Thursday, November 22, 2012

You can be part of the Alzheimer’s Prevention Initiative

Today I joined the Registry of the Alzheimer’s Prevention Initiative. It only took a few minutes of my time. I hope you join too. 

The Registry was created by Banner Alzheimer's Institute (BAI) which is involved in advancing Alzheimer's disease care and treatment through research. It serves as a portal to connect people who want to help end Alzheimer’s with prevention studies and information on the latest research news. 

Participants become part of an online community that provides them with regular updates on the latest scientific advances and news, information on overall brain health and the potential opportunity (but no obligation) to participate in prevention studies. The only requirement to sign up for the registry is to be 18 or older. 

For More Information

  • To view the initial edition of the Alzheimer's Prevention Registry newsletter click here.

  • To read Paula Span’s New York Times “New Old Age” blog article on the Registry click here.

Sunday, November 18, 2012

Report Describes National and Pennsylvania Long-Term Care Costs and Trends

Each year the MetLife Mature Market Institute collects survey data on nursing home, assisted living, adult day and home care costs. The survey contains daily private-pay rates for private and semi-private rooms in licensed nursing homes, monthly base rates for assisted living communities, hourly rates for home health aides from licensed agencies and agency provided homemaker companion services, and daily rates for adult day services.  

The report for 2012 has just been released (November 2012). The survey reveals steadily increasing prices for institutional care and mixed home care and adult day care cost increases.  

Nursing Homes: For purposes of the survey a nursing home is a facility which provides residents with a room, meals, personal care, nursing care, and medical services. National average rates for a private room in a nursing home increased by 3.8% to $248 daily ($90,520 annually) in 2012. National average rates for a semi-private room increased by 3.7%, to $222 daily ($81,030 annually) in 2012. 

Assisted Living: Assisted living communities provide housing for those who need help in day-to-day living, but who do not need the round-the-clock level of skilled nursing care found in nursing homes. Many communities, however, have nurses on staff and provide health care monitoring. National average assisted living base rates increased by 2.1%, to $3,550 monthly or $42,600 annually in 2012.

Home Care Services: This category surveys a diverse variety of services and providers including custodial and supportive caregivers hired through an agency, registry, or privately. Home health aides are trained to provide hands-on care and assistance to people in their homes who need help with ADLs (bathing, dressing, transferring, eating, toileting, or continence). They are also able to help with needed tasks such as cooking, shopping, and laundry. Homemakers or companions provide services that include light housekeeping, meal preparation, transportation, and companionship. This type of care is often appropriate for those with Alzheimer’s disease or other forms of dementia who may be physically healthy but require supervision. Homemakers and companions are not trained to provide hands-on assistance with ADLs such as bathing and dressing. The 2012 national average private-pay hourly rates for home health aides remain unchanged from 2011 at $21. The average hourly rate for homemakers increased by $1 (5.3%) to $20 per hour in 2012.

Adult Day Services: Adult day services provide health, social, and therapeutic activities in a supportive group environment for individuals with cognitive and/or functional impairments. Some are freestanding centers or programs; others are affiliated with a facility or organization such as a nursing home, assisted living community, senior center, or rehabilitation facility. Adult day services national average daily rates remain unchanged since 2011 at $70 per day.


For Pennsylvania the MetLife report provides average cost of care figures for three metropolitan areas (Philadelphia, Pittsburgh and Scranton) and for the rest of the state. The Pennsylvania average costs for 2012 in the “Rest of State” category are as follows: 

  • Nursing Home Semi-Private Room: $266 per day

  • Nursing Home Private Room: $280 per day

  • Assisted Living: $3,320 per month

  • Home Health Aide: $21 per hour

  • Homemaker: $21 per hour

  • Adult Day Services: $60 per day

Further Information:

Saturday, November 17, 2012

Medicaid LTC Home Equity Limit Increasing to $536,000

Under Section 6014 of the Deficit Reduction Act of 2005 some individuals with substantial home equity are disqualified from receiving Medicaid assistance to pay for long term care.  The section is codified at 42 U.S.C. 1396p(f). The idea underlying this provision of Medicaid law is to force individuals with substantial equity in their homes to tap into that equity to pay for their care before applying for Medicaid long term care benefits.

The law initially set an equity interest of $500,000 as the threshold for disqualification. States were given the option to increase this level to $750,000 but Pennsylvania declined to do so. The law also specified that beginning in 2011 the threshold would be adjusted for inflation based on the percentage increase in the consumer price index -Urban (CPIU).

As a result of this inflation adjustment, the home equity limitation will be $536,000 in Pennsylvania during 2013.  In states like New York, New Jersey, and California which elected to use the higher level, the limit in 2013 will be $802,000.

This limitation on the on the value of home equity does not apply if the applicant has a spouse, a child under age 21, or a child who is blind or disabled, any of whom lawfully reside in the home. The limitation is also to be waived in the case of a demonstrated hardship. (See 42 U.S.C. 1396p(f)(4). In Pennsylvania see also 55 Pa.Code § 178.62a).

The limitation applies to Medicaid long term care benefits provided to nursing facility residents and through home and community based services like the Aging Waiver program. It does not affect an individual’s eligibility for other medically necessary Medicaid covered services. Individuals who are disqualified for benefits due to the equity limit may be able to reduce their equity interest through the use of a home equity line of credit or reverse mortgage.  

For more information on the home equity limitation, see my December 2011 blog post here

Friday, November 16, 2012

Health Law changes to look for in 2013

The re-election of President Obama means the health reform law (“The Affordable Care Act” aka “Obamacare”) is here to stay. The constitutionality of most of the law was upheld by the US Supreme Court in a decision issued in June. The health law phases in over a number of years. Some of its provisions are already in effect. Here are some new changes you can look for starting in 2013.

Reducing the donut hole.  The health reform law gradually reduces the amount that Medicare Part D enrollees are required to pay for their prescriptions when they reach the coverage gap.  As part of this reduction, in 2013 Medicare Part D beneficiaries will get higher 52.5 % discounts on their band name prescriptions while in the gap. (The discount on generic drugs is 21%).

Expanding preventive health coverage.  To expand the number of Americans receiving preventive care, effective January 1, 2013 the law provides new funding to state Medicaid programs that choose to cover preventive services for patients. 

Improving access to primary care.
    • The law requires state Medicaid programs to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The goal is to help ensure that there are a sufficient number of doctors available to treat Medicaid patients. The increase is fully funded by the federal government. See CMS news release
    • Medicare will be increasing its payments for primary care doctors including family physicians, internists, and geriatricians. It will be reducing Medicare payments made to some specialists.
    • Medicare is instituting a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay. This is known as Transitional Care Management services.

Financial disclosure. The law requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies. Basically, health care providers must tell you in writing if they will make money from a drug or treatment they recommend to you.

Higher spending caps. Before the health reform law, health insurance plans could set low annual limits on how much they would spend in total on your covered benefits. In 2013 the reform law will require plans to provide no less than $2 million in coverage. (The ability of plans to cap their payments will be eliminated entirely in 2014).   

Now for the bad news – new taxes and deduction reductions will impact some taxpayers. 

Medicare high earner taxes begin. The law increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher income taxpayers. See my June 2012 blog post New Medicare Contribution Tax on Investment Income starts on January 1, 2013 for more information on this tax change.

Increase in the threshold for the itemized deduction of unreimbursed medical expenses. The threshold for deducting medical expenses on your federal income tax return is increased from 7.5% of adjusted gross income to 10% of adjusted gross income. However, the lower 7.5% threshold will continue to apply for individuals age 65 and older for tax years 2013 through 2016. See my June 2012 blog post Medical Expense Deduction Threshold Set to Increase on January 1, 2013 for more information on this issue.

Tax on medical devices. The law imposes an excise tax of 2.3% on the sale of any taxable medical device. The IRS has issued a proposed rule that provides guidance on the tax being imposed on medical devices.  

Limit on flexible spending accounts. Starting in 2013 there will be a $2,500 limit on the amount of pre-tax money that an employee can place in a flexible spending account to use for unreimbursed health-related expenses.

Health care is immensely complicated and so is the health reform law. 2013 is actually a modest year in terms of the changes that are being implemented. Much more dramatic changes including health-insurance exchanges, tax credits to help people buy coverage, and Medicaid expansion for states that choose to participate will become reality in 2014. 

Meanwhile, if you are looking for a new health insurance plan for 2013 you can check the plan rankings provided by the National Committee for Quality Assurance. Help in finding a Medicare insurance plan is available at  The Medicare site has a helpful tool that allows you to answer a few questions to find the options available to you given your location and situation. Note that the Medicare open enrollment period ends on December 7, 2012.

More Information:
For an easy to use guide on the health reform changes taking effect in 2013 and 2014 see the “Implementation Timeline” prepared by the Kaiser Family Foundation which is available here

More information on the physician payment changes scheduled for 2013 is available online here.