Long-Term Care Insurance Policyholder Wins Suit Against Company for Hiking Premiums

A long-term care policyholder has successfully sued her insurance company for breach of contract after the company raised her premiums.

At age 56, Margery Newman bought a long-term care insurance policy from Metropolitan Life Insurance Company. She chose an option called "Reduced-Pay at 65" in which she paid higher premiums until she reached age 65, when the premium would drop to half the original amount. The long-term care insurance contract set out the terms of the reduced-pay option. It also stated that the company could increase premiums on policyholders in the same "class." When Ms. Newman was 67 years old, the company notified her that it was doubling her premium.

Ms. Newman sued MetLife for breach of contract and fraudulent and deceptive business practices, among other things. In its defense, the company argued that the increase was imposed on a class-wide basis and applied to all long-term care policyholders over the age of 65, including reduced-pay policyholders. A federal district court dismissed Ms. Newman’s suit, ruling that the contract permitted MetLife to raise her premium. Ms. Newman appealed.

The U.S. Court of Appeals for the Seventh Circuit reversed the lower court's decision and held that MetLife breached its contract when it raised Ms. Newman's premium (Newman v. Metropolitan Life Insurance Company, U.S. Ct. App., 7th Cir., No. 17-1844, Feb. 6, 2018). According to the court, reasonable people would believe that signing up for the reduced-pay option meant that they were not at risk of having their premiums increased. The court also allowed Ms. Newman's fraudulent and deceptive business practices claim to proceed, ruling that she showed evidence that the company's marketing of the policy was deceptive and unfair.

Are Medicare Advantage Plans Steering Enrollees to Lower-Quality Nursing Homes?

A new study has found that people enrolled in a Medicare Advantage plan were more likely to enter a lower-quality nursing home than were people in traditional Medicare. The study raises questions about whether Medicare Advantage plans are influencing beneficiaries' decisionmaking when it comes to choosing a nursing home.

Medicare Advantage plans, an alternative to traditional Medicare, are provided by private insurers rather than the federal government. The government pays Medicare Advantage plans a fixed monthly fee to provide services to each Medicare beneficiary under their care, and the services must at least be equal to regular Medicare’s. While the plans sometimes offer benefits that original Medicare does not, the plans usually only cover care provided by doctors in their network or charge higher rates for out-of-network care.

The study, conducted by researchers at Brown University School of Public Health, examined Medicare beneficiaries entering nursing homes between 2012 and 2014. Using Medicare’s Nursing Home Compare website as the measure of quality, the study found that beneficiaries in Medicare Advantage plans tended to enter lower quality nursing homes than beneficiaries in original Medicare. This was true even when the researchers took into account the beneficiaries' distance from the nursing home and other decision factors. Even beneficiaries enrolled in highly rated Medicare Advantage plans were more likely to enter a low-quality nursing home compared to original Medicare beneficiaries.

The study does not draw any conclusions about whether the Medicare Advantage beneficiaries fared worse than original Medicare beneficiaries, only that they tended to enter facilities that had higher re-hospitalization rates and worse outcomes. The study concluded that Medicare Advantage plans may be influencing beneficiary decisionmaking around nursing home selection. According to Skilled Nursing News, one of the study’s authors speculated that a Medicare Advantage plan "might be incentivized to send patients to a given nursing home regardless of what the quality ratings are, because of a relationship with that nursing home or because they have a lot of patients in that nursing home and can better manage their care."

Information on exactly why this is happening is “of vital policy importance,” according to the study's authors. They recommend gathering more information about Medicare Advantage nursing home claims and re-hospitalization rates and requiring Medicare Advantage plans to be more transparent about the quality of nursing homes in their networks.

To read the study, which was also published in the January issue of the journal Health Affairs, click here.

Tailoring a Will and Power of Attorney for Multiple States

If you own property -- whether houses, bank accounts, or vehicles -- in more than one state, do you need estate planning documents for each state? The answer is probably no, but you need to do some planning if you want to avoid going through probate in each of the states.

A lawyer can generally draft a will that is generic enough to be probated in any state except Louisiana, which has very specific rules. However, real property in another state is subject to probate in that state even if you don't live there. If you aren't careful, your estate may have to go through probate in every state you have property in.

To avoid multiple probate actions, you may want to use probate avoidance techniques for the property that is out of state. If your estate is under the estate tax limit and you don't have family complications, you may hold your property jointly with your spouse. Joint property will pass to your spouse without going through probate. If holding property jointly won't work, you can put your property into a revocable trust. Property in a revocable trust will pass to whoever is named in the trust. It does not come under the jurisdiction of the probate court and its distribution won't be held up by the probate process.

A power of attorney -- which allows a person you appoint to act in your place for financial purposes if you ever become incapacitated -- is an important estate planning document for anyone, including individuals with property in multiple states. One power of attorney should work in multiple states as long as it is written generally enough, but states may have different rules for what makes a valid power of attorney. State laws usually recognize a valid power of attorney created in another state, but you should check with an attorney in the state to make sure it will be recognized. Even if the power of attorney complies with state law, a bank may not accept it. You should let the bank know about your power of attorney and make sure there are no specific forms that the bank requires.

Contact your attorney to make sure your estate planning documents will work in multiple states.