Will Medicare Cover a Coronavirus Vaccine?

With the coronavirus pandemic responsible for more than a hundred thousand deaths and disrupting life across the United States, the only way for the country to return to normal is an effective vaccine. When a vaccine is available, Medicare will cover the cost. 

Medicare covers vaccines in a variety of ways, depending on the vaccine.  It may be through Medicare Part B, Medicare Part D, or a Medicare Advantage plan if you are enrolled in one. Part B covers vaccines only for certain illnesses: flu, pneumonia, and Hepatitis B (if you are at medium or high risk). Medicare covers 100 percent of the cost of these vaccines if you go to an approved provider, and you do not have to pay a deductible or coinsurance. Medicare Advantage is also required to provide these vaccines at no additional costs. 

Part B also covers vaccines if you are exposed to a dangerous virus or disease, such as rabies or tetanus. In those cases, you will have to pay a deductible and a 20 percent coinsurance. 

Part D covers all other doctor-recommended vaccines, such as the shingles vaccine and the Tdap (tetanus, diphtheria, pertussis) vaccine. How much the vaccine costs will depend on whether you go to a provider who is in-network for your Part D plan. If you get the vaccine in-network, you will have to pay the co-pay amount. If you get the vaccine out-of-network, you may have to pay for the entire vaccine and bill Medicare. Medicare will only pay for the approved cost, which may be less than what you paid. If you have a Medicare Advantage plan that covers prescription drugs, it may cover these vaccines. The cost to you will vary, depending on the plan.  

With regard to COVID-19, the CARES Act provides that if a vaccine becomes available, Medicare is required to cover this vaccine under Part B with no cost sharing. Medicare Advantage plans are required to include the basic coverage offered by Medicare Parts A and B, so this coverage also applies to beneficiaries in Medicare Advantage plans. 

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Elise Lampert, Esq.

Law Office of Elise Lampert

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

https://www.eliselampert.com

 

A Modest Raise for Nursing Home Workers Could Save 15,000 Lives a Year: Study

Raising the minimum wage by as little as 10 percent would significantly improve the safety and health of nursing home residents, according to new research.

Most direct care in nursing homes is provided by nursing assistants, who make up about 40 percent of the nursing home workforce and are among the lowest-paid workers in the U.S. economy. Nursing assistants help residents with activities of daily living like eating, bathing and dressing, and and work with certified nurses and elder care teams to monitor patients’ conditions.

Due in part of their low wages, nursing assistants frequently change jobs for better pay or working conditions.  “Between 60 percent and 85 percent of nursing assistants leave their employers each year, most often to go work in other nursing homes,” writes Krista Ruffini, a visiting scholar at the Minneapolis Federal Reserve. Nursing homes frequently report difficulty in recruiting and retaining staff, she says.

Ruffini recently looked at the impact increasing the minimum wage has on nursing home staff turnover and quality.  She compared facilities in hundreds of U.S. counties that had increased their minimum wage with those that hadn’t between 1990 to 2017.

In findings based on her preliminary data published in a working paper, Ruffini found that “increasing the minimum wage by 10 percent would reduce the number of health inspection violations by 1 percent to 2 percent, the number of residents with moderate to severe pressure ulcers [bed sores] by about 1.7 percent, and the number of deaths by 3 percent.”  The 3 percent reduction in deaths, she notes, translates to 15,000 fewer deaths in nursing homes each year.

Ruffini found that raising the minimum wage reduced turnover and increased tenure among nursing assistants.  This greater continuity of care, she says, translated into improved health and safety conditions for the patients.  At the same time, nursing home profits held steady because the extra costs were passed on in the form of higher fees.

Ruffini notes that her findings have particular relevance in a time when the coronavirus pandemic is overwhelming nursing homes.  Comparing a facility’s number of COVID-19 deaths with its quality-of-care performance, she concluded: “The data provide some suggestive evidence that higher service quality is associated with fewer deaths from COVID-19 in nursing homes.”

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Questions? Contact us at Law Office of Elise Lampert   

Elise Lampert, Esq.

Law Office of Elise Lampert

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

https://www.eliselampert.com

Caregiver Contracts: How to Pay a Family Member for Care

Although people are willing to voluntarily care for a parent or loved one without any promise of compensation, entering into a caregiver contract (also called personal service or personal care agreement) with a family member can have many benefits. It rewards the family member doing the work. It can help alleviate tension between family members by making sure the work is fairly compensated. In addition, it can be a key part of Medi-Cal planning, helping to spend down savings so that the elder might more easily be able to qualify for Medi-Cal long-term care coverage, if necessary.

The following are some things to keep in mind when drafting a caregiver contract:

• Meet with your attorney. It is important to get your attorney's help in drafting the contract, especially if qualifying for Medi-Cal is a goal.

• Caregiver's duties. The contract should set out the caregiver's duties, which can be anything from driving to doctor's appointments and attending doctor's meetings to grocery shopping to help with paying bills. The length of the term of the contract is usually for the elder's lifetime, so it is important to cover all possibilities, even if they are not currently needed. The contract can continue even if the elder enters a nursing home, with the caregiver acting as the elder's advocate to ensure the best possible care.

• Payment. Payment to the caregiver can either be made with a lump-sum payment or in weekly or monthly installments. For Medi-Cal purposes, it is very important that the pay not be excessive. Excessive pay could be viewed as a gift for Medi-Cal eligibility purposes. The pay should be similar to what other caregivers in the area are making, or less. To calculate a lump-sum payment, take the monthly rate and multiply it by the elder's life expectancy. (Note that some states, Georgia for example, do not recognize the ability to create a lump sum contract based upon life expectancy.)

• Taxes. Keep in mind that there are tax consequences. The caregiver will have to pay taxes on the income he or she receives.

• Other sources of payment. If the elder does not have enough money to pay his or her caregiver, there may be other sources of payment. A long-term care insurance policy may cover family caregivers, for example. Also, there may be state or federal government programs that compensate family caregivers. Check with your local Agency on Aging to get more information.

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Questions? Contact us   

Elise Lampert, Esq.

Law Office of Elise Lampert

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

https://www.eliselampert.com