A recent analysis of generic drug prices paid by Medicare Part D enrollees by healthcare consulting firm Avalere Health determined that despite the relatively stable prices of these medications, some seniors find themselves paying more and more each year. The reasons, according to the report, have to do with the way insurance companies place enrollees into pricing tiers and the lack of policy changes to curb higher out of pocket costs for elders.

As reported by Avalere, insurance companies have been moving many generic drugs into copay tiers requiring patients to pay larger portions of the drugs’ cost, thus shifting more costs onto patients this way and keeping Part D premiums stable. The moves are important to insurance companies because they understand enrollees decide on their Medicare Part D plans based on the price of the premiums. Unfortunately for patients, they do not realize the full costs of their healthcare plans until they start filing prescriptions.

The numbers on just how much Part D enrollees are paying for their generic drugs is quite staggering. Despite the average prices of generic drugs increasing by on 1 percent from 2011 to 2015, total out of pocket costs increased by $6.2 billion, or 93 percent. Unfortunately, some of the drugs subject to these massive upcharges include some of the most widely prescribed and low cost medications for chronic conditions such as cholesterol, hypertension, and diabetes.

Federal regulators recently issue a warning health care providers accepting federal funding to be on the lookout for inappropriate prescriptions of a powerful antipsychotic drug commonly used in nursing homes to treat a host of disruptive behaviors. The memo comes from the Centers for Medicare and Medicaid Studies and applies to providers accepting Medicare Part D,  including nursing homes and pharmaceutical distributors.

The drug in question is called Nuedexta and is commonly used to treat a rare condition marked by uncontrollable laughing and crying, called pseudobulbar affect (PBA) but is suspected to also be overprescribed for so-called “off label” uses. In the past year, several media reports have indicated that doctors at nursing homes have been overprescribing Nuedexta in order to control not only the symptoms of those struggling with dementia but also generally unruly behavior in residents without dementia.

While Neudexta’s maker, Avanir Pharmaceuticals, claims many dementia patients suffer from PBA and benefit from the drug, the company has also generated millions of dollars in annual sales in nursing homes since the drug launched in 2011. In most cases, the federal government picked up the costs for those bills when it reimbursed nursing homes through Medicare’s Part D program.

A recent survey of family home caregivers revealed that many of these individuals are strained and stressed out by their duties the demands of their loved ones with developmental disabilities and deeply concerned about the future. The survey analyzed the feelings of over 3,000 individuals caring for family members at home with developmental disabilities and found that 95 percent said they were stressed out with nearly half describing themselves as very or extremely stressed.

The questionnaire was conducted by Family & Individual Needs for Disability Supports (FINDS) Community Report and released by The Arc and The University of Minnesota’s Institute on Community Integration. The data collected is based on responses from 3,398 unpaid caregivers across the country who responded to an online survey conducted between January and April 2017.

Researchers conducted the FINDS primarily through an on-line survey administered between January to April of 2017 and made available in English and Spanish paper versions. Those invited to take part in the survey included caregivers who were family members or friends providing support to people with intellectual or developmental disabilities.

A recent analysis by researchers at the University of Wisconsin-Madison revealed that employers contributed significantly higher amounts of capital to defined-benefit pension plans in 2017, likely because of the new tax law signed by President Donald Trump. That law cut tax corporate tax rates from 35 to 21 percent starting this year and provided an incentive for corporations to increase deductions in 2017, including deductions for pension contributions.

The study analyzed data samples taken from over 400 non-financial firm which calculate their financial statements on a calendar-year basis and found that, on average, that firms increased their unexpected pension contributions by $16 million each. These unexpected pension contributions are considered the difference between the amount a firm contributed and the amount of money it was expected to contribute on prior-year financial statements.

Those numbers came out to a 24-percent increase in 2017 on average compared to the same averages for individual firms from 2014 to 2016. Furthermore, the study determined that taxpaying firms made larger unexpected contributions than non-taxpaying firms which the researchers took as a sign that the increased contributions could be due to the cut in corporate tax rates.

A recent poll conducted by the University of Michigan showed that older Americans are slow to embrace the use of their health care provider’s secure online patient access portals to communicate with the doctors and other health care providers. Despite the widespread availability of online healthcare access portals, only about half of people between the ages of 50 to 80-years old have set up an account on a secure online access sites offered by their health care provider, according to the new findings from the National Poll on Healthy Aging conducted by the University of Michigan.

However, those with higher educations and income levels had higher rates of patient portal use even though those with lower household incomes and less education generally have more healthcare needs. Additionally, age appears to play a role in adoption rates of the technology as those aged 65-years and older were more likely than people in their 50s and early 60s to report they do not like using computers to communicate about their health or are generally comfortable with technology.

The poll, sponsored by AARP and University of Michigan’s academic medical center, Michigan Medicine, analyzed the preferences of over 2,000 participants and found that among older adults who had not yet set up access to a patient portal, 52-percent cited concerns about communicating online about health information. Another 50-percent reported they did not see the need for this kind of access to their health information and about 40-percent simply had not gotten around to setting up their access yet.

A pair of proposed bills are working their way through the halls of Congress that could help encourage Americans to make voluntary contributions to their retirement funds, helping them live more comfortable and financially stable lives in their golden years. With looming changes to Social Security and rising healthcare costs, Americans young and old need to take heed of warnings by economists and activity plan for their retirements.

One of those bills is the Retirement Enhancement and Savings Act of 2018, jointly sponsored by Orrin Hatch (R-Utah) and Ron Wyden (D-Oregon), which is a collection of smaller bills that combined call help ordinary people make larger contributions to their retirement accounts. This legislation mirrors a similar proposal approved by the Finance Committee in 2016 but floundered when Congress adjourned before taking any action on the bill.The bill would help participants in retirement savings programs think in terms of lifetime income instead of accumulated balances.

The Retirement Enhancement and Savings Act of 2018 would require benefit statements include estimates of lifetime income at least once a year and would direct the Department of Labor to develop a model for constructing income estimates. The Act would also provide fiduciaries a safer place for selecting a lifetime income provider thus eliminating uncertainty concerning applicable fiduciary standards for offering lifetime income benefits under a defined-contribution plan.

The broad scope of “intellectual property” (IP) laws protects United States Patent and Trademark Office (USPTO) registered ideas in the form of copyrights, patents, and trademarks. With the rapid expansion of technological innovation at the global level, the growth of statutory and legislative rule elements in this area of law has been remarkable. Estate law and its ability to protect the IP rights of inventors, artists, and authors, is now also applied to the rights of heirs and beneficiaries gifted intellectual property by way of inheritance. Estates without a will are subject to probate court proceeding. Intellectual property included in an estate will be divided according to a plan drafted by state legislature where the estate is held.

Transfer by Bequest

If a will has been written before a decedent has died, the transfer of intellectual property rights will be performed at the bequest of the owner in a written estate planning document. Bequests traditionally written to transfer tangible personal and real property, are now drafted with language that allows for the inclusion of intellectual property rights. Depending on the intent of the Decedent, the estate may also be structured to designate intellectual property assets separately in a “residuary estate” to be subsequently divided among its beneficiaries, rather than accorded specific heirs.

Robo-advisers are transforming the investment industry, including the estate advisory and planning segment. Algorithms present cost-effectiveness that translates to further savings for the investor by eliminating the “middleman.” Human advisers charge significantly more than these alternative wealth management services, making traditional services less appealing of an option for younger investors sold on technology and rapid returns. How does this bode for retirement investors, and especially the estate planning segment of the market?

Robo-Adviser Investment Services

The more complex the management of a fund, product, or portfolio of services, the less likely an investor will be fully-satisfied with robo-advisory services one hundred percent of the time. Major investment firms piloting robo platform as part of their consumer services offerings, are finding artificial intelligence to be a support feature rather than an obstacle to delivery of high-quality investment advisory services. Robo-advisers offer the kind of on-demand attention that a “living trust” requires; collecting the current financial position and investing goals of a client without the imposition of human delays. According to industry experts, the best is yet to come. Now that robo-advisers are capable of handling sophisticated tasks like retirement and estate planning, both investors and human advisers benefit from an obsolescence of human error. It is perhaps for this reason that legislators have been laissez faire in creation of new regulatory rules associated with robo-adviser practice.   

When estate planning clients require a legal guardian to perform power of attorney, the process can be complicated. This is especially true when rules of guardianship are involved in distribution of revocable trust assets for purposes of medical care or other life-sustaining care need of the trustee. In some states, like New York, state law allows for the legal guardians of incapacitated parties to withdraw life-sustaining therapies if the former deems the patient’s wishes are met with the decision. While informed consent laws provide for guardian power of attorney in meeting those medical treatment requirements, the payment for those professional services may be beyond a patient’s means without disbursement of convertible trust assets.

Guardianship and Estate Planning

The following is a checklist for representation of a trustee who is an incapacitated party in the estate planning process:    

At the turn of the 21st century, divorce or annulment of a marriage did not automatically revoke any revocable disposition or appointment of property from an ex-spouse at time of a decedent’s death in New York.  Since 2008, with the amendment of the. Existing Estates, Powers and Trusts Law, EPTL 5-1.4, estate law rules to divorce or annulment revocation of inheritance applies to any revocable disposition or appointment of property assigned a former Spouse as a designated beneficiary. New York Law EPTL 5-1.4 revokes any nomination of an ex-spouse as trust fiduciary, executor, agent, guardian, representative, trustee, or attorney-in-fact. Under the prior divorce and annulment revocation rule, the legal termination of a marriage agreement did not automatically revoke an ex-spouse’s power of attorney, or most revocable dispositions (“testamentary substitutes”), including joint tenancies (i.e. joint banking accounts), lifetime revocable trusts, or insurance policies (IN RE: The Estate of Joseph SUGG, Deceased. No. 2013–5055/B, Decided: June 29, 2015).

Amend, Restate or Execute a New Will?

When a couple divorces, changes to a will must be effectuated to an estate. Amendment, restatement, or execution of a new will is required under current New York estate law. Estate planning documents can be changed with the assistance of a licensed attorney experienced in matters of trust document modification and probate litigation. A client undergoing divorce is advised to review existing estate planning documentation at the commencement of a divorce, and at time of finalization. Estate law rules to entitlements provide that a soon to become ex-spouse will automatically lose named beneficiary status in a will or revocable trust. In matters where there is a judicial separation, annulment or final decree of divorce in process, revocation occurs only at the end of those proceedings, regardless of couple or court determined outcome.

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