The Elder Law Practice of Scott E. Collins, PLLC The Elder Law Practice of Scott E. Collins, PLLC
Protecting Families from the Loss of Everything they Own to the Extreme Cost of Long-term Health Care Here To Serve The People Of Madison And Surrounding Counties In Richmond, Kentucky

Elder Law Glossary

Elder Law Glossary

Additional Benefits: Offered to Medicare beneficiaries at no additional premium. These benefits are healthcare services not covered by Medicare and reductions in premiums or cost sharing for Medicare covered services. They can be different for each plan offered to beneficiaries.

Adjusted Average Per Capita Cost (AAPCC): An estimate of how much Medicare will spend in a year for an average beneficiary.

Adjusted Community Rating (ACR): Premium rates are determined by all Medicare members usage rather than a single person's use.

Advanced Directive: (See Living Will)

Administrative Law Judge (ALJ): A hearings officer who presides over the appeal involving a conflict between providers of services, or beneficiaries, and Medicare contractor.

Administrator/Administratrix: (See Executor)

Advance Beneficiary Notice (ABN): A notice that a doctor or supplier should give a Medicare beneficiary before they receive an item or service that Medicare is expected to deny.

Advanced Directive : a document in which a person states his or her wishes regarding medical treatment in the event of mental incompetency or an inability to communicate.

Annual Election Period: The Annual Election Period for Medicare beneficiaries is the month of November each year. Enrollment will begin the following January.

Appeal : A complaint that you make to the agency, disagreeing with their decision to deny a healthcare request or pay for services that have already been received. If services were stopped, a complaint could be made for that as well. There is a specific process that must be followed when asking for an appeal.

APPR: Medicaid uses this number to determine the penalty on transfers within their five year look back. (See Penalty Divisor)

Area Agency on Aging (AAA): State and local programs that help older people plan and care for their life-long needs. These needs include adult day care, skilled nursing care/therapy, transportation, personal care, respite care, and meals.

Assisted Living: A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with daily activities are available as needed to people who still live on their own in a residential facility. Not eligible under Medicaid in Kentucky.

Basic Benefits: includes both Medicare-covered benefits (except hospice services) and additional benefits.

Beneficiary: a person who is receiving property or benefits in a will; a person who receives benefits from a trust; a person who has health insurance through a Medicare or Medicaid program.

Benefit Period: it begins the day that you go into a hospital or skilled nursing facility. If you have not received care for 60 days in a row, the period ends. If you return after the benefit period has ended, it will depend on the insurance plan that you have whether the period will begin again. The deductible must still be paid for each benefit period.

Board and Care Home: A type of group living arrangement designed to meet the needs of people who cannot live on their own. These homes offer help with some personal care services.

Caregiver: a person who provides care to someone who is ill, disabled, or aged. Caregivers can be relatives, friends, or caregiving services that require payment.

Carrier: A private company that has a contract with Medicare to pay your Medicare Part B bills.

Catastrophic Illness: A very serious and costly health problem that could be life threatening or cause life-long disability. The cost of medical services alone for this type of serious condition could cause you financial hardship.

Catastrophic Limit: The highest amount of money you must pay out of your pocket during a certain period for certain covered charges. Setting a maximum amount, you will have to pay protects you.

CCRC:Continued Care Retirement Community.

CHAMPVA: Civilian Health and Medical Program of the VA which is health insurance for spouses and dependent children of living veterans with 100% SC conditions and for surviving spouses and dependent children who are eligible for DIC (Death and Indemnity Compensation) ....must apply for is not automatic.

Codicil: an amendment to a will. A codicil must be executed in the same manner as a Last Will and Testament.

Coinsurance (Medicare Private Fee-For-Service Plan): The percentage that you may have to pay after you pay any plan deductibles. In a Private Fee-for-Service Plan, the coinsurance payment is a percentage of the cost of the service (like 20%).

Coinsurance (Outpatient Prospective Payment System): The percentage of the Medicare payment rate or a hospital's billed charge that you must pay after you pay the deductible for Medicare Part B services.

Community Spouse: the healthy spouse who resides in the community and does not require Medicaid services. The spouse is entitled to the Community Spouse Resource Allowance (CSRA).

Community Spouse Resource Allowance (CSRA): the amount of resources the community spouse is permitted to retain while the other spouse receives Medicaid LTC coverage. 2018 CSRA is $24,720-123,600.

Compensated Transfer: transfer of assets by Medicaid applicant for which the applicant received fair market value.

Conditional Payment: A payment made by Medicare for services for which another payer is responsible.

Coordination of Benefits: Determining the responsibilities of two or more health plans that have financial responsibility to a medical claim. (Also known as cross-over)

Coordination Period: A period when your employer group health plan will pay first on your health care bills and Medicare will pay second. If your employer group health plan doesn't pay 100% of your health care bills during the coordination period, Medicare may pay the remaining costs.

Cost Sharing: The cost for medical care that you pay yourself like a copayment, coinsurance, or deductible.

Covered Benefit: A health service or item that is included in your health plan, and that is paid either partially or fully.

CUE: Clear and Unmistakable Error; in other words, errors of fact or of law.

Custodial Care: Nonskilled care involving daily living activities such as bathing, dressing, eating, using the restroom, etc.

Death Certificate: a certificate signed by a doctor, providing the age, gender, time, place, and cause of death. This document is used in all processes involving probate.

Decedent: an individual who has passed away.

Deductible (Medicare): An amount that you must pay for healthcare before Medicare begins paying for the bill.

Deemed: Providers know prior to providing services that you are in a Private Fee for Service Plan and agree to provide you care.

Deficiency (Nursing Home): A finding that a nursing home failed to meet one or more federal or state requirements.

Disability: A physical or mental condition that affects one's abilities to perform life activities.

DIC:Death and Indemnity Compensation.

Discharge Planning: A process used to determine a patient's needs and make a smooth transition from one level of care (hospital) to another level of care (nursing home).

Dual Eligible: People who are entitled to both Medicare and Medicaid.

Durable Power of Attorney: A written document authorizing a person (agent) to act on behalf of another person. This document will survive one becoming incapacitated andare unable to handle matters on their own.

Elder Abuse: An intentional or failure to act by a person whom has a relationship with the elder adult involving some level of trust. Abuse can be in the form of physical, emotional or mental, sexual, neglect, or financial abuse.

Eldercare: Helping find ways to meet the needs of the elderly, including: housing, home care, pensions, Social Security, long-term care, health insurance, elder law, VA benefits, and Medicaid.

Estate: The sum of the decedent's assets (property, cash, certificates of deposit, savings accounts, etc.) minus a decedent's liabilities.

Excess Charges: The difference between the healthcare provider's actual charge and the Medicare approved payment amount.

Executor/ Executrix (gender based): The person named in Last Will and Testament to oversee the Probate process for the decedent's estate. (See also Administrator/Administratrix)

Expedited Appeal: A second look at whether Medicare will pay for the service. A beneficiary may receive a fast decision within 72 hours when life, health or ability to regain function may be jeopardized.

Fiduciary: A person who is placed in a position of trust to oversee certain affairs on behalf of another person. These could be Administrators of Estates, Power of Attorneys, Executors, etc.

Fiscal Intermediary: A private company that has a contract with Medicare to pay Part A and some Part B bills.

Funding: Process of transferring assets from the individual name of the grantor into the name of the Trustee of the trust

Gaps: The costs or services that are not covered under the Original Medicare Plan.

Gift: A transfer of Assets for less than Fair Market Value

Grantor (settlor or trustmaker): Creates the trust

Guardian: A court-appointed individual or agency in charge of the care of a minor or incompetent person's physical well-being and finances.

Guardianship: Through the process of a hearing, a person must be deemed incompetent and unable to manage his or her own affairs. The guardian is responsible for taking care of the ward and their property.

Healthcare Power of Attorney: (See Living Will)

Healthcare Surrogate: (See Living Will)

Home Health Agency: An organization that gives home care services, like skilled nursing care, physical therapy, occupational therapy, speech therapy, and personal care by home health aides.

Home Health Care: Limited part-time or intermittent skilled nursing care and home health aide services such as: physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, etc.

Homebound: Leaving home is incredibly difficult and takes extreme effort. The person may only leave home to attend medical appointments or religious services assisted by another person.

Hospice: Cares for people who are terminally ill, their family, and their caregivers. They help with a person's physical, emotional, social, and spiritual needs.

IDGT: Intentionally Defective Grantor Trust.

Income Cap State: A state that imposes a limit on a Medicaid applicants' income

Income only trust: Income is paid to the grantor

Incompetent: No longer having the mental capacity to make decisions necessary to manage one's property and personal affairs. All adults are presumed to be competent until a court has ruled otherwise. A determination of incompetency does not mean that the individual is mentally ill or mentally insane.

Inter vivos (Lifetime) Trust: Established during the lifetime of the grantor.

Intestate: (see testate)

Irrevocable Trust: A trust in which the Grantor does not reserve the right to revoke the trust agreement or change the structure of the trust., and has no power to control the assets within the trust.

IVAP:Income for VA Purposes.

Living Will: States the wishes of the person regarding the use of extraordinary measures and other medical care. In Kentucky, statutory living will can name a healthcare surrogate, but primarily the determination is for breathing machines and feeding tubes (life support).

Long-Term Care: Services that are required to assist with daily living and other personal care needs such as shopping, caring for pets, housework etc.

MAPR: Maximum Annual Pension Rate.

Medicaid: A government funded program that pays covered medical expenses of low-income and low asset individuals who are aged, blind, or disabled.

Medical Nexus: More likely than not that this injury caused the disability

Medicare: The federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Medicare Benefits Notice: A notice you receive after a doctor files a claim. It states what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. You might also get an Explanation of Medicare Benefits (EOMB) for Part B services or a Medicare Summary Notice (MSN).

Medicare Select: A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.

Medicare Summary Notice (MSN): A notice you receive after a doctor files a claim. It states what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. You might also get an Explanation of Medicare Benefits (EOMB) for Part B services or a Medicare Benefits Notice.

Medicare Supplement Insurance: This is sold by private insurance companies to fill gaps within their Medicare policy. This only works for certain Medicare plans.

Medicare+Choice: A Medicare program offered by a private company that gives you more choices among health plans. Everyone who has Medicare Parts A and B is eligible, except those who have End-Stage Renal Disease.

NOD: Notice OfDisagreement.

NSC: Non-Service Connected (pension benefits).

Nursing Facility: A facility which primarily provides skilled nursing care and related services for injured, disabled, sick persons, or the elder above the level of custodial care.

Nursing Home: A residence that provides a room, meals, and help with activities of daily living and recreation. Generally, nursing home residents have physical or mental problems that keep them from living on their own.

Ombudsman: An advocate (supporter) who works to solve problems between residents and nursing homes or assisted living facilities.

Optional Supplemental Benefits: Enrollees can choose to buy services that are not covered by Medicare. They are paid through directly through premiums or cost sharing.

Organizational Determination: The health plan's decision as to whether they will pay for the medical services once you have filed an appeal.

Patient Advocate: A hospital employee whose job is to speak on a patient's behalf and help patients get the information or services they need.

Payment Rate: The total payment that a hospital or community mental health center gets when they give outpatient services to Medicare patients.

Penalty Divisor: number used by Medicaid to penalize uncompensated transfers. Based on average cost of nursing home care per day across the state of Kentucky= $199.46 or $6,066 monthly.

Personal Care: Nonskilled, personal care, such as help with activities of daily living. The Medicare home health benefit does pay for personal care services.

Personal Needs Allowance: the amount of income that a Medicaid recipient can keep each month to be used for their personal needs.

Plan of Care: A doctor's plan as to the kind of services and care that you need for your health problem.

POW: Prisoner OfWar.

Power of Attorney: The authority to act on behalf of another person. There are "general" powers of attorney, "limited" or "special" powers of attorney, and "durable" powers of attorney. A general or limited power of attorney ends when the principal becomes incapacitated. A durable power of attorney stays in effect if the principal becomes incapacitated.

Presumption of Aggravation: Had a pre-existing condition, the condition was made worse by military service, unless there is clear evidence to the contrary.

Presumption of Soundness: A veteran enlisted in the service in good health unless there is clear and convincing evidence to the contrary.

Presumptive Service-Connected Conditions: A veteran is presumed to have a certain condition.

Private Fee-For-Service Plan: A type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the services you get. You may pay for Medicare-covered benefits.

Probate: a judicial action of proving that a will is valid. The size of the estate will determine the length of the probate proceeding. Also used to refer to the process of handling a decedent estate.

Qualified Medicare Beneficiary (QMB): This is a Medicaid program for beneficiaries who need help in paying for Medicare services. The beneficiary must have Medicare Part A and limited income and resources. For those who qualify, the Medicaid program pays Medicare Part A premiums, Part B premiums, and Medicare deductibles and coinsurance amounts for Medicare services.

Qualifying Individuals (1) (QI-1S): This is a Medicaid program for beneficiaries who need help in paying for Medicare Part B premiums. The beneficiary must have Medicare Part A and limited income and resources and not be otherwise eligible for Medicaid. For those who qualify, the Medicaid program pays full Medicare Part B premiums only.

Qualifying Individuals (2) (QI-2S): This is a Medicaid program for beneficiaries who need help in paying for Medicare Part B premiums. The beneficiary must have Medicare Part A and limited income and resources and not be otherwise eligible for Medicaid. For those who qualify, Medicaid pays a percentage of Medicare Part B premiums only.

Regional Home Health Intermediary (RHHI): A private company that contracts with Medicare to pay home health bills and check on the quality of home health care.

Residuary beneficiaries: gain access at death of grantor or at a specified time by grantor.

Respite Care: Temporary or periodic care provided in a nursing home, assisted living residence, or other type of long-term care program so that the usual caregiver can rest or take some time off.

Revocable Trust: A revocable trust is one where the Grantor has a right to revoke or terminate the Trust. There areexceptions as to when a beneficiary has the right to revoke the trust. Also called a Living Trust.

Risk Adjustment: The way that payments to health plans are changed to consider a person's health status.

RVN: Republic of Vietnam.

Secondary Service Connection:Available for any disability that is a result of another military service connected condition.

SC:Service Connected (compensation benefits).

Skilled Nursing Care:A level of care that includes services that can only be performed safely and correctly by a licensed nurse.

Skilled Nursing Facility (SNF): A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services. Most commonly known as nursing home or resting home.

Specialty Plan: A type of Medicare Advantage Plan that provides more focused health care. These plans give you all your Medicare health care as well as more focused care to manage a disease or condition such as congestive heart failure, diabetes, or End-Stage Renal Disease.

Specified Disease Insurance: This kind of insurance pays benefits for only a single disease, such as cancer, or for a group of diseases. Specified Disease Insurance doesn't fill gaps in your Medicare coverage.

Spend Down State: The amount allowed must be contributed toward the cost of care after income allowances and exemptions have been deducted.

SPIA: Single Premium Immediate Annuity.

Successor trustee: Steps in if acting trustee is incapacitated or dies.

SWA: South West Asia.

Testamentary Trust: Trust created by a will.

Tricare: A health care program for active duty and retired uniformed services members and their families.

Tricare for Life (TFL): Expanded medical coverage available to Medicare-eligible uniformed services retirees age 65 or older, their eligible family members and survivors, and certain former spouses.

Trust: A trust manages the distribution of a person's property by transferring its benefits and obligations to different people. There are many reasons to create a trust, making this property distribution technique a popular choice for many people when creating an estate plan.

Trustee: Holds legal title to the assets, is the key holder, and is responsible for funding the trust (placing assets in the trust).

Trust Administration: How the trust is managed and administered both during the lifetime of the grantor and at the death.

Trust Corpus: All the assets in the trust, the body of the trust.

Trusted Principal: Assets held in the trust from which income is produced.

Trust Protector: Has no beneficial interest in the trust who can perform varying duties: remove a trustee, amend a trust, correct a scrivener's error, and others allowed by the statutes and judicial decisions. They can also amend a provision that Medicaid does not approve of.

UME: Unreimbursed Medical Expenses.

VAMC: VA Medical Center.

Waiting Period: The time between when you sign up with a Medigap insurance company or Medicare health plan and when the coverage starts.

Will: A legal document designating how a Decedent wants his or her property distributed following the Decedent's death.

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