Senate Looks at Doctor-Dropping by Medicare Advantage Plans:

What to do when Medicare Advantage insurers drop large numbers of doctors from their plans?

medicare-pillOn Jan. 22, members of the Senate Special Committee on Aging met in Hartford, Conn., in search of an answer. UnitedHealthcare, the nation’s largest Medicare Advantage insurer, planned to drop its contracts with some 2,250 doctors in the state on Feb. 1, but a court has ordered the terminations delayed while the issue is being litigated.

Raymond H. Welch, a dermatologist in Rhode Island, told the committee that when Medicare Advantage plans can summarily drop providers, it leaves doctors focused on pleasing the insurer instead of advocating for their patients. “It is this perversion of the doctor-patient relationship that I fear the most,” Welch said. “It is said you cannot serve two masters. The master that physicians serve must be their patients, not UnitedHealthcare.”

But attorney Stephanie Kanwit, testifying on behalf of America’s Health Insurance Plans, the industry’s national trade association, countered that insurers need the freedom to drop doctors from their networks.

“As a direct result of the serious funding challenges facing the Medicare Advantage program,” Kanwit told the committee, “the need is greater today than ever before for innovations that deliver increased value to beneficiaries with the increasingly limited resources that are available to support the MA program.” Insurers, she said, are looking at which medical providers are most cost-effective as well as which score best on measures of quality care.

Richard D. Johnson, a retiree who lives in Bridgeport, Conn., said he was disappointed and confused when the doctor he trusted was dropped from his Medicare Advantage plan.

“I just want to see the doctor who has been taking good care of me for three years,” Johnson testified. “ I want to say that I am not just worried about myself. There are lots of other seniors who are affected by this. … When you have health problems, you want to stay with the doctors who know you personally and take excellent care of you.”

Posted on 01/27/2014 by  | Washington Watch | 



9 (Potential) Problems with Your Trust:

All trusts should be reviewed every few years to make sure that they are up-to-date with the law and meet your goals today. Following is a checklist of trust features you can review yourself. But be aware that these only refer to revocable “living” trusts, not to irrevocable trusts.

elder law, brian raphan,

  1. Do you have the right successor trustees? Typically you will be the trustee of your own revocable trust with your spouse as co-trustee (if you’re married). Trusts should name one or more successors in the event the original trustee or trustees are unable to serve. Make sure that you still want the successors you originally named. Also, do you want them to come on and begin acting as trustee now? And if you and your spouse are co-trustees, do you want the successor or successors to step in when the first of you becomes incapacitated or passes away, or not until neither of you can serve?
  2. Who can remove trustees? You can always change the trustees of your revocable trust. But do you want your heirs to have this right after you pass away? This can often avoid problems if there are communication problems or disagreements with the trustee. On the other hand, you might want to limit this to some extent to make sure heirs aren’t just looking for a trustee to do whatever they say.
  3. Can your spouse change the ultimate distribution of trust assets after you have passed away? Many trusts give surviving spouses a so-called power of appointment to redirect trust assets at their death. This can be important to provide for flexibility to respond to changes in family circumstances. However, this usually doesn’t make sense in second marriages. In a Massachusetts court case, the second wife used her power to give everything to her children instead of to the original beneficiaries: her deceased husband’s children. Even in the case of a first marriage, removing this provision from the trust can provide protection for children and grandchildren in case the surviving spouse remarries and becomes estranged from his family.
  4. Does your trust protect your children and grandchildren from lawsuits and divorce? You have the option of drafting your trust to continue for your children’s lives to provide creditor and divorce protection.
  5. Have you funded your trust? We often see great trust documents that don’t do all that’s intended because the clients’ assets are still titled in their names. You can avoid probate and make sure that the estate tax protections in your trust operate as planned through retitling assets in the name of the trust.
  6. Who is named as beneficiary of your retirement plans and other investments? Often clients spend hours with their attorneys crafting an estate plan to match their goals and then circumvent it through naming individuals as beneficiaries of retirement plans and investment accounts. Make sure these are all coordinated.
  7. At what age will children and grandchildren receive their inheritance? Most trusts provide that funds will remain in trust until those inheriting reach a certain age, often 21 or 25. But you can set any age you choose and even permit them to withdraw a portion of the trust at set ages, say half at 25 and half at 30, or a third each at 25, 30 and 35. This doesn’t mean that they can’t benefit from the trust assets in the meantime, but that distribution decisions are made by the trustees until children and grandchildren have more financial experience.
  8. Does your trust have provisions providing for maximum tax deferral if it is named the beneficiary of a retirement plan? While you may choose to have your retirement plans go directly to your heirs — and often this is the simplest approach — if they are going to your trust, it must have special provisions to stretch out the annual required distributions for as long as possible.
  9. Is your trust up-to-date for estate tax purposes? Congress and many states have changed the estate tax laws several times in recent years. If your trust is more than five years old, or if you lived in a different state when it was drafted, it should be reviewed by an estate planning attorney to make certain it is still current.

You can check many of these questions on your own. In fact, it’s a useful exercise to make sure that you understand what is in your trust. Other issues, particularly those related to tax issues, will require consulting with an estate planning professional.

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Regards, Brian