QMB Connecticut Legislative Changes Fact Sheet

What is QMB?

  1. QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary) and ALMB (Additional Low-Income Medicare Beneficiary) are Medicare Savings Programs by which the State of Connecticut (through the Department of Social Services) helps low income Medicare beneficiaries with the cost of health care.

What did the legislature change?

  1. The 2017 session of the Connecticut legislature dramatically reduced the income a resident can have and still qualify for one of these Medicare Savings Programs. As a result, it is estimated that as many as 100,000 Connecticut residents may lose their eligibility for Medicare Savings Programs starting on January 1, 2018.
Program 2017 income limit

Single Person

2018 income limit

Single Person

2017 income limit

Couple

2018 income limit

Couple

QMB $2,120.00/month $1,025.00/month $2,854.00/month $1,374.00/month
SLMB $2,321.00/month $1,226.00/month $3,125.00/month $1,644.00/month
ALMB $2,472.00/month $1,377.00/month $3,328.00/month $1,847.00/month

 

How does a Medicare Savings Program help me?

  1. QMB. If you have QMB coverage, the State pays your Medicare A premium (if applicable), your Medicare B premium, and all Medicare co-insurance and deductible amounts.
    1. In 2017, the standard Medicare B premium is $134.00 per month.
    2. In 2017, the Hospital in-patient deductible is $1,316.00 per benefit period.
    3. In 2017, the Hospital in-patient co-insurance amount begins at $329.00 per day after 60 days in the Hospital.
    4. In 2017, the Medicare B deductible is $183.00.
    5. In 2017, the Medicare B co-insurance amount is 20% of the Medicare approved amount.
  2. SLMB. If you have SLMB coverage, the State pays your Medicare B premium.
  3. ALMB. If you have ALMB coverage, the State pays your Medicare B premium.
  4. Extra Help with prescriptions. If the State is paying your Medicare B premium, you automatically also qualify for Extra Help (also called a Low-Income Subsidy) with the cost of prescription medicine. In most cases this means you will pay no more than $3.35 for a 30-day supply of a generic drug, or $8.35 for a 30-day supply of a brand-name drug.

What can I do?

  1. If you were on QMB, you still may qualify for SLMB or ALMB. If you were on SLMB, you still may qualify for ALMB (check the income limits above). You may also qualify for “Extra Help/LIS.”
  2. If you have no Medigap insurance (covers Medicare co-insurance and deductibles) because you had been on QMB, speak to a knowledgeable health-care insurance agent about purchasing Medigap coverage.
  3. You can divert your “excess income” to what is called a “Pooled Trust” administered by a Connecticut non-profit corporation called Planned Lifetime Assistance Network of Connecticut, Inc. (“PLAN”). This will allow you to remain eligible for QMB, SLMB, or ALMB.

Example:

Assume a 70 year old widow whose only income is $1,850.00 per month from Social Security. For years, she has been eligible for QMB benefits. In 2018, she will have $825.00 per month of excess income ($1,850.00- $1,025.00). If she diverts the excess income to a PLAN Pooled Trust, this is how things will work:

  1. She will need to pay PLAN an Enrollment Fee of $1,050.00 to get started.
  2. Every month she will send PLAN a check for $825.00. This will make her eligible for continuing QMB coverage in 2018.
  3. She will direct PLAN to use the $825.00 to pay bills she previously paid from her checking account. Examples are utilities, taxes, insurance, automobile payments, etc.
  4. In addition to the Enrollment Fee, PLAN charges a monthly trust administration fee of $100.00 when PLAN actively pays bills and a one time closing fee of $300.00. Please note that there may be other fees assessed depending on how the trust is used.

Is it worth establishing a PLAN Pooled Trust?

  • As often is the case, the answer is “it depends.”
  • You need to weigh the cost involved in establishing and maintaining the Pooled Trust against the money you will save by not paying a Medicare B premium, possibly, not needing to have Medigap insurance, and having Extra Help with prescription costs.
  • You also need to weigh whether it annoys you to need to use an intermediary (PLAN) to pay some of the monthly bills you previously paid yourself.
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Connecticut General Assembly adopts new budget which includes an increased recording fee

The Connecticut General Assembly has adopted a new budget which includes an increased recording fee.  This increased recording fee will become effective December 1, 2017. The new fee will be seven dollars more per document to record documents on the land records.  At the time of publication, it is still unclear if the Governor will sign the bill.  however, even if he were to veto it, the affirmative votes cast in both the House and Senate appear to make the bill veto-proof.

 

 

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Allison and Nicole named to 2017 New England Super Lawyers (R) Rising Stars List

We’re excited to announce that Allison and Nicole have been named on the 2017 New England Super Lawyers Rising Stars list! This is an exclusive list, recognizing the top 2.5% of New England attorneys under 40 years of age and in practice for 10 years or less. This is Allison’s third consecutive year named to the Rising Stars list. Nicole has been named to the Rising Stars list after just two years of practicing law.  Both Allison and Nicole have been nominated to the list by their peers who have recognized Allison and Nicole for their work in estate planning.

Congratulations to Allison, Nicole, and all of the other attorneys recognized! To view the list click this link: Super Lawyers Digital Magazine.

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Living Well in Orange, Connecticut

Join us at Maplewood at Orange on Thursday November 2nd from 5 to 7pm to learn about all of the local resources available to support seniors as they age. A panel style discussion will include professionals from Floman DePaola regarding planning to pay for long term care. Maplewood will discuss the options that assisting living can offer. Orange Rehabilitation and Health Care Center will touch on the issues seniors face with regard to rehabilitation and skilled nursing care, and Orange VNA will cover in-home care options. Light supper and refreshments will be served. We look forward to seeing you there!

Please RSVP to 203-795-3117 by October 30th or to lcastiline@maplewoodsl.com

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Connecticut Legal News: What’s new and what’s not for Connecticut residents.

There have been some updates to Connecticut law that impact Connecticut estate planning and Connecticut advance directives.  Additionally, there are recent developments in the discussion regarding Connecticut Estate Tax changes scheduled for 2018.

  • The MOLST Pilot Project (discussed in our July 2017 article) has been made permanent. Recently, Governor Malloy signed into law Public Act 17-70 which makes what had been a “pilot project” for certain institutions in certain parts of the State, a permanent Statewide option.
  • ABLE (Achieving a Better Life Experience) accounts were authorized by the Connecticut legislature in 2015 (discussed in our April 2015 article). The enabling legislation directed the Office of the State Treasurer to establish a protocol for such accounts for Connecticut residents. That still has not occurred. As a result, a Connecticut resident wanting to establish an ABLE account must do so through a State that allows non-residents to do that. At the present time, that is either Ohio or Kentucky.
  • The new Connecticut Uniform Power of Attorney Act (discussed in our October 2016 article) which became effective on October 1, 2016 was amended. For the most part, the amendments just cleaned up ambiguities in the new law that had become effective on October 1, 2016. Don’t worry if you have a Power of Attorney Instrument signed before October 1, 2016. If it was valid when you signed it, it still is.
  • Public Act 17-91 adopts the Uniform Recognition of Substitute Decision Making Act in Connecticut. This is particularly important for residents who have moved to Connecticut or live part of the year in Connecticut and part of the year elsewhere. The Act says that if you have signed a Power of Attorney Instrument or Health Care Instructions valid in the State where you signed them, Connecticut must recognize the documents as valid, as well.
  • As of the time we go to press, the Connecticut Estate Tax Exemption for property passing to anyone other than a citizen spouse increases, gradually, to the same amount as the federal exemption (presently $5,490,000.00). The increase is phased in over 3 years, beginning in 2018. This is very good news for many Connecticut residents as it will allow for much less complicated estate planning documents.

If you are interested in learning more about any of these subjects, please visit our website and read our blog for recent posts.  For advice specific to you or your family, please contact the office.  We would be glad to meet with you for a no hassle, no charge initial consultation, no matter how long it lasts.

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Steve Celebrates 50 years of practicing law!

We congratulate Steve Floman, our partner, friend, and mentor, who has been practicing law for 50 years, 40 of them from our present location at 378 Boston Post Road. On August 8, 1967, Steve was sworn in to the Connecticut Bar.  Before entering private practice, Steve worked for the New Haven Legal Assistance Association.  Since entering private practice in 1972, Steve has dedicated his practice of law to helping clients in various areas of the law.  During recent years, Steve has focused exclusively on estate planning, long term care planning, special needs planning, and estate administration matters.   Steve is an active member of the National Academy of Elder Law Attorneys (NAELA) and has been recognized for his pro bono services by the Connecticut Bar Association.

In April of this year, Steve was honored as a Half Century Honoree by the Connecticut Bar Association at its Celebrate With The Stars dinner.

We all look forward to practicing law and helping clients together for many years to come.

 

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What commonly has been referred to as the 21st Century Cures Act (became law on December 13, 2016) makes an important change for special needs trust planning for a disabled person younger than 65.

  • Who it helps: A disabled person younger than 65 who comes into assets (typically by inheritance or settling a personal injury case) that otherwise would make him/her ineligible for government benefit programs such as Supplemental Security Income (“SSI”) or Medicaid can maintain eligibility for government benefits by placing the assets into a specific type of special needs trust (“SNT”) that has been authorized by federal law since 1993.
  • What happened before? Before the 21st Century Cures Act, however, the disabled person was not allowed to establish the SNT. The SNT needed to be established by a 3rd party such as a parent, grandparent, guardian, conservator, or Probate Court. When there was no parent or grandparent around to establish the SNT, it became extremely complicated (and expensive) for the disabled person to get the SNT established.
  • What will happen now? 21st Century Cures Act undoes that inequity by allowing a disabled person to establish the SNT for himself/herself. No longer is a parent, grandparent or other third party required to be the one that establishes the SNT.
  • How this benefits individuals: This will make life significantly easier for a disabled person younger than 65 who needs to preserve eligibility for many means tested government benefit programs.

If you are interested in learning more about special needs trust planning, please visit our website and read our blog for recent posts.  For advice specific to you or your family, please contact the office.  We would be glad to meet with you for a no hassle, no charge initial consultation, no matter how long it lasts.

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Have you ever seen the acronym MOLST?

It is a potentially very important and sensitive written document that stands for Medical Orders for Life Sustaining Treatment. Not all States permit a MOLST. Connecticut has a pilot program, now in place.

  • What does a MOLST do? A MOLST allows a person who is “approaching the end stage of a serious, life-limiting illness” or who is “in a condition of advanced, chronic progressive frailty” to express binding wishes about the extent of care he/she wants.
  • Is it the same as a DNR? No, it is more extensive than a DNR. A DNR only addresses resuscitation. A MOLST addresses CPR, transfers from home or a facility to a hospital, non-CPR intubation and ventilation, medically administered hydration and nutrition, and dialysis.
  • Is it the same as a Living Will? No, it is more extensive than a Living Will. A Living Will becomes operative only if you are in a “persistent vegetative state” or the “final stage of a terminal illness”. A MOLST is operative much earlier in the process.
  • Why would the Legislature authorize a MOLST? The policy reason for a MOLST is to encourage end of life discussions between an approved health care provider and patient at a time when the patient is not critically ill and the patient (and family) are not in a crisis mode.
  • Who can sign a MOLST? A MOLST can be signed by a certified physician, DO, physician’s assistant, or advanced practice registered nurse who has received special training about end of life discussions. It, of course, also must be signed by the patient.
  • How can I be sure people know about the MOLST? It is on lime green paper to make it easy to recognize. If you are at home, you should paste it to your refrigerator. If you are in a Hospital or Skilled Nursing Facility, it is part of your file and it will follow you from place to place.

If you are interested in learning more about the MOLST or other end of life decision making, please visit our website and read our blog for recent posts.  For advice specific to you or your family, please contact the office.  We would be glad to meet with you for a no hassle, no charge initial consultation, no matter how long it lasts.

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What’s the difference between a Living Will and a Do Not Resuscitate Order?  

A Living Will:

  • Comes into play only if you are in a “persistent vegetative state” or the “final stage of a terminal illness” and are being kept alive by a “mechanical device.”
  • A Living Will tells the world whether you want to be kept alive in those specific circumstances. The choice is yours.
  • A Living Will also authorizes others to communicate your wishes if you are not able to do so.
  • A Living Will can be prepared by an attorney, or any other knowledgeable third party.

A Do Not Resuscitate Order:

  • Can come into play even if you are not in a “persistent vegetative state,” the “final stage of a terminal illness,” or being kept alive by a “mechanical device.”
  • A Do Not Resuscitate Order (commonly called “DNR”) means you don’t want the application of efforts to resuscitate you using methods such as CPR, chest compression, defibrillation, mouth to mouth or mouth to mask, ventilator or any similar medical procedure.
  • A DNR order can only be authorized by a physician. You, or someone authorized to act on your behalf, of course, must approve the DNR order, in writing.

Example 1:

  • You are in reasonably good health and have a heart attack at home. You have a Living Will. Some type of resuscitation is required to keep you alive; it will be administered.

Example 2:

  • You are in extremely poor health, have lost lots of your mental acuity, and have been in and out of hospitals for many serious medical conditions over the past few years. You have a heart attack at home. You have a Living Will. Some type of resuscitation is required to keep you alive; it will be administered.

Example 3:

  • Same facts as example 2 except you also have a DNR order. You will not be resuscitated.

If you are interested in learning more about these types of advance medical directives, please visit our website and read our blog for recent posts.  For advice specific to you or your family, please contact the office.  We would be glad to meet with you for a no hassle, no charge initial consultation, no matter how long it lasts.

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Learn about Connecticut Wills, Living Trusts, Probate, and Long Term Care from our Attorneys

Do you have questions about Connecticut Wills, Living Trusts, Probate, or Long Term Care?

We often write about Wills, Living Trusts, Probate matters, and other legal topics here on our blog and in our social media.  This Spring, we’re offering classes so that we can review these topics in detail.  Please join us to learn more and ask questions that are helpful to you.

CONNECTICUT Probate:

In March we will discuss the Connecticut Estate Administration and Probate Process.

Connecticut Estate Planning: Wills, Living Trusts, Durable Power of Attorney and Health Care InstruCTIONS

In April we will discuss the importance of Estate Planning in Connecticut.  Topics include Wills, Revocable and Irrevocable Trusts, and Advance Directives, which consist of Durable Power of Attorney Instruments, Living Wills, and Health Care Instructions.

Myths and Truths about Connecticut Living Trusts

Living Trusts are a popular planning tool.  This class is dedicated to uncovering the myths and truths about Connecticut Living Trusts.  In this class you will learn about questions to determine if  a Living Trust is right for you.

Planning and Paying for Long Term Care in Connecticut

Finally, we’ll discuss planning and paying for long term care, and what government benefits, like Medicaid, are available to Connecticut residents.

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