Archive for the 'Social Security' Category

Share of Cost, Watch Out for Romance Scams

Monday, Feb. 4th 2019 5:58 AM

With Valentine’s Day upon us, the Consumer Financial Protection Bureau (CFPB) reminds elders to be aware of romance scams and to “guard your wallet as well as your heart.” Below is an article from the CFPB on what to watch out for and how to protect yourself from such scams.

If you or your friends and family members are looking for romance, make sure to be choosy about that next sweetheart because anyone can become a victim of a romance scam . Perhaps your friend meets someone new and they both seem smitten quickly. After a few weeks, the new darling asks your friend to loan them money or wants control over your friend’s bank account. And that’s when you realize that your friend has fallen for a scam instead of a new love. These scams happen when a new love pretends to be interested in you as a way to get your money. In fact, they may not even be who they say they are.

Romance scammers focus on single people, often older adults who might be more trusting. Widows and widowers, LGBT elders, and isolated single adults are common targets, but scammers look for anyone eager for a new relationship. Romance scams can happen in person, but often happen online through social media or dating websites and smartphone apps.

Here are some common scenarios that may be a scam:

  • A new love who lives far away asks you to wire them money or share your credit card number with them—even if they say they’ll pay you back.
  • Your new romantic interest asks you to sign a document that would give them control of your finances or your house.
  • Your new sweetheart asks you to open a new joint account or co-sign a loan with them.
  • Your new darling asks for access to your bank or credit card accounts.
  • Protect yourself and others from romance scams

Romance scams are not limited to Valentine’s Day, so be smart about who you connect with, and save yourself the worry about Cupid’s arrow striking your wallet instead of your heart! Here are some ways you can protect yourself and your friends and family from romance scams:

  • Don’t give a new friend access to your money—including ATM cards, bank accounts, credit cards, or investment accounts.
  • Report any crimes to your law enforcement’s non-emergency number. If you suspect that someone is a victim of elder abuse or financial exploitation, report it to Adult Protective Services (APS). Find your local APS at If you think the person’s safety may be at risk, call 911.
  • Report romance scams and financial abuse to your state attorney general. Visit the National Association of Attorneys General website  for the contact information of your state attorney general.
    Report suspected romance scams to the Federal Trade Commission at
Posted on Monday, Feb. 4th 2019 5:58 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Watch Out for Romance Scams

Share of Cost, Do You Know People Who May Be Eligible for Part D’s Extra Help?

Tuesday, Oct. 23rd 2018 6:17 AM

Do you know people who are struggling to pay their Medicare Part D prescription drug costs? If so, they may qualify for help through Medicare’s Part D low-income subsidy (LIS), also known as Extra Help. For those who qualify, the Extra Help can save them thousands of dollars a year by helping cover the cost of their Part D plan premium, deductible and drug copayments. Despite how good these benefits are, many people who qualify are unaware of this program. Please help us reach those not yet enrolled by passing on the word on the Extra Help program and encouraging people to apply. (Note: the Medicare Savings Programs (MSPs) can also help cover some of Medicare’s costs for those who qualify, and save beneficiaries thousands of dollars a year.)

Below are 5 good enticing facts to know about Medicare Part D’s Extra Help, taken from the National Center on Law and Elder Rights.

  1. People with Medicare can enroll in the Part D low-income subsidy (LIS), or Extra Help, at any time in the year. Applications can be completed online at the Social Security website1 or in person at any Social Security office. Enrollment usually does not require producing documents like bank statements or insurance policies.
  2. Extra Help coverage lasts until the end of the year, even for those who no longer qualify for Medicaid. This can be particularly helpful for older adults with a Medicaid share of cost. If they meet their share of cost even once, they qualify for Extra Help for the rest of the year. If they meet it in July or later, they qualify for Extra Help for the rest of that year and all of the next year.
  3. People with Extra Help can change Part D plans and Medicare Advantage Part D (MA-PD) plans at any time without a penalty.They do not have to wait for an open enrollment period. This can be helpful for clients who have recently been diagnosed with a chronic condition or who have changed prescriptions and find that the formulary of their current plan does not meet their needs.
  4. Extra Help is not subject to estate recovery. Many seniors are fearful of applying for Medicaid because estate recovery laws may allow states to recoup some costs from their estates. Extra Help is different. There is no estate recovery for Extra Help costs. Federal law does not permit states or the federal government to collect money from your client’s estate for Extra Help costs. Medicare Savings Programs (QMB, SLMB and QI) also are exempt from estate recovery.
  5. People with full Extra Help qualify for a $10 a month Social Security overpayment plan. It is not uncommon for clients to owe Social Security for an overpayment of benefits. When this happens, clients often find that a large portion of their Social Security benefit is being deducted to pay back the debt. If your client has Extra Help, however, the client can request that Social Security take out only $10 a month. Social Security is required to automatically honor the request when it is made.


Posted on Tuesday, Oct. 23rd 2018 6:17 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Do You Know People Who May Be Eligible for Part D’s Extra Help?

Share of Cost, hat State or Federal laws, regulations, or policies or restrict competition and choice in healthcare markets

Sunday, Oct. 21st 2018 6:16 AM

What State or Federal laws, regulations, or policies (including Medicare, Medicaid, and other sources of payment) reduce or restrict competition and choice in healthcare markets?

Medicare can be confusing or even overwhelming, especially when a person has chronic illness, limited resources, or a lack of help. Choosing among traditional Medicare, Medicare Advantage (MA), Medicare Part D, and supplemental or “Medigap” options can make it almost paralyzingly complex. We rely on people with Medicare to make informed, savvy choices—in other words, to “vote with their feet”—so that competition can reward plan innovations that work, identify bad actors and problematic behaviors, and reduce both beneficiary and program costs. Yet, studies show that older adults struggle to compare plans1 and often do not change MA or Part D plans even when doing so may lead to lower premiums and reduced cost-sharing.2 To put it simply—people with Medicare are overwhelmed with information, but it may not be the information they need.

As policymakers consider putting beneficiaries on the hook for plan and health care choices, the absence of quality, useful information becomes increasingly punitive. We cannot support proposals that will shift costs to people with Medicare, penalize them for failing to make optimum choices, or otherwise transfer burdens onto their shoulders. Doing so becomes especially egregious when people are kept in the dark about what their choices are or what they might mean. The existing resources are insufficient. They must be improved before new complexities are added.

Currently the only Medicare choice tool is Plan Finder. While Plan Finder allows head- to-head comparisons of prescription drug plans, its utility is limited as it does not even allow a beneficiary to search across plans for particular providers. And there is no adequately-resourced tool to fill the gaps. The vital State Health Insurance Assistance (SHIP) program, which offers one-on-one personalized assistance,3 is woefully underfunded, faces challenges meeting current demands, and is constantly under threat.4 1-800- MEDICARE, while a needed resource, is no substitute for in-person assistance. We urge the administration not to move forward with any proposals to increase plan flexibility that would also further complicate beneficiary choice until adequate tools and resources are available for beneficiaries to effectively evaluate and compare their options.

We also note that as plan offerings become more complex, the administration’s responsibility to oversee plans appears to be getting less emphasis. Such oversight is an obligation that the Centers for Medicare & Medicaid Services (CMS) owes to beneficiaries, and is only increased by increasing complexity.

We might point out that CMS’s inability to negotiate prices for prescription drugs further compounds beneficiaries’ options, as plans are free to choose the pharmaceutical benefit managers that give them the “best price for a restricted formulary” regardless of how it will impact the beneficiary.

Recently an 81 year old beneficiary with diminished capabilities succumbed to marketing mailers from a United Healthcare plan endorsed by AARP and enrolled in a Medicare Advantage HMO plan without understanding the implications of her decision. She just “trusted AARP!” The local HICAP (California’s SHIP) will attempt to unravel her situation to ensure that she and her daughter understand the consequences of her decision, and make any needed changes based on her unique circumstances.



Posted on Sunday, Oct. 21st 2018 6:16 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, hat State or Federal laws, regulations, or policies or restrict competition and choice in healthcare markets

Share of Cost, New Medicare Cards Coming to Californians April – June 2018

Saturday, Mar. 10th 2018 1:01 PM

The Centers for Medicare and Medicaid Services will mail new Medicare cards to all Medicare beneficiaries to help protect people from identity fraud. In California, your cards will arrive between April and June. Fraudsters are always looking for ways to get people’s Social Security Numbers (SSNs) so Medicare is removing SSNs from all Medicare cards to make them safer.

Your new card will have a new Medicare Number that’s unique to you. The new card will help protect your identity and keep your personal information more secure. Your Medicare coverage and benefits stay the same.

Medicare will automatically mail your new card at no cost to the address you have on file with Social Security. There’s nothing you need to do! If you need to update your official mailing address, visit your online my Social Security account.

Once you get your new Medicare card, take these 3 steps to make it harder for someone to steal your information and identity:

  1. Destroy your old Medicare card right away.
  1. Use your new card. Doctors, other health care providers, and plans approved by Medicare know that Medicare is replacing the old cards. They are ready to accept your new card when you need care.
  1. Beware of people contacting you about your new Medicare card and asking you for your Medicare Number, personal information, or to pay a fee for your new card. Treat your Medicare Number like you treat your Social Security or credit card numbers. Remember, Medicare will never contact you uninvited to ask for your personal information.

For more information about your new Medicare card, visit Also see this beneficiary Fact Sheet in English and Spanish, and watch the video below. In addition, you can visit for tips to prevent Medicare fraud, or see our Fraud & Abuse section of our website. If you have any fraud related questions or suspected incidences to report, call our California Senior Medicare Patrol (SMP) at 1-855-613-7080.


Posted on Saturday, Mar. 10th 2018 1:01 PM | by Share of Cost | in Social Security | Comments Off on Share of Cost, New Medicare Cards Coming to Californians April – June 2018

Share of Cost, Navigating Medicare and the Health Insurance Marketplace

Wednesday, Jan. 3rd 2018 9:03 AM

Many people purchase their health insurance through the Health Insurance Marketplaces established by the Affordable Care Act in 2010. Yet when people become eligible for Medicare, there is little notification and thus much confusion on how and when to make the transition to this federal health care program. Below is some information with 3 main points and several action tips put together by the national SHIP Tech Center, the Senior Medicare Patrol National Resource Center and Medicare Rights Center on Health Insurance Marketplaces and how they affect Medicare. This information can help you can make informed decisions about your Medicare enrollment. For questions and/or assistance, contact your local Health Insurance Counseling and Advocacy Program (HICAP).

Posted on Wednesday, Jan. 3rd 2018 9:03 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Navigating Medicare and the Health Insurance Marketplace

Share of Cost, Medigap Legislation Would Provide New Consumer Rights

Thursday, Sep. 21st 2017 6:49 AM

Below is a summary of Rep Jim McDermott’s newly introduced Medigap Consumer Protection Act of 2016. We support this long-awaited legislation to update the Medigap program and add new consumer protections, including the right to purchase a Medigap to those with disabilities and/or end stage renal disease (ESRD).

Medicare provides affordable health insurance to 57 million American seniors and people with disabilities. However, there are gaps in the program’s benefit package. Beneficiaries are expected to pay a significant amount of out-of-pocket costs through deductibles and coinsurance, and traditional Medicare currently lacks a limit on catastrophic expenses. As a result, approximately 11 million beneficiaries choose to enroll in supplemental Medigap policies, which provide additional benefits and help reduce out-of-pocket expenses.

Although Medigap plans are an important insurance product for millions of Americans, many of the laws governing the Medigap market have remained largely unchanged since 1990. In particular, consumer protections have lagged behind other forms of insurance, leaving beneficiaries subject to discriminatory market practices, lacking sufficient information about their plan options, and at times enrolled in lower quality coverage.

The Medigap Consumer Protection Act provides the first major update to the laws governing Medigap plans in more than two decades. It will improve the beneficiary experience by:

— Expanding guaranteed issue rights to prevent issuers from denying coverage to individuals with disabilities and End-Stage Renal Disease, as well as other beneficiaries who are not currently protected.

— Calling on the National Association of Insurance Commissioners to update medical loss ratio standards to improve the efficiency of Medigap policies.

— Placing limitations on pricing Medigap products based on beneficiary age.

— Requiring Medigap issuers to price their products by county level.

— Improving the Medicare Plan Finder website to facilitate beneficiary access to information and increase consumer understanding of available plan options.

— Restoring access to popular Medigap plan options that provide first-dollar coverage of the Part B deductible.

— Increasing transparency by requiring issuers to publicly disclose payments made to brokers that sell Medigap policies.

The Medigap Consumer Protection Act makes these long overdue updates to federal law. It will significantly improve the beneficiary experience and strengthen the health security of millions of Americans enrolled in Medicare. I hope you will join me in supporting this important legislation.


Posted on Thursday, Sep. 21st 2017 6:49 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Medigap Legislation Would Provide New Consumer Rights

Share of Cost, A Brief Overview of the California Partnership for Long Term Care

Tuesday, Sep. 5th 2017 6:03 AM

This policy brief, written by Bonnie Burns, our Training and Policy Specialist provides background and an overview of the California Partnership for Long Term Care, and discusses reasons for its gradual decline. She raises the tough questions as to whether the program is meeting the goal of protecting those consumers most in danger of spending down to Medi-Cal with a long term care expense, and whether the program is saving any Medi-Cal funds that would otherwise pay for care. Earlier this year, Governor Brown signed SB 1384 (Liu) that, among other things, charges the Partnership program with establishing a task force of industry, consumer groups, and agency stakeholders to review and make recommendations on necessary changes to the program to make sure it fulfills that very goal.



Posted on Tuesday, Sep. 5th 2017 6:03 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, A Brief Overview of the California Partnership for Long Term Care

Share of Cost, Guard Your Medicare Card

Wednesday, Aug. 23rd 2017 6:24 AM

Health care fraud drives up costs for everyone in the health care system. One way to protect against such fraud is to guard your Medicare number. Fraud schemes often depend on identity thieves getting hold of people’s Medicare numbers, so treat your number as you would a credit card.



Posted on Wednesday, Aug. 23rd 2017 6:24 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Guard Your Medicare Card

Share of Cost, CHA Comments on Proposed Short Term Care Insurance Regulations

Thursday, Aug. 17th 2017 5:29 AM

October 20, 2016


Commissioner Katharine L. Wade
State of Connecticut Insurance Department
Attention: Kristin M. Campanelli
P.O. Box 816
Hartford, CT 06142-0816


Re: Proposed Short Term Care Insurance Regulations


Dear Commissioner Weddle:

We write to comment on your department’s proposed regulatory changes to short term care insurance policies. As you know, I am a funded consumer representative to the National Association of Insurance Commissioners (NAIC). I am a Policy Specialist for California Health Advocates (CHA), a not-for- profit organization that among many other Medicare related topics provides information, training, and education on long-term care and long term care insurance. We promote high legislative and regulatory standards for long-term care insurance in our state legislature, at the NAIC, and in Congressional testimony.

At the national Summer meeting of the NAIC, a new subgroup was appointed at our request to explore the issue of how these short term care policies are regulated. My request was backed up by a letter to the SITF signed by 20 consumer group representatives requesting that these products be regulated as long term care insurance. It seems illogical to many people that a product offering nursing home and home care benefits for 360 days or less is regulated differently, and under very general minimum standards, than one that provides those same benefits for 364 days or more. We have not heard a reasonable argument about why consumers should not be protected under the same standard simply because they buy a benefit that covers them for a fewer number of days.

As I review your proposed regulation I note that you have incorporated some of the standards from the long term care insurance models. I would encourage you to go beyond HR 5521 and bring these products under the umbrella of the long term care insurance standards with any exceptions for those elements you think shouldn’t apply to these products.

All of the definitions of benefit triggers, benefits, services, and places of care should be the same in a short term policy as they are in the NAIC Model

All of the disclosures in the NAIC Models should be required in a short term care policy, plus one additional disclosure.

A disclosure should be developed to clearly describe the limitations of a short term care policy with very limited benefits. Purchasers of a short term care policy should also be advised about the availability of a Partnership policy to cover one year of care that can potentially provide them with additional protection of their assets.

In any replacement situation agents should be required to identify in writing the reason for replacement, and explain why the replacement policy is to the advantage of the consumer. If coverage is being added to existing coverage agent should be required to explain in writing the advantage of the additional coverage to the applicant. These explanations should be part of the application or separately attached to the policy.

There is no justifiable reason that companies selling short term coverage ranging from a few months of benefit to just under one year be allowed a 55% loss ratio. The profit margin on these limited benefits is unreasonable, and short term policies should at a minimum comply with a 65% loss ratio for individual coverage and 75% for group coverage.

The actuarial evaluation of premiums for these policies should include an assessment of the limited risk a short term care policy is assuming, and require premiums to reflect that limited risk. In addition, an actuarial evaluation should take into account the difference in underwriting for a short term policy and for a traditional policy. Even with limited benefits it’s possible a company selling one of these short term care policies could underestimate their ultimate claims assumptions and fall into a spiral of rate increases. In another instance a policyholder could ultimately pay more in premiums over their lifetime than the small amount of benefit promised by a few months of coverage.

A consumer buying a short term care product providing benefits for a few months of coverage instead of years should not be less secure or less protected than someone buying more of the same benefits. In fact, consumers buying these limited benefits may require even more protection. They are more likely to be lower income or have a health condition than those who can afford or qualify for a greater amount of coverage. Consumers who buy short term care policies need all of the regulatory protections provided to those who buy a traditional long term care insurance product.

I’ve identified a few issues for your consideration with portions of the proposed regulation:

People buying these products think they are buying long term care insurance or benefits, but for a shorter period of time. Terminology throughout the regulation reinforces the ability of short term care policies to restrict benefits to needs and services that are primarily medical in nature, provided by or under the direction of medical personnel, and in facilities primarily or secondarily providing medical care services. This medical connection has little application to the need for nursing home and home care and community based care. It simply allows companies to restrict or limit benefits by connecting them in some way to medical care.

The use of the term “home health care” instead of home care allows medical criteria and personnel to be applied to care that is primarily a need for personal care services (formerly custodial care).
The use of “own home” and home “health” care throughout the regulation reinforces the ability of companies to restrict benefits and care.

Definitions throughout the regulation of “own home” would allow companies to deny benefits to someone living in the home of a family member, living in an independent living situation from receiving home care services in that setting.

Cognitive impairment represents about half the claims for long term care services today, along with functional impairments, but that broader term is missing throughout the regulation. Nowhere in the regulation are benefit triggers required or spelled out. Dementias other than Alzheimer’s are not recognized in exceptions or exclusions, or elsewhere in the regulation where all causes of dementias should be included. A short term policy would not be required under the proposed regulation to cover cognitive impairment at all.

It is possible, as this regulation is currently written, to write a short term policy with benefit triggers of 5 out of 6 (or even less) ADLs, for care in a nursing home that must be medically necessary at the beginning, and that is not at first custodial in nature.

Here are specific comments on a few provisions of the proposed regulation.

(New) Sec, 38a-xxx-2. Definitions

Definitions in this section reinforce the ability of companies to apply medical standards to benefit triggers, services, providers, and places of care. …..for necessary care or treatment of an injury, illness or loss of functional capacity provided by a certified or licensed health care provider…… and for…confinement in the insured’s own home….

(New) Sec. 38a-xxx-3 Policy definitions and terms

This section lists but does not contain definitions related to activities of daily living or of cognitive impairment thereby allowing companies to define these in very restrictive terms.

There is no requirement that ADLs or cognitive impairment be a benefit trigger, leaving companies free to exclude them completely or require a simultaneous number of ADLs, or require an unrealistic number of ADLs before benefits would be available. The definitions of “accidental injury” or an “acute condition” or medically necessary care” allows these terms to be applied to a benefit trigger or to the policy benefits. These terms and definitions in the regulation have little applicability to the need for the services in short term policies and give companies unrestricted ability to deny benefits.

Under (e) (3) of this section “a home or facility primarily used for the care and treatment of a mental disease or disorders, or custodial care” could exclude care in facilities that provide psychiatric care, or facilities that provide care to people with dementias. Many of those facilities are referred to as memory care facilities, and under these definitions could be excluded. (Some of the definitions of places of care should of course accurately correspond to where care is provided in your state, and how each place of care is regulated in Connecticut.)

Under (h) of this section “Home health care services” includes “medical and non-medical services, provided to ill, disabled or infirm persons who reside at home.”

This is very restrictive when applied to people who need long term care services. Terms like these would allow companies to sell very restrictive benefits that policyholders would be unlikely to discover until they filed a claim.

There is no definition in the regulation of assisted living which could allow companies to refuse to pay for home care in such a facility under the definitions in this regulation.

In (m) of this section: Alzheimer’s disease is excluded from the definition of mental and nervous disorders, but other dementias are not, leaving companies free to demand that benefits are only payable for Alzheimer’s disease.

In (n) of this section: Necessary care for confinement in the insured’s own home is predicated on home “health” care, again linking care to health and not ADLs or conditions of functional or cognitive impairments.

In (o) of this section: Necessary care for confinement in a nursing home is predicated on medically necessary care… that is not at first custodial care.” That is a Medicare standard for payment of nursing home benefits and completely out of place in policies that purport to provide care in a nursing home.

In (s) of this section: the standard of sickness or illness by disease has no place in any insurance policy providing benefits for nursing home and home care, and reinforces the connection to medical services.

Under Other Exclusions (2) (B) there is no exception from mental disease or disorder for Alzheimer’s or other dementias.

Under Limitations and Exclusions (d)(3) A policy is prevented from duplicating Medicare benefits, deductible, or copayment despite the fact that these are not tax qualified policies. There is no justification for carving out these benefits given the short term nature of these benefits and the high cost of care in a nursing home. This requirement is very detrimental to consumers and only benefits companies that write these policies.

Under Renewability (n) companies are able to use words and terms, “usual and customary,” “reasonable and customary,” that have caused claims problems in the past and are all medical in nature. Typically policies providing benefits for institutional and home care use a daily benefit dollar amount and there should be no reason to use those medically related terms. This is another option for companies to limit the amount of benefit they will pay at the time of a claim.

In short, many of the minimum requirements in the proposed regulation could lead to very restrictive policy benefits being sold in a short term care policy to the disadvantage of consumers. I urge you to consider bringing these products under the umbrella of long term care insurance standards with specific exceptions for those elements you think shouldn’t apply to these products.

Bonnie Burns, Policy Specialist


Posted on Thursday, Aug. 17th 2017 5:29 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, CHA Comments on Proposed Short Term Care Insurance Regulations

Share of Cost, CHA Provides Testimony on Long Term Care Insurance Rate Increases

Tuesday, Jul. 25th 2017 5:48 AM

October 25, 2016

Commissioner Alfred W. Redmer Jr.
State of Maryland Insurance Administration
Attention: Adam Zimmerman, Actuarial Analyst
200 St. Paul Place, Suite 2700,
Baltimore, MD 21202

RE: Long Term Care Insurance Rate Increase Hearing October 27, 2016

Dear Commissioner Redmer:

I am submitting these comments for the hearing record regarding the premium increase hearing on October 27th in the event I am unable to comment by phone about the requested rate increases on that date. As you know, I have been a long time participant in the National Association of Insurance Commissioner’s (NAIC) consumer participation program, and I frequently testify and comment on behalf of consumers during the proceedings of the NAIC Senior Issue Task Force (SITF) and other NAIC Committees and subgroups.

Rate increases in long term care insurance have been an ongoing topic of concern for the NAIC members, and specifically for the SITF, as members have struggled for decades to regulate the pricing of long term care insurance and prevent large, unexpected rate increases. Since the 1990’s and at least 3 regulatory attempts by the NAIC to limit these increases, this now seems to be a failed regulatory task.

The large ongoing rate increases being requested in Maryland and other states and the continuing inability of state regulators to protect their consumers, regardless of the regulatory controls that states establish, are obvious. Regardless of how pricing is regulated, companies continue to demand these rate increases leaving behind anguished policyholders struggling to pay those increased premiums. The pain inflicted on Maryland policyholders is evident in the testimony already submitted for this hearing by the very people who will be paying those increased costs. Policyholders who have spoken out in their testimony represent hundreds, maybe thousands more policyholders unaware of the hearing, unable to participate, or simply assuming that their protest is useless.

These policyholders have a series of untenable choices. Faced with paying steadily increasing premiums late in life robs people of resources for other needs, and pushes some people into dropping coverage, some of whom may later require help from the state’s Medicaid program.

Some may have previously downgraded their benefits to reduce a rate increase, and now have little room for further downgrades, making retention of their policy impossible.

I am not certain which NAIC consumer protections Maryland has adopted, or the extent of your regulatory authority, but here are some suggestions for mitigating the effect of these ongoing rate increases on consumers.

  • No amount of a rate increase should be applied to any of the company’s administrative costs
  • No amount of a rate increase should be applied to any agent compensation
  • Any rate increase of 20% or more during the lifetime of the policy form should require offsetting reductions in company expenses
  • Any cumulative rate increase of 50% during the lifetime of the policy form should require the company to pool all of their existing long term care policy forms issued, bought, or assumed by the company to calculate the amount of a rate increase
  • Any cumulative rate increase greater that 50% during the life of the policy form should not be granted, except when company solvency is in question

A rate increase notice should allow 90 days of consideration by the policyholder and a referral in writing for face-to-face counseling with the Maryland State Health Insurance Program (SHIP) to ensure that policyholders have all the information they need to make an informed decision about their benefits, options, and any benefit reductions.

  • Policyholders who have previously downgraded their daily benefit amount to an amount less than 70% of the current cost of nursing home care, and reduced their duration of coverage to 2 years should be exempt from any further rate increases
  • Policyholders age 70 or older who’ve had their policy for at least 10 years should be exempt from any rate increases
  • Policyholders age 80 or older should be exempt from any rate increases, regardless of the duration of their coverage
  • Policyholders who have had their policies for 10 or more years should have the option of choosing a paid-up benefits equal to the premiums they’ve previously paid
    • The amount of benefits subsequently paid under their paid-up policy should qualify as protected assets under the state Medicaid program
  • Any policyholder who reduces or drops their inflation protection should be entitled to retain the current amount of their inflated daily benefit amount and lifetime benefit amount
    • The amount of benefits subsequently paid under their paid-up policy should qualify as protected assets under the state Medicaid program

I am well aware that some of my suggestions are extreme, and some would require a change in state law or regulations. But after three decades of helping policyholders hang on to coverage through numerous rate increases I believe companies should bear the burden of decisions they’ve made about the products they’ve sold, not policyholders.

The burden of mistaken assumptions and experience should not be borne by consumers who placed their trust in the industry by buying this coverage. Consumers have no expertise to verify assumptions made by actuaries that result in the premium they’ve agreed to pay. Policyholders don’t participate in the profitability of an insurance product, except to the extent that they rely on the benefits they’ve been sold. And policyholders certainly wouldn’t participate in any excess profit a company made based on their previous assumptions.

Policyholders have done what the federal and state governments asked, and the industry has promoted, by taking responsibility to pay for their own care. They should not now be faced with losing both the premiums they’ve invested in that promise and the benefits they bought.

Thank you for the opportunity to comment on the subject of your hearing. I hope you’re able to mitigate some of the effects of these rate increases on the policyholders in your state.



Bonnie Burns, Consultant


Posted on Tuesday, Jul. 25th 2017 5:48 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, CHA Provides Testimony on Long Term Care Insurance Rate Increases

Share of Cost, Looking to Save Money? Start with Rx Costs

Wednesday, May. 31st 2017 5:27 AM

Did you know that drug costs rose 12.2% in 2014 alone which is 5 times as fast as the year before? And that the price of the 50 top most-used generic drugs has soared over 373% between 2010-2014? What’s happening and how can we as consumers save money and be savvy about our prescriptions? One thing that’s happening is company mergers, currently leaving 3 companies in control of 40% of the generic drug market. Also, some of the newest drugs are prohibitively expensive, such as the new Hepatitis C treatment Sovaldi which is $1,000 a pill for an 84-pill treatment.

With prices and rising costs like these, it’s no wonder that insurance companies look for ways to shift more costs to consumers and make it harder to receive the higher costs drugs. For example, many drug plans have increased the number of drug tiers in their formulary (covered drugs) from just 2 tiers (one for generics, one for brand name drugs) to 3, 4 and even 5 tiers – with each tier corresponding to higher costs. This makes it confusing for consumers to know what exactly their drug costs will be when comparing plan formularies. Drug plans have also increased the number of drugs requiring step therapy or prior authorization. Such strategies shift rising drug costs to consumers and put up a barrier to receiving the higher cost medicines.

So what are some ways to save money? Money Magazine’s March 2016 edition details some good cost-saving strategies, several of which are summarized below.

  • Change your medication. If you’re taking a brand name drug, ask your doctor for its generic equivalent. Also, if you’re taking multiple medications, see if there’s one medication that can be used for multiple conditions. That option does exist in some circumstances.
  • Use mail-order to fill and refill your prescriptions. You can get a 90-day supply and will generally have a lower copay than if you get a 90-day supply at a retail store.
  • Watch out for online pharmacy scams. According to a 2013 Government Accountability Report, many of the online “Canadian pharmacies” are illegitimate. Some have been found selling drugs with lethal contaminants such as lead or rat poison. If you do use an online pharmacy, make sure the website URL ends in “.pharmacy”. This means the site meets certain regulation requirements and has been approved by the National Association of Boards of Pharmacy.
  • Use your Medicare Part D plan’s coverage determination and exceptions processes to get affordable coverage for the drug(s) you need.
  • Change your insurance. One of the most effective ways to reduce drug costs is to change your drug plan. Medicare Part D drug plans change their coverage every year, and just because one plan meets your drug needs and is affordable one year, does not guarantee it will be the same the next year. During Medicare’s Open Enrollment period (Oct 15 – Dec 7) each year, you have the option to switch plans. Review your plan’s coverage for the coming year and shop around. California’s Health Insurance Counseling and Advocacy Program (HICAP) literally helped clients save millions of dollars this year by helping them find a plan that meets their mediation needs. You can use Medicare’s Plan Finder tool at This tools allows you to easily search for compatible plans by entering your medication, dosage, frequency, and preferred pharmacies. The plan finder will then give you a list of plans with your estimated out-of-pocket costs.


Posted on Wednesday, May. 31st 2017 5:27 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Looking to Save Money? Start with Rx Costs

Share of Cost, Are Medical Costs Taking a Toll?

Thursday, May. 25th 2017 6:26 AM

Yes, and a big one. Over 26% of people in a recent poll said that health care costs posed a significant financial burden on them and/or their family. Forty-two percent of the people said they have paid all or nearly all of their savings on medical costs, and 27% said they were unable to pay for basic necessities such as food, heating, or housing. Seven percent have also declared bankruptcy because of health care costs. This is an unnecessary burden that faces both the younger population on Obamacare and the older population and people with disabilities on Medicare. In fact, a recent National Public Radio article notes that while 89% of Americans now have health insurance through Obamacare and Medcare, simply having insurance is no longer enough. The consumer costs keep rising.

According to a Kaiser Family Foundation study done last year, more and more companies are also shifting rising health care costs to their employees. For example, the workers’ share of health insurance premiums for their families rose 83% from 2005 to 2015. The amount employees had to pay for deductibles for individual insurance also increased 255% from 2006 to 2015. These increases are much higher than growth in workers’ wages. And this example demonstrates what’s happening in all areas of health care coverage, with the sickest people being hurt the most.

For more information on the poll, see NPR’s recent article, Medical Bills Still Take a Big Toll, Even with Insurance.

Posted on Thursday, May. 25th 2017 6:26 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Are Medical Costs Taking a Toll?

Share of Cost, Got Long-Term Care Insurance? Dealing with Rate Increases?

Friday, May. 19th 2017 6:05 AM

Do you have long-term care insurance? Concerned about premium increases? If so, you’re not alone. This is a conundrum elders and policy makers face nationwide. With 1 year of nursing home care costing at least $90,000, who can afford such care? In the 1970s, policy makers hoped long-term care (LTC) insurance would be their answer. Yet this industry has been nothing short of disastrous, as most companies greatly underestimated how long people would live, how much nursing home care they would require, how few people would drop their policies, and how little interest they would actually gain from banked premiums. As a result, most LTC insurance companies have left the market and policyholders are grappling with steep premium increases from each year from the remaining companies. Even California’s CalPERS (California Public Employee Retirement System), the state workers’ retirement plan, has raised their premiums 85% in the last 2 years.

Many policyholders were told to plan ahead and buy a policy early on to secure a good price, as the rates would just increase if one waited to buy a policy later in life. Well this early purchase has not paid off for many policyholders, such as one women featured in a recent Money Magazine article. Currently 69, she bought her policy 20 years ago and has had her premium quadrupled in the last 2 years. She’s facing 3 unattractive options: she can pay the higher cost; reduce the price by reducing the benefits in her policy; or cancel her policy. With so many people facing these undesirable options, California Health Advocates, along with several advocate groups, pushed for more consumer protections, including one that allows those who lapse in their policies to at least use an amount of benefits that equals the amount of premiums already paid out.

With one of the fastest growing population groups being people who are 80 and older, our nation has a long-term care crisis on its hands. Currently Medicaid (Medi-Cal in California), the federal public health insurance program for people with low-incomes and/or disability, covers about ½ of the nation’s long-term care costs and the price tag will continue to rise as baby boomers reach their 80s and 90s in growing numbers. Many people mistakenly assume Medicare, the federal health program for people 65 and older and those younger with disabilities will pay for long term care. While Medicare does pay for short nursing home stays after at least 3 days of inpatient hospital care, it does not pay for personal, or formally referred to as “custodial care” such as eating, bathing, cleaning, cooking, walking, dressing, etc. (See our Medicare Basics section for more info on Medicare coverage.) And, as highlighted, long-term care insurance has priced itself out of the middle class market, especially for women whose premiums are generally 40% higher than men’s.

So where we go from here is something California Health Advocates and several other policy groups are working on

Posted on Friday, May. 19th 2017 6:05 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Got Long-Term Care Insurance? Dealing with Rate Increases?

Share of Cost, Part D Penalties What Are They and Can They Be Avoided?

Tuesday, May. 9th 2017 6:23 AM

Nobody likes penalties, especially when it means paying more money. When it comes to Medicare, most people can avoid penalties by enrolling in Parts A, B and D when first eligible, during their Initial Enrollment Period. Those who don’t enroll during this time, may have a penalty. The IEP is different for different parts of Medicare. This article reviews the Part D late enrollment penalty (LEP) and exceptions.

Unlike Part A and B late enrollment penalties that don’t start until someone has delayed enrollment for 12 or more months, the Part D LEP begins accruing 63 days after one’s initial enrollment period has ended. The penalty amount varies depending on how long one delays enrolling in Part D after becoming eligible. To calculate the cost, Medicare multiplies 1% of the national average Part D premium ($34.10 in 2016) by the number of months without coverage. And this penalty is paid for eternity….well, not exactly, but the point is the penalty stays and one will pay it as long as s/he has Part D coverage.

Are there exceptions?

Yes, there are a couple of exceptions. The LEP is waived if you had “creditable drug coverage” during the months of delayed enrollment. To be considered creditable, the coverage must be at least as good as Medicare’s standard drug coverage. This could be coverage from an employer, union, TRICARE, Veterans Affairs, Indian Health Services or a Medicare Advantage plan with drug coverage. Each year you should receive a letter from your health plan stating that your coverage is creditable. Hold onto this letter. You may need it if you sign up for Part D at a later time.

Another exception is for people who qualify for the Part D low-income subsidy, known as Extra Help that covers most premium and deductible costs. Those who qualify do not have to pay a penalty, regardless of how long they didn’t have drug coverage.

See Prescription Drugs for more information on Medicare Part D, and our section on late enrollment penalties for more info on Part A and B LEPs.

Posted on Tuesday, May. 9th 2017 6:23 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Part D Penalties What Are They and Can They Be Avoided?

Share of Cost, America’s 65+ Population Will Double to 88 Million in 2050

Wednesday, May. 3rd 2017 6:51 AM

The world’s older population continues to grow at an unprecedented rate. Today, 8.5% of people worldwide (617 million) are aged 65 and over. According to a new report by the National Institute on Aging (NIA) and produced by the U.S. Census Bureau, “An Aging World: 2015,”  this percentage is projected to jump to nearly 17% of the world’s population by 2050 (1.6 billion). The report examines the demographic, health and socioeconomic trends accompanying the growth of the aging population.

“An Aging World: 2015” contains detailed information about life expectancy, gender balance, health, mortality, disability, health care systems, labor force participation and retirement, pensions and poverty among older people around the world. Below are a few highlights.

  • America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.
  • By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.
  • The global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.
  • Among the older population worldwide, noncommunicable diseases are the main health concern. In low-income countries, many in Africa, the older population faces a considerable burden from both noncommunicable and communicable diseases.
  • Risk factors — such as tobacco and alcohol use, insufficient consumption of vegetables and fruit, and low levels of physical activity — directly or indirectly contribute to the global burden of disease. Changes in risk factors have been observed, such as a decline in tobacco use in some high-income countries, with the majority of smokers worldwide now living in low- and middle-income countries.



Posted on Wednesday, May. 3rd 2017 6:51 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, America’s 65+ Population Will Double to 88 Million in 2050

Share of Cost, May is Older American’s Month

Friday, Apr. 21st 2017 5:53 AM

Did you know that our senior population is the fastest growing population group in America? And that worldwide the age group of 80+ is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million?! By the year 2017, the world — for the first time — will have more people 65 and older than children younger than 5. With so many people coming into “elderhood”, celebrating and honoring our older adults and empowering them to contribute and live rich, quality lives in their golden years will benefit all of society.

Established in 1963, Older Americans Month (OAM) provides one way to do this, as it historically has been a time to acknowledge the contributions of past and current older persons in our country, in particular those who defended our country. Every President since Kennedy has issued a formal proclamation during or before the month of May asking that the entire nation pay tribute in some way to older persons in their communities. Older Americans Month is celebrated across the country through ceremonies, events, fairs, and other such activities.

How will you celebrate this month? We encourage you to connect with the elders in your life — your grandparents, teachers, mentors, seniors in your community and find out what events are happening in your area. You can also host an event or gathering yourself. :-)

The Administration for Community Living has a number of outreach materials. This year’s OAM theme is Blaze a Trail. We all blaze our own path in life and as an elder, what is the legacy you’ll be leaving? ACL has some tip sheets on blazing trails in the areas of civic engagement, finances, reinvention and wellness. Listed below are some past Older Americans Month themes.

Here’s to all the elders in our country and the many contributions they have brought forth throughout their lives and the wisdom they shine in their golden years.

Posted on Friday, Apr. 21st 2017 5:53 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, May is Older American’s Month