line client who was you know, heart sold on the telephone into this program, there will be others and they want this this program to go. Medicare is paying the HMO about two or 300. Sometimes more a month more.

Unknown Speaker  22:31
Depending upon the locale.

Unknown Speaker  22:35
$3,600 A year is being paid. Because it's a cool, no, no, it's a pool. It's a pool. It really costs $3,600 to insure somebody, Medicare would have to be paid in terms of paying in app benefits Hospital in there, I think people should know that with the deed they joined the HMO, they can unjoin they can retire they can leave it simply by writing a letter this saying I resigned tells it they tell it to the HMO send a letter to the HMO say I quit this month, effective before following their back into the regular Medicare system. They must send the letter registered, they should send it registered certify.

Unknown Speaker  23:30
When you mentioned the 95 the very first clients that are enrolled in the HMM that I was Medicare director. I sat with them justice. We're sitting here. We went over the entire program. I did it personally. So I feel very pleased that they understood the program. They went home. The woman collapsed with hit. She had pains in her head her husband took her to the local hospital. She had a brain tumor. She had surgery. While in the hospital, the daughter said to her father, Dad, do you have insurance? He said yes. We're fully covered. Don't worry about it. A couple of weeks later, when mom was ready to come home and she went downstairs to pay the bill. They said they said you belong to total health, and they're not a member of our hospital. And you're not covered from total health and you're not covered from Medicare. Justice Martin said we petitioned the federal government headphones, I took the onus completely on us. I said they obviously did not understand it because we didn't explain it properly. These people cannot pay the bill and they will retroactively re enrolled disenrolled and re enrolled in Medicare and that's how the bill was paid. But as Martin said, it goes on more frequently than you realize. And it's not something that I recommend only in dire circumstances when people just feel they can't do anything else. I would do do they stay as Martin said on Medicare without a supplemental, and go to the doctor and go to the hospital and work through the Medicare 20% of the approved amount.

Unknown Speaker  25:16
So the doctor charges you $300. Demand is

Unknown Speaker  25:26
given to you in easy numbers, the doctor charge you 150 Medicare approved 100. From the 100, Medicare pays 80% or $80 of the approved amount, you are responsible for the 20% of the approved amount. And you are responsible for the excess charge the $100 to the 150, the $50 that you will owe that was charged over the approved amount. Or you know you're not, but we close to 5% here in New York, okay. Now that has been changed, because it's you, the doctor can only charge you 5% More than the approved amount. So if he had charged you 150, you have the right to say sorry, you overcharge, I'm only responsible for $5 5%. New York. Yes, that's New York. And it's in here. And it will on your explanation. If anyone's on Medicare. On their explanation of build it, there's a code that tells you where the where you fit. The supplement because you're still looking at the 20% You're looking at $739 for a hospital stay. Each time you go into the hospital, you have a $739 deductible to go into the hospital. No, that has always been, that has always been Not all doctors will accept assignment, which means they will accept what Medicare has allowed them. And if you're in the hospital, and you're talking to a specialist, and you have a major problem, you can look at significant bills without the supplemental assignment is when a doctor has entered into an agreement with Medicare and has agreed to accept what Medicare will pay them

Unknown Speaker  27:20
80 and 20 80%. He still gets his 20. That's correct. But he doesn't get anything above it. In New York State, there is a cap of 5% above the Medicare approved rate for virtually all services except a couple of years of office visits. Maybe a home visit, nobody makes home visits, but a few office visits, certain types of office visits, there's a 10% cap, it's really important to know that as a senior to know that your pockets can't be completely drained. You know, there's a fear we all have a fear of the doctor is going to take everything we all know there's a cap, Medicare covers 80%, your your your your Medigap covers 20%. And the doctors basically for major for major services don't get more than 5% of that. So you're like, No, no, if they accept assignment, there's no 5%. There's only an 80% and a 20%. But it can live in New Jersey. If you live in the other states, there is a cap there still is a federal cap. And I don't know whether it's 10 or 15%. But I think basically is 10% in Massachusetts, no doctors and they charge any more than the 80 and the 20. Doctors billing,

Unknown Speaker  28:48
yes. And they all the clients don't understand Correct?

Unknown Speaker  28:52
Yes, I have a bill. I have. I have a bill now right in front of me. Here's the problem in New York State. It's New York state law that caps it at 5%. And the federal government which is financing Empire Blue Cross Blue Shield, or GH is sending out those explanation of Medicare benefits. That's a federal unit. They will not police the 5% So my client has a bill without any top there's no mention of it. That it's that's that's capped but indeed it is capped at at least the 10% cap should appear on the bill. I don't know why the cap is not there is the code more on the bill. There is then I fair to code is I've got one right on my

Unknown Speaker  29:45
screen here and if not, I have it at home. To get down to the if you don't find it in this material.

Unknown Speaker  29:53
New York will New York's Empire Blue Cross Blue Shield which is an eight cap and intermediary for carrier for the federal government will not tell you about will not enforce the 5% Glorious suggested to enforce the 5%, your COVID Medicare beneficiaries defense funded, I think you have their number here, they will help you. But that cap is really important. There are supposedly some state offices that are supposed to enforce it. But there's no real muscle power in the law. So there's a lot of confusion.

Unknown Speaker  30:30
Well, for years, Hector did not explain Medicare properly to seniors, there was never any correspondence about it, people were totally in the dark about how it worked and what it did and what it didn't do. And it's only recently that they are even sending any materials out with the Medicare information. Prior to that there was just no information on it. Their staff was even instructed, don't bother. But you don't have to tell the beneficiary their number was not allowed to be given out the Health Care Financing Administration number was not given out, it was something that you had no somebody to get the number to get the information, I

Unknown Speaker  31:08
do a publicity, something on behalf of this book. Sure. So

Unknown Speaker  31:15
that nearly pay 20% of the approved amount, or will also pay any amount in

Unknown Speaker  31:22
excess of supplemental will pay excess depending upon the plan that you buy, the more expensive

Unknown Speaker  31:27
one will pay. If you turn to this booklet, to page 14, you will see the Plan

Unknown Speaker  31:38
F F, F pays 100 100%

Unknown Speaker  31:40
of the part the excess part G pays 80%. So it pays 80% to five. I mean, God knows what that is. That's four, that's 4%. And then you go a little further down and it goes back to 100. And J goes back to 100. If you notice also the line below that talks about foreign travel. Medicare does not cover people who travel seniors who travel a bulk abroad and it doesn't cover people who literally get on a cruise ship. Even if it's an American cruise ship. If it's outside of territorial waters, you're out of luck and you're sick

Unknown Speaker  32:22
of depriving. If you are traveling however, you should look at Plan F at least Plan F because that will give you Medicare coverage out of the country

Unknown Speaker  32:31
see adults with starts with C but only limited amount usually about 25,000. Yes. And you you there is foreign travel insurance. Long. Yeah, yeah.

Unknown Speaker  32:48
That plan i n j will offer you some drugs. h h, i and j offer you drugs. You need to sit down and figure out what you are spending for your medications for the year and see whether it's cost effective for you to spend the extra money for those plans versus paying for the medication out of your own pocket. Medicare also does not pay for eyeglasses, which most people need after the age of 40. They will not pay for dentures and they do not pay for hearing all of the things that people need as they get older.

Unknown Speaker  33:26
Medigap doesn't mitigate coverage does not fill in all the gaps. And one of the big gaps that boy you didn't really hit hard on is prescription drug coverage. Prescription drugs are covered in their entirety in a hospital as if the Medicare beneficiary is an inpatient hospital patient. Outpatient coverage there is virtually no medical no pharmaceutical coverage. A person who takes a camp chemotherapeutic drug intravenously, outpatient will be covered. But that's about it. And I think flu shots are something other than that. There's very there's no coverage, this Medigap these Medigap policies at the higher end of the scale, cover a little bit of that,

Unknown Speaker  34:21
but not Not, not much. You need to look at it. If people really have a serious medical need prescription need. You can have your physician write to the pharmaceutical company that is providing you with the medication. Sometimes the pharmaceutical company will send that medication to the doctor based upon your need and the doctor's letter, so that that's something that you can look into, but it has to go from your physician to the pharmaceutical company. For people that work with or know men that are veterans or women that are veterans. They can get their medications through the Veterans Hospital, they can go to the Veterans Hospital with a prescription from their physician 95% of the times the physicians there will honor that prescription, they can then get six months prescription sent to them on a monthly basis for a fee of $5 a month. So that it's worth looking into other areas, if you have a strong medical need. The medical the medications came to my attention recently, my husband has become disabled and his medications are over $400 a month. He's on a Medigap supplemental. And I happened to be at a an advisory meeting for one of the offices for the aging and there was a Veterans Council there and he discussed it and he told me how this process work. So we're in the process of see if it works in the way that he said. And if we have another meeting, or if you want to call me at some time, I'll let you know how successful we've been. But there are ways that you can. And to come back to what you said before with seniors who can't advocate for themselves. Most seniors cannot advocate for themselves. It's seniors that have families or have an interested professional or someone else that can do some of the advocacy work for them. It becomes very difficult for seniors to get the services that they need. Yes, I don't know what the law is I have a New York State $2 million catastrophic, with a $25,000 deductible. And my assumption is that if you spend that 25,000, you send them the bills, and I don't think there's any limit to anything, they will just pay well, I understand. But that's the each occurrence and the occurrence figured on a five year basis. And then you have to start again. Now is that similar to the Medicare that's different than the Medigap policy, the Medigap policy falls into place immediately. When you're on Medicare, you have to really incur a good deal of medical expenses. And

Unknown Speaker  37:08
they don't question they'll pay any any bill, I think they would pay the skilled nursing also trying to find out,

Unknown Speaker  37:15
I don't, I don't I don't know they might pay skilled nursing. But it would be a limited benefit, it would not be a nursing home benefit. And it may dovetail with the benefits that you would receive through Medicare. So you really need to sit down with someone and look at that policy and see whether it is something that it's in your best interest to continue carrying. I don't know enough about

Unknown Speaker  37:40
those. I was under the assumption that you send them any bill over that amount and then just pay.

Unknown Speaker  37:48
I think it's difficult to reach the $25,000 is what I'm saying. Two days in the hospital. Well, but if you have Medicare and you have a Medicare supplemental, I think it's unlikely that you might reach the $25,000. I don't

Unknown Speaker  38:03
think they care about you, you get your you get your 25 whoever pays for it, and then you come into the program, then they have the liability, but Medicare will continue paying first, I think and so your insurance won't come in until Medicare runs out. Medicare really doesn't run out in most instances. Well, if you're in the hospital for a long time, and Medicare stops pay, it's because you really don't belong. In most instances, and you don't really want to be there if you don't belong that the event is this a Wallers policy for the US. You want to look at that because that may have that does have like a $400 a week nursing home component that runs for about a year or two, I think providing you have a skilled, skilled nursing need, I think, and it may have some pharmaceutical, so you don't want to drop it for so little money may be valuable. But you should, as Gloria suggests, really review it, at least know what you've got. I don't think the nursing home benefit kicks in unless you're skilled nursing. And most people who are in nursing homes are not skilled nursing people there. So can I just mentioned this book, yes, which is a wonderful book. However, it's extremely well written, but don't try to read it, especially from cover to cover. It doesn't work. No matter how bright you may be. You cannot absorb it. It's all English and every sentence sort of fits. But it is like overwhelming. You will have a nervous breakdown and Medicare is very poor on psychiatric psychological comfort. So don't lead however, use this to dip in Do you want to know what ambulance coverages, you want to know what skilled nursing coverages get into it, use it as a kind of like a dictionary for definitions of the services. But don't think that just because you've read this book and committed it to memory, you've got the system. It's a wonderful book. It just doesn't isn't the kind of glorious introduction system is much more, much more is much clearer than anything you'll ever be able to

Unknown Speaker  40:33
pull out. Most of the information from that has been put into English here. So that most of it is here, but as Martin said, use it as a reference. It

Unknown Speaker  40:44
looks like English, it sounds like English reads like English, but it isn't English.

Unknown Speaker  40:47
And you question yourself, you wonder, what is it? Why don't I understand this, but nobody can understand it.

Unknown Speaker  40:55
Again, because my father is 86 and he's got Medicare, but he doesn't have any supplemental insurance.

Unknown Speaker  41:02
So where do you get this? ABC? TJ? Okay, there are three Medicare. No, no, their insurance companies will sell you. Medigap Insurance. One of the largest salespeople sales organization is our American Association of Retired people. If your father has someone who can help him with our, then our app may be the way to go because ox rates are lower than the other companies. You deal with an 800 number you deal with people that you don't necessarily know. And you can get confusion depending upon who's handling your claims. One of the companies that is a very good company for Medigap insurance is first United Medicare supplemental, it's a company if you give me a call, or give me your there's a sheet here, fill it out with your name and address and I'll have information sent to you. First, United is a company that whose home offices in Dallas, Texas, they've been in the Medicare business since the law was enacted in the 60s. They did not come into the New York area until about eight, nine years ago. for very specific reasons. They did not trust New York doctors, they were afraid of New York fees. They were afraid of the New York consumer that they were too smart and would go to the doctor to frequently and more importantly, they did not trust the agents that were going to sell the product. They felt that most insurance agents did not understand Medicare and would not represent it ethically. I happen to represent the product, anyone that represents the product must understand Medicare must go for ongoing training and must be up on all of the rules that apply to Medicare and must represent the company in a very ethical way. When an insurance company sells insurance, they do not sell it directly to the consumer. They contract with a brokerage house who then contracts with agents to represent the product, the brokerage house that they contracted with, they wouldn't even take someone in the New York area. It's up in the Rockland area. And they have an entire geriatric department that deals strictly with the older person. They're very personable, you get them on the phone, you get answers. If you want to break down of what you have been paid through Medicare, they send you a printout that you can understand. It's a good company, and it's worth looking into. And I'll be happy to send anybody information on it. Are there other questions about Medicare? And as I said, look through the materials and when you go home, if you have questions, call me. I'll be happy to answer them. I want to touch a little bit on long term care and then let Morton speak a little bit more about some of the issues that affect long term care. Long Term Care Insurance is an insurance policy that will pay you for either assistance at home or assistance in a nursing home. You need to look at a long term care plan that will be easy enough to access that has a mechanism that allows you to access the services of good long term care plan will allow you to have services provided to you if you are medically necessary. If you are deficient in two activities of daily living, bathing, dressing, eating, transferring and it or if you are cognitively impaired. A good policy will allow you to access services on any one of those things. Not a couple, one, one and another one.

Unknown Speaker  44:44
The plans will pay for you. As I said to live at home, as well as in a nursing home. There are two ways to buy three ways to buy Long Term Care Insurance. One is through a principal that's known as the bucket of money. One is through a defined benefit plan. And another one is the partnership plan the New York state partnership plan, under the bucket of money concept, you purchase a benefit for the nursing home a daily benefit for the nursing home arbitrarily, let's say you select $300, which is the maximum, you then select a daily benefit for your home care $300 A day $300 A day, I'm sorry, thank you, Martin $300 a day for care in the nursing home, you then select an at home benefit, that can be 50% of the nursing home benefit that you have selected, or up to 100% of the nursing home benefit. So let's say you have selected $300 in the nursing home and $300 at home. And let's say that arbitrarily you say you want to be covered for five years, either in a nursing home or at home, they would take that daily benefit of $300 and multiply it times five years, which is 1875 days, and you would come up with about a half a million dollars. That total dollar amount is now your discretionary income to spend either at home or in the nursing home up to $300 a day. If you were able to obtain services at home for $150 a day, well, that bucket of money would last longer. And conversely, if you were able to obtain benefits in a nursing home like $200 a day, you would have money that would last longer than that arbitrary five years. When you select and what you need to look at is your elimination period, do you want the plan to pay you immediately upon going into the nursing home? Or do you want to delay it 3060 or 90 days, if you do that, then you need to look at that also as a deductible to your plan. If you're delaying it 30 days, and you've really thrown on $9,000 deductible to your plan, you're not going to be paid before you have spent $9,000

Unknown Speaker  47:14
percent of whatever your costs are on a defined benefit plan. You decide the same daily benefit, but then you say to the company, I want to be paid for three years at home and six years in a nursing home. And that's what you will receive you will receive three years of benefits at home. And six years in a nursing home. There's a procedure where if you are without services for six months, well then you go back to the original amount of time you haven't used up six months, so to speak, you've been in the nursing home and you come out come out of the nursing home in your home for six months, you go back to having benefits at the full period of time. That's your defined benefit plan. Your assets are yours to keep your income is yours to keep nothing is affected with a private Long Term Care Insurance Plan. The partnership plan, which is a plan that is run by the state of New York and a private insurance company is a dual plan. When you purchase that plan for the first three years of the plan, you are paid through the private insurance company, you can live anyplace in the United States and you can be in any nursing home in the United States. After the first three years, you will then go on to Medicaid, the state part of the plan, and you must be living in the state where you purchase the partnership plan, New York State or Connecticut or what other state has it, you have to live in the state that you purchased the plan. The partnership plan only protects your assets, not your income. Your assets are sheltered you can have any amount of money, but any monies that come in to you through Social Security, pension CDs, Treasury notes, anything that is considered income rental, that is contributed towards your cost of your stay in the nursing home. Martin will go into it further in terms of what the spouse is allowed, etcetera, etcetera. But that's your basic concept, a quick concept of your different Long Term Care Nursing Home policies. The younger you are of course, the less expensive they are. The older you are, the more expensive if you're over age 80 There are limitations to how long a period of time you can have for your benefits on the long term care plans. I'm going to turn it over to more and any

Unknown Speaker  49:50
yes the premiums on that would be

Unknown Speaker  49:53
well I'll tell you I'm in my 60s I'm 64 this year and I purchased a plan I purchased the bucket of money plan And this year with a $300 a day benefit. And there's also an inflation rider that comes with it my purchase the inflation rider for the years that I'm productive, and I feel I want my daily benefit to rise the inflation rider through my premium of 15%, should I decide to drop it, my premium will come down 15%, I'm paying over $5,000 a year for it. Yeah. And well, then what happens is you need to modify it, I took, I took the Cadillac of the plan, I took an immediate payment, I took the top benefit I then you modify it and you say, look, I can I can pay for the first 30 days, I will be able to manage on $200 a day, I don't need $300 A day at home 150 And how you modify it. But I took the maximum plan because I felt it was how I could maximum maximize the plan for myself. But you are looking at big numbers when you get older.

Unknown Speaker  50:58
They eliminate pre existing conditions. It

Unknown Speaker  51:00
depends upon the condition. It cancer is covered heart conditions are covered, certain hip replacements are covered, you really need to talk to someone and look at their underwriting guidelines. If you want further information, I'll be happy to send it to anyone that wants information. But don't arbitrarily except to know. If you're working with an agent, tell them to go back to the underwriter and document everything. I've had some very difficult cases issue, because I'm very honest, I put them doctors names, numbers, date of treatment, prognosis, how they're doing, I give them all the information. I've never had a case to find, thank God and I've had some very sick people apply. Some of them are rated. They're not always preferred. But people have gotten insurance when they're honest. And say what you know, really is the problem. Martin, let me let you get into

Unknown Speaker  51:54
a put together a little portfolio of materials, articles on durable powers of attorney health care proxies. GLORIA suggested that I really focus on Medicaid. And there's a brief article on Medicaid here and I see this yellow one in the middle. And I'll I'll probably mentioned it several times, and maybe mark it up. Discussion a separate article on Medicaid trusts behind it. Then there's a long article on supplement MainStrasse, which I might have a moment to cover copy of our newsletter. And in the back is an article that my partner did on the Alzheimer's Association newsletter. I incorporate it in here because it has some of the most frequently asked questions on planning for the LG. And when I guess when I'm talking about planning for the elderly, I'm really talking about planning for long term care or planning for catastrophic long term care. Because what we're really talking about is the high cost of more homecare today in New York, can cost homecare for some of our clients runs easily $100 A day sleep in one sleep in person 24 hours a day is $100 a day, seven days a week, 30 days a month $3,000 And that's a fairly straightforward situation, nothing terribly complicated. In so many instances we need to 12 hour shifts and of course that brings up the rate suddenly to maybe 44,000 to 4500 nursing home costs in New York City and in the metropolitan area. Nassau, Suffolk, Westchester, Rockland County are going up to $125,000 a year. It's very, very, very simple to to there's no sweat in finding places that cost eight or $9,000 right down the street here. Isabella, cattery Mary Mani Walsh, at least eight or $9,000 that, you know, and then clients will say to me, Well, Mr. Petrov, I could stay in the world or for less, and I said, Yes, you can. The reality is that about 80% of our beds in New York State nursing homes are medically funded. We also have a very, very large Medicaid home care system in New York state that's dedicated to keeping people in the community and out of nursing homes. The Medicaid system is very generous. The Medicaid And we didn't really cover this so much. We'll pay Medicare premiums for impoverished Medicaid beneficiaries will actually pay my Medicare premiums if I can't pay them for myself, will pay the 20%. For me, if I'm indeed Medicaid eligible. Medicaid will pay all my pharmaceutical coverage, it will pay my homecare coverage, it will pay my nursing who uses Medicaid? The initial, the initial concept of Medicaid was a program for the poor. What's happened in New York is something that we don't fully understand. But nursing home costs have really skyrocketed, in part because perhaps it is basically a Medicaid program funded by the Medicaid system, with really not that much cost control built into it. There is no cost control for the private pay. There is no caps on private pay in nursing homes. There is no gap. There are no caps for homecare, it's a private pay, it's an open market free market. So when we're talking about, you know, a serious kind of issue, the program was essentially set up for the poor, it has become a program in many instances for the middle class, what constitutes middle class, or to define it? How do we use Medicaid for four people? A person to be eligible for Medicaid cannot have more than $4,850 in savings.

Unknown Speaker  56:46
And no more than $559 a month in income. And Medicaid doesn't care what your living costs are, what your rent is, what your food bill is nothing except maybe what your health insurance or your medical costs. So can I be eligible for Medicaid, live in the community and have income of 1000 a month? I said, the limit is 559. Yes, I can get Medicaid in the community. If my income is above 575, assume my income is $1,075 a month. To get Medicaid, I would have to give the Medicaid program, the differential between 559 and 1075. I'd have to pay in my surplus income to the Medicaid program to get Medicaid does it pay for me to do it? Yes. If I paid $3,000 a month for homecare. It pays for me to do it. Especially if I don't have any money left. And I need the Homecare. How doable is it? I don't have enough rent money. It isn't doable. If I give Medicaid, my surplus income. And my rent is above my income level. I'm really between a rock and a hard place. I'm not viable financially in the community. Why do I want the Medicaid I probably want it because I need the Homecare. And many many clients do this. This is the kind of this is where the Medicaid program and transfer of assets is an important piece. We have hundreds if not 1000s of people living in New York Have you followed this kind of formula? I have $100,000 my lifetimes earn $200,000 in the bank, but I am spending at the rate of three and I have $1,000 A month I'm spending at the rate of three $4,000 a month from my own care in just so many months, forget about nursing it just so many months, I will have spent down is there a way out for me there is I can transfer away my $200,000 lifetime saving I could transfer it into a trust or outright to my children or a friend. I can impoverish myself. bring myself down to no more than $4,850 I then will be eligible for the Medicaid home care benefit. My family member or my friend can pay for my additional services from this nest egg that I have now transferred away. What about the income on the income on the trust? If it's a trust, the income has to go to me. When the income comes to me it becomes part of my surplus income. So in this type of scenario, I don't even want the income. I give the money away. I get the whole 200,000 So the way my son puts the money in a fund for me, I can give it all away simply by writing a check. I give my son 200,000. What about the tax on that? There is a small New York State gift tax, that I have to pay the bad $7,000. That's all.

Unknown Speaker  1:00:24
And the income can also be given to the Son.

Unknown Speaker  1:00:26
Well, I've given him $200,000. He's got now Okay, so now the income goes to him, the income goes to him, okay, but I'm in the community, and my rent is 1000 a month, my food bill is three or 400, my telephone my electric, he's going to pay most of that I've only got 575 in my pocket, he's going to pay that something out of my savings. In the meantime, I am going hopefully, and in the meantime, I'm going to get my Medicare home care. My son hopefully he's not running off to Brazil with the 200,000. A year, thank you. My I can give away to you, my dear $200,000, I don't have to give you nearly 10,000. But if I give you 200,000, I will have to pay a gift tax. If I immediately give you 10,000. That's an invisible gift. Give this lady 10,000 and invisible give 10,000 I can give everyone all of my friends and family $10,000 a year. The gift tax begins when I give you more than 10,000. Above to about 3% Star starting at $118,000 in New York State. And then much, much more if I've given away 600,000. But I don't necessarily need to do this. If I have more than 600,000. The person who is doing this type of Medicaid planning has really less than 600,000. So the $10,000 rule doesn't prevent me from giving away my money. It's an IRS rule, not a Medicaid rule. I can give my money away after all, I could give my money to charity. I can give you more than $10,000. I just may have to pay a tax, a gift tax, which is really the equivalent of having died today you inherit my $200,000 and my estate would be paying an estate tax.

Unknown Speaker  1:02:48
Graduated you go over your 600,000

Unknown Speaker  1:02:52
Yes, I mean precipitous precipitously graduate, but we're not going to basically be doing Medicaid planning for people who have more than six $700,000. Now a client will come in with six or $700,000. He will be 55 years old with a diagnosis of Alzheimer's and he's going to be able to live 20 more years. We are going to transfer that six or $700,000 and try to preserve that for him outside and begin to get him his Medicaid homecare that Alzheimer's patient at 55 can live a good 1520 years. He will need round the clock double shifts at home.

Unknown Speaker  1:03:37
Martin please explain the difference between receiving medicaid at home and nursing home and the timeframe that you can receive Medicaid assistance at home transferring your assets today or tomorrow whereas nursing home you have

Unknown Speaker  1:03:53
right. My client comes in today and he says Mr. Petrov I have that $200,000 I need homecare. I've been paying three $4,000 a month. I'm running down running down and hopefully I'll be paying three or $4,000 month for the next five years. And I won't have anything. So I say Mr. Smith, transfer the $200,000. No problem. You impoverish yourself this month, you are eligible next month, there is no penalty period. However, I have to caution the same client that should he get sick and the nursing home care when he has made this transfer. He has incurred a penalty period for Medicaid nursing home care. And that's discussed in that little one page pamphlet that I have here. Let me tell you what that Medicaid penalty period is all of that. My client transferred $200,000 This month The next one, suddenly he needs a nursing home, doesn't need home care anymore. He has had a massive stroke. He needs the nursing home. What has he done? He has transferred 100 $200,000. He has incurred a penalty period of approximately 3032 months during which he is eligible for Medicaid nursing home coverage. How did we get to 32 months, Medicaid takes the average cost of the nursing home in this county or in New York City. It says it's roughly $7,000 divided into 200,000 and gets 32 months and a fraction. Beginning November, my client is ineligible for nursing home care for the next 32 months. What happens? What we do is he's had the stroke in November, we say to his son, give that back $100,000. Some gifts that back 100,000. My client instead of having incurred a penalty period of 16 months, has incur unsought instead of having incurred a penalty period of 32 months. The 7200 1000 has now really only incur the penalty period of half as much. He's given away 100,000. He's incurred a penalty period of 16 months. What about where's he going to pay for the 16 months? We've just given him back 100,000. He's going to take his 100,000 to Social Security, and he's going to pay for the next two months. What does Medicaid require when we go in for Medicaid Home Care application? Medicaid will look back remarks. My client's financial history. Three months, I'll look back for three months for Medicaid homecare. But my client now has had a stroke. What will Medicaid do? Medicaid will look back 36 months, they will say ah Sir, one you're not eligible yet, because you still have 100,000. But I will I will explain the system to you. Or we're going to look back 36 months when you come to us. And we're going to see that back in November of 1996. You transferred 100,000 We're going to look back 36 months, we're going to look back. We're going to look back to whatever 1995 And we're going to see that in 1996, you transferred 100,000, you incurred a penalty period. But you're not coming to us until your penalty period has expired. You're not coming to us until January of 1998. We're going to look back three years, we're going to see you made the transfer. You made the transfer 17 months ago, your penalty period has now expired. So what a very, very bad example. Okay, I will give it to you again. Let me let me give you a new scenario. client comes in. He's going through, he's going into a nursing home. His family says my my father transferred 100,020 months ago.

Unknown Speaker  1:08:47
Medicaid says it's going to look back 36 months and his financial history. They're going to see he made a transfer of $100,000 gave $100,000 away impoverished himself and got home care. Okay. What does that mean? Does that mean my father doesn't get the Medicaid nursing home cover? So we say how much he transferred, transferred 100,000. How many months ago 20 months ago, when he transferred it. He incurred a penalty period of 7000 divided by 100,000. He incurred a penalty period of 16 months. But that happened 20 months ago. And if the period is over, he's eligible. Medicaid looked back 36 months 20 months ago they saw he made a transfer but the transfer penalty period has expired. He is eligible. I won't take the time to go into the entire question about spousal protections. Spousal protection really comes into play when there's a couple and gone husband or wife is going into the nursing home. Are there protections for the so called well spouse? I say called the so called well spouse because in a normal scenario has been ADA is going into the nurse, you know, wife is at three, she's not so terrific either. You know, she's she's frail living in the community. She's the so called Well, spouse, are there protections for her. There all the major protection is this. The well spouse is allowed at least $75,000 in savings, it's important to remember that well spouse who may be coming, who may have $200,000 in savings does not have to spend down to the $75,000 limit. The $75,000 limit is the minimum she's allowed to have if she has more, if she has less, that's too bad. If she has more, it is subject to review and negotiation. The scenario was this. Mrs. Smith comes to the nursing home, her husband needs nursing home care, the nursing home says Mrs. Smith, Mr. Smith is not eligible until you are down to $75,000. Is that true? It is not true. Mrs. Smith does not have to bring yourself down to the 75,000. So two or three important points. 36 month look back period is not necessarily a 36 month penalty period. Well, spouses living in the community with the unwell spouse in the nursing home, don't have to spend down to that $75,000. And finally, I won't talk about it now go home, which is for Medicaid purposes, for Medicaid eligibility purposes. And exempt resource is finally not really exempt and needs to be protected, just like all other mammals. And I discussed that briefly here. If you have any questions, please give me a call.

Unknown Speaker  1:12:25
Through academic reasons, get rid of new stuff. You know

Unknown Speaker  1:12:36
in general, no, that's what I'm trying to tell you. That old rules, the rules change all the time. Very confusing. There is no hard and fast rule about a penalty period. There's a look back period, which is 36 months, and the penalty period could be could be anything. You should do it in advance. Yes, your assets should be protected in advance, indeed, but it depends upon how much your assets all take steady. Thank you very much. You're welcome. Thank you. Thank you