Archive for October, 2018

Medicare Open Enrollment, Original Medicare Parts A and B, Medicare Part C Advantage Plans, Medicare Part D Prescription Drug Plan Donut Hole Partially Plugged

Posted on: October 23rd, 2018 by Lawrence A. Friedman

The following article was written by guest author Lindsay Engle, editor of Medicare FAQ, and Lindsay is solely  responsible for its content.  As with all our blog posts, please remember that this website provides general information that isn’t tailored to your particular situation and may not take into account updates, rules and exceptions that affect you.

There are many Medicare beneficiaries who have enrolled into a Medicare Advantage plan and realized in January that their doctor wasn’t in network, or didn’t even realize they had a network they needed to stay in.
1. Return of the Open Enrollment Period
The Medicare Open Enrollment will replace the Medicare Advantage Disenrollment Period (MADP) that was from January 1 until February 14 of every year.
This was an opportunity to disenroll from a Medicare Advantage plan and return to Original Medicare. The option to enroll in another plan wasn’t available during this time.
Now that is about to change. The new Medicare changes of 2019 will make changing from the unsuitable Medicare Advantage plan to a more suitable plan, possible.
Medicare is reinstating the Open Enrollment Period for all beneficiaries in New Jersey. During this time Medicare beneficiaries can disenroll from their Medicare Advantage plan and enroll in a new plan or switch back to Original Medicare.
If you are Medicare eligible and you’re enrolled in a stand-alone Part D prescription drug plan, you need to make changes to your Part D Prescription Drug plan during AEP (October 15 through December 7 of every year). Part D beneficiaries won’t qualify for plan changes during OEP.
Other Coverage Changes in Medicare 2019
1. Starting in April of 2018, Medicare recipients will start to receive new Medicare ID cards that no longer have a Social Security number displayed on them. This change was announced in September 2017, the biggest reason for the change was to help prevent seniors from being victims of identity theft and fraud.
a. As required by the Medicare Access and CHIP Reauthorization Act-MACRA all beneficiaries will have a new Medicare ID cards by April 2019. The new cards will display a random ID number instead of Social Security numbers.
2. In 2019, a new premium bracket for the highest-income Part B and Part D enrollees with go into effect. Under the BBA 2018 enrollees with an income of $500,000 or more ($750,000 for married couples) will pay a higher premium for Part B and Part D coverage.
3. The coverage gap will be eliminated in 2019 for brand-name drugs, which is a year sooner than predicted. The Bipartisan Budget Act of 2018 (BBA 2018) will close the donut hole one for brand name drugs. This means that beneficiaries will only pay 25% of the cost of brand name drugs. The cost of closing the donut hole for brand name prescriptions is being shifted to the drug manufactures instead of insurance companies or beneficiaries.
4. Medicare Advantage and Part D prescription drug plans change every year. 33 percent of Medicare recipients enrolled into a Medicare Advantage plan in 2017. These plans are popular, but they change every year, it’s important to stay informed on yearly plan changes.
5. For those on Social Security, you might notice an almost 3% increase on your social security checks. This could be up to an additional $500 per year.
Each year by September 30th, Medicare Advantage recipients receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing insurance carrier for their Medicare Advantage and Medicare Prescription drug plan providers.
Medicare Supplements don’t change year to year. You can expect consistent benefits from one year to the next year.
The Center for Medicare and Medicaid services posts plan changes for the following year sometime in October, several months before the new year begins. is a valuable resource that
Medicare beneficiaries can use to compare plans, look up information and learn more about Medicare.
The changes for 2019 will be beneficial to many Medicare recipients; freedom to change plans, more social security income, new Medicare ID cards and so much more.

New SSI POMS on Sole Benefit Rule for SNT’s

Posted on: October 3rd, 2018 by Mark R. Friedman

A few months ago, the Social Security Administration released new POMS on the sole benefit rule for first-party special needs trusts.

A first-party special needs trust (SNT) is an SNT established to hold the property of the beneficiary – the disabled person.  Often this is funded as part of a lawsuit, using funds that a disabled person won or received in settlement of a personal injury lawsuit.

In order for the beneficiary (the disabled person) of the SNT to qualify for SSI, Medicaid and other benefits, distributions (payments) from the SNT must be for the sole benefit of the beneficiary.  This is called the sole benefit rule.

For some things, this is clear.  If the trust pays for a doctor visit for the beneficiary, it’s clearly for the beneficiary’s sole benefit.

But what if the trust purchases a house for the beneficiary?  If the beneficiary is a young child, odds are good that her parents are taking care of her, and her parents are going to live with her in the house.  Perhaps her siblings would live there too.  If the trust buys a house for the beneficiary, but she has other family members living there, was the house purchase really for the beneficiary’s sole benefit?

What if the beneficiary likes watching TV?  The trust might buy a television for the living room of the house, and the beneficiary will watch it there.  But other family members will probably watch it too.  Is the purchase then really for the beneficiary’s sole benefit?

Previously this wasn’t clear, and some trustees had significant problems as a result.  However, the new POMS provide some guidance:

“The key to evaluating this provision is that, when the trust makes a payment to a third party for goods or services, the goods or services must be for the primary benefit of the trust beneficiary. You should not read this so strictly as to prevent any collateral benefit to anyone else. For example, if the trust buys a house for the beneficiary to live in, that does not mean that no one else can live there, or if the trust purchases a television, that no one else can watch it. On the other hand, it would violate the sole benefit rule if the trust purchased a car for the beneficiary’s grandson to take her to her doctor’s appointments twice a month, but he was also driving it to work every day.”

So distributions must be for the primary benefit of the beneficiary, but may allow incidental benefits to third parties.  I think the key here is whether that incidental benefit is is reasonable, as the examples illustrate.

The POMS also provide guidance of travel expenses, credit cards, and other important issues, which we’ll try to cover in forthcoming blog posts.  In the meantime, if you have any questions about special needs trusts, call (908-704-1900) or email FriedmanLaw today.

As this website provides general information and isn’t tailored to your particular situation, it doesn’t constitute legal advice and may not take into account rules and exceptions that affect you. Although updated from time to time, this website may not take account of recent legal developments or differences in laws from state to state. For safety sake, obtain individual legal advice before you act! You assume all risk of acting on information contained in this website. This website doesn’t constitute legal advice, and no attorney-client relationship exists unless FriedmanLaw and you execute a written engagement agreement. Please contact us at 908-704-1900 to discuss engaging FriedmanLaw to help resolve your legal concerns.
Homepage photo: Cows grazing at Meadowbrook Farm, Bernardsville, NJ by Siddharth Mallya. October 23, 2012.
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