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Good News for Seniors

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Since the beginning of the pandemic, seniors have found healthcare to often be a struggle – but there is Good News.

For example, the Social Security Administration has finally announced that it will soon reopen its 1,200 local offices.

Previously only “dire need” appointments were allowed, and the decisions were made at the discretion of managers. Offices were closed since the pandemic hit in March 2020. Mark Hinkle, a spokesman for the agency stated, “We anticipate that local field offices will restore increased in-person service to the public, without an appointment, in early April.”

Why is this important? “There are things that have to be done in person for Social Security,” said Kate Lang, senior staff attorney at Justice in Aging. You can apply online for retirement benefits but not for survivors’ benefits or for Supplemental Security Income, or S.S.I., which helps support seniors with very low income.

As a result, “in-person” requirements have resulted in hundreds of thousands of applicants who would normally walk into local Social Security offices, carrying the required original documents, have not been able to be served for two years.

In addition, “people already on benefits have gotten notices saying their benefits are being reduced or discontinued, and they’re unable to get in touch with anyone at Social Security to find out what’s going on,” Ms. Lang said. “There’s no way to fix these problems.”

And, attempting to contact Social Security by phone has been very frustrating for many. Recently, a report from the agency’s inspector general showed that monthly calls to field offices rose from 4.6 million before the pandemic to 7.5 million in April through September 2020, and to 12 million in March of 2021. If you called field offices or the national 1-800 number, often resulted in busy signals or long waits; consequently, many callers abandoned the effort.

Even after the Social Security Administration agreed to reopen offices, protracted negotiations with its uneasy employees followed. But the agency and its unions have reached agreements, although they are still working out the logistics of reopening.

One catch: Visitors to a field office will likely face occupancy limits, and the agency must cope with huge backlogs. In an email, Mr. Hinkle said that the agency encourages the public to use its online or phone services when possible and to schedule in-person appointments in advance.

Ms. Lang noted: “It’s not like everything will be hunky-dory on April 1.” In fact, Justice in Aging has brought a class-action suit against the Social Security Administration on behalf of S.S.I. recipients who were unable to provide information or challenge decisions while offices were shuttered.

But, Mr. Hinkle said, offices will reopen this spring “dependent on the course of the pandemic” — indisputably a good thing.

 

 

Right to Appeal Medicare Decisions

In the past, hospital patients have struggled with issues of eligibility for nursing home coverage. For example, if you were in a hospital bed, doctors and nurses provided care, you were examined and perhaps received medication, but you were not actually admitted. Or you were, and then the hospital changed your status to “on observation.” Technically you were an outpatient, not an inpatient.

A federal appellate court recently ruled that if Medicare declines to pay for your rehabilitation in a nursing home after you’ve left the hospital because you were “on observation,” you can appeal the decision.

Medicare requires three consecutive days as an inpatient for you to be eligible for nursing home coverage. As a result, you may be left either having to pay the tab yourself (the national average nursing home cost is $260 a day) or forgoing care. In fact, if you are among the 9 percent of Medicare beneficiaries who don’t have Part B, which covers outpatient care, you must pay the hospital bill, too.

Hundreds of thousands of patients discharged from hospitals have probably faced this confusing issue. “You can appeal just about every issue regarding your Medicare coverage, but not that one,” said Alice Bers, litigation director at the Center for Medicare Advocacy.

To change this, the center — along with Justice in Aging and a private law firm — sued the federal Department of Health and Human Services in 2011.

Recently, the U.S. Court of Appeals for the Second Circuit affirmed that Medicare beneficiaries have a constitutional right to appeal if hospitals reclassify them as observation patients. If patients win their appeals, traditional Medicare will pay for up to 100 days of nursing home care, and those who were previously forced to pay out-of-pocket could receive refunds. (Note: Medicare Advantage plans don’t generally require a three-day stay.)

One catch: The government could still ask the Supreme Court to take the case or seek a rehearing by the Second Circuit court. And the Medicare appeals process is no picnic. “People have the best chance of winning if they persist and work their way up through the levels,” Ms. Bers said.

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