Greater Wisconsin Agency on Aging Resources (GWAAR) is a nonprofit agency committed to supporting the successful delivery of programs and services to seniors in 70 counties and 11 tribes in Wisconsin. The legal issues that our seniors face are complex. Wisconsin may be unique in how it provides access to Elder Benefit Specialists in every county with legal backup provided by GWAAR.
Everyone has heard that our population is aging, but what does that mean for Wisconsinites? It is estimated that by the year 2035, approximately 28 percent of Wisconsin’s total population will be age 60 and older. In many rural, northern counties, up to 48 percent of the population is expected to be age 60 and older in 2035. (Source: DHS, Bureau of Aging and Disability Resources, aging demographics)
Upon turning age 65, people become eligible for health insurance through Medicare, but increasing health insurance costs combined with income near the poverty level equates to many older adults struggling financially to make ends meet each month. “In 2013, half of all people on Medicare had income less than $23,500, which is equivalent to 200 percent of the federal poverty line in 2015.” (Source: Jacobson et al., “Income and Assets of Medicare Beneficiaries, 2013–2030)
Medicare Part B covers outpatient medical appointments, emergency room visits, most lab work and durable medical equipment. For services covered under Medicare Part B, Medicare pays 80 percent, and the consumer pays the remaining 20 percent out of pocket. While subsidy programs are available to help pay monthly Medicare premiums and/or copays for low-income older adults, those programs are limited to people with income below 150 percent of the federal poverty line. Many older adults fall just slightly above the eligibility line and, therefore, must pay those costs out of pocket.
The Affordable Care Act has begun to close the Part D coverage gap for prescription medications; however, in 2015 consumers in the “donut hole” (upon reaching $2,960 in covered medications) still have to pay 45 percent of brand name medications and 65 percent of generic medications. Although the coverage gap will close by the year 2020, it continues to present a large financial hurdle for many Medicare consumers who must decide between taking their medications, buying groceries and paying rent.
Increasing medical costs have been met by increasing housing costs as well. Quality, subsidized housing for older adults is hard to find in the state. Many counties, such as Dane County, have closed the wait lists for Section 8 housing vouchers. Other federally funded programs through the Department of Housing and Urban Development (HUD) typically have long wait lists. That means older adults must continue to pay market rate rental amounts until there is an opening or they get off the wait list. It is not uncommon for a consumer to pay $915 per month in rental costs in some counties.
Unfortunately, with the population aging, there has also been an increase in elder financial abuse. Telephone and mail scammers pretend to be staff from the IRS, Social Security, Medicare and other government programs trying to obtain Social Security numbers, bank account numbers, and credit card information from well-meaning elderly people. Financial exploitation was the second highest form of elder abuse in the year 2014. (Source: DHS, WITS Statistical Summary Report for Elder Adults-at-Risk Age 60+ State Reporting Year 2014 – As of 04/01/2015)
It’s important for older adults to be aware that services exist to help them and are provided free of charge. Most Elder Benefit Specialists are located within the Aging and Disability Resource Center (ADRC) or within the local aging or tribal office. Each county in Wisconsin has an Elder Benefit Specialist who specializes in elder law and benefits issues specific to residents age 60 and older. These services are funded with state and local funds, as well as federal funding from the Older Americans Act. The Elder Benefit Specialist program is an innovative and efficient way to deliver legal services to older adults in the state. Each year approximately 50,000 people are served under this unique model.
There are approximately 92 Elder Benefit Specialists in the state — some counties employ more than one due to high demand. These specialists consult with licensed attorneys at GWAAR regarding complex benefit eligibility and coordination issues, health insurance denials, Social Security benefits and overpayments, debt collection issues, consumer protection, and elder law issues. Through this model, the consumer is able to meet in person with a highly-trained individual who can explain these complex and dynamic areas of law. Elder Benefit Specialists can also assist clients who are new to Medicare and need assistance to better understand their options (original Medicare, Advantage plans, Medigap plans and Part D plans), which change every year in the fall. GWAAR has 4 attorneys who train and provide legal backup to the benefit specialists.
Elder Benefit Specialists assist clients with questions related to:
- Medicare: enrollments, coverage denials, Advantage plans, Medigap plans, drug plans, skilled nursing facility coverage, network restrictions, coordination with employer coverage;
- Medicaid: eligibility, long-term care Medicaid, divestment, estate recovery, community spouse income allocation, burial planning;
- Social Security: SSI, SSDI, retirement, work quarters, overpayments, derivative benefits;
- Housing: landlord/tenant disputes, security deposits, eviction notices, subsidized rent;
- Consumer law; debtor/creditor issues, scams, identity theft, small claims court;
- Benefits Checkup: FoodShare, Medicare Savings Programs, drug subsidy, energy assistance.
Elder Benefit Specialists do NOT assist with the following legal matters:
- Workers compensation
- Unemployment insurance
- SSDI appeals
- Probate, estate planning
- Criminal law
- Family law
- Personal injury
Kate Schilling is the Legal Services Manager for GWAAR and is based in Madison.