By Megan Leonhardt January 29, 2018 via Time.com

When a bank calls with alert about fraudulent activity, most people assume that it’s their own account that’s been compromised. But several banks now have alert systems to let people watch for problems in an elderly parent or grandparent’s account.

That’s because more banks are on the front lines of protecting older Americans from financial fraud—even as millions are falling victim every year. One academic study published in July in the American Journal of Public Health estimated that more than 5% of the elderly experience some sort of fraud or scam every year.

“The problem is real for both older Americans and the [banking] industry,” says Jilenne Gunther, the director of AARP’s BankSafe initiative. AARP estimates that victims of elder financial fraud lose an average of more than $120,000 when fraud occurs.

With that in mind, MONEY set out to determine which banks offered the most protections—and the best overall rates—for older Americans. Many financial institutions are in fact offering a range of elder protections—everything from alerts and withdrawal limits to software that closely monitors accounts for red flags.

We analyzed offerings from those banks with the largest national footprint: more than a dozen in all, with either more than 1,000 branches or locations in least a dozen states.

To survey how banks are protecting seniors, MONEY generated a 15-item checklist using guidelines recommended by the Consumer Financial Protection Bureau and AARP. We also surveyed each institution’s checking options (including those for older Americans), prioritizing those with no (or easily waived) monthly fees and ATM charges.

Among the elder protections: We checked to see whether banks offered account alerts, monitoring software, and the ability to create alerts for a trusted family member or friend about suspected exploitation. Another item recommended by both groups: read-only access for financial caregivers, to allow a second pair of eyes to monitor an account.

Other items were related to training for bank staff—including both tellers and local branch managers, among others. “The best way to fight exploitation is to prevent money from ever leaving the account,” Gunther says. “The most effective way to do that is to train tellers, call center staff and other frontline staff.”
Winner: TD Bank

Why It Wins: TD Bank scored highest for options offered to help protect older Americans from frauds and scams. Unlike many of its peers, the bank offers the ability for a customer to give read-only access to a trusted family member or friend who has been granted power of attorney, allowing that person to keep an eye on the account. It also lets customers say in advance that the bank may share information with a trusted contact when it suspects fraudulent activity.

TD Bank has other consumer-friendly policies that help make it a standout. It offers accounts with easy ways to waive monthly fees, and an above-average customer service score from J.D. Power. Older customers may appreciate the free checks that come with TD Bank’s 60 Plus checking account (see below).

Caveat: TD Bank is primarily based on the East Coast, so if you live outside its branch network, consider banking at PNC or Bank of America—both of which merited honorable mentions for their banking options for seniors.

Branches: Over 1,200 branches in 14 states (Conn., Del., Fla., Maine, Mass., N.H., N.J., N.Y., N.C., Pa., R.I., S.C., Vt., Va.), plus Washington D.C.

Notable Accounts

TD 60 Plus Checking

Monthly Fee: $10, waived with $250 daily balance
Out-of-Network ATM Fee: $3
Overdraft Fee: $35
Paper Statements: Free
Interest: 0.05%

TD Premier Checking

Monthly Fee: $25, waived with a $2,500 daily balance
Out-of-Network ATM Fee: None, with other surcharges reimbursed at a $2,500 balance
Overdraft Fee: $35
Paper Statements: Free
Interest: 0.05%

Honorable Mention: Bank of America

What’s Good: One of the largest national banks, Bank of America is also a frontrunner for its elder protection, which includes providing information to both bank and wealth management customers about planning for incapacity.

Caveat: The bank’s standard checking account has a $12 monthly fee, and you’ll need a $1,500 monthly deposit to waive it; it also has higher overdraft fees than either TD or PNC. And unlike TD, BofA does not currently provide read-only account access to other parties.
Honorable Mention: PNC

What’s Good: Midwest-based PNC (branches in 19 states) also offers many of the vital protections for seniors. And its checking account has a $7 monthly fee that’s easily waived with either a $500 monthly balance or $500 in monthly direct deposits.

Caveat: PNC also does not provide read-only access to an online account, although it will send paper statements upon request to those people whom older customers have authorized to act as their power of attorney.
Methodology

MONEY evaluated the largest 15 brick-and-mortar banks in terms of consumer deposits, as identified by bank consultancy firm Novantas. Bankrate.com, MONEY’s partner for its bank ratings, helped to collect data on fees, interest rates, and account requirements for checking and savings accounts. Account data was collected in July and August, and MONEY independently fact-checked information for each winner in December and early January.

To determine which banks offered the best practices for protecting elder Americans, MONEY consulted the guidelines previously released by the CFPB and AARP. MONEY then sent a checklist to each bank, asking if they require staff to undergo elder financial fraud training, allow customers to set up alerts for large withdrawals and suspicious activity, report potential fraud cases to the authorities, utilize software to monitor account activity—as well as offered ability to set up read-only access to accounts and advanced consent to alert trusted contacts when there is suspected fraud. (Two of the biggest 15 banks, KeyBank and SunTrust, did not answer MONEY’s questions about elder fraud protections.)

Winning banks scored highest regarding their elder protection policies, and also offered a checking account with easily waived monthly fees and free paper statements.

By Tamara Mathias via Reuters.com

After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions.

Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the United States’ huge over-65 health program Medicare from reimbursing doctors’ and medical visits, which often start over the phone.

The bills come at a time when the industry’s claims of cost savings – powered by apps and mass smartphone usage – have begun to gain traction with private insurers striving to save on healthcare costs.

One issue for public spending on telehealth has been the inability to charge across state lines. Another is that Medicare does not recognize medical consultations that do not happen in person as the equivalent of a visit to the doctor.

The fate of legislative amendments that unlock these barriers is far from clear in a fractured U.S. Congress, but investors and some of the world’s big healthcare providers are already circling firms like the U.S. sector’s dominant player Teladoc Inc.

Analysts say Teladoc racked up 75 percent of reported video or phone visits, according to 2016 estimates, but European insurance company Allianz Group earlier this month committed $59 million to American Well, one of a handful of smaller privately-run operations expanding in the sector.

Apple Inc’s Heart Study app, which flags irregular heart rhythms in users wearing Apple Watches, allows them to instantly connect with a doctor using American Well’s technology.

American Well Chief Executive Roy Schoenberg says that while revenue is steadily rising in the industry, it could grow 10-fold if payment parity, state-line and location-based constraints were lifted.

“There is a big black line between the availability of telehealth services to Americans under the age of 65 and Americans that are above the age of 65,” Schoenberg said.

“This (legislation) would be an earthquake.”
TELEHEALTH COSTS SAVINGS

Private insurers who cover the medical expenses of nearly 70 percent of U.S. adults aged 18-64 are attracted by costs that analysts say are at most a third of traditional face-to-face care.

Cowen and Co analyst Charles Rhyee estimates the average cost of a telehealth call is between $40-$50 compared to around $150 for an urgent care visit, and nearly $1,500 for a trip to the emergency room.

Rhyee also estimates that roughly $135 billion of Medicare’s annual $675 billion in spending could be done by telehealth.

Whether legislators agree may depend substantially on a report from MedPAC, the Medicare Payment Advisory Commission that advises Congress on Medicare payments, which is due by mid-March.

Critics question whether the service will be quite so wallet-friendly when used en masse, warning of costs from telehealth visits that supplement, rather than substitute, in-person visits.

“The healthcare system is still being educated in terms of the value of telehealth and where it’s best suited,” says Matthew Gillmor, an analyst with brokerage Baird.

Still, Jason Gorevic, chief executive of Teladoc, points hopefully to the furthest along of the four bills – the telehealth-friendly CHRONIC Care Act – which was recently approved by the Senate and seeks to promote home-based care and expand the remote treatment of stroke and dialysis patients.

“The current crystal ball on Washington looks like the Centers For Medicare And Medicaid Services will allow Medicare Advantage plans to include telehealth in their bid for the 2020 plan year,” Gorevic told Reuters.

By Tammy Luby at CNN Money

That didn’t take long.

Three consumer advocacy groups are suing the Trump administration seeking to stop it from allowing states for the first time to impose work requirements on certain Medicaid recipients.

The National Health Law Program, along with the Kentucky Equal Justice Center and the Southern Poverty Law Center, filed the suit in federal court in Washington, D.C., on Wednesday. The move comes less than two weeks after the Trump administration released guidelines for states to add work requirements to Medicaid and then granted Kentucky permission to do just that.

The suit charges that the approval of Kentucky’s waiver — which also requires many Medicaid recipients to pay premiums and locks them out of the program for up to six months if they violate certain rules — runs counter to Medicaid’s objective of providing the poor with access to health care. The work requirement, which can also be fulfilled through volunteering, going to job training and participating in other activities, applies to working age, non-disabled adults.

The 79-page complaint was filed on behalf of 15 Kentucky residents who are on Medicaid and would be harmed by the state’s new rules, according to the advocates. It cites a 62-year-old man who suffers from diabetes, arthritis and high-blood pressure and is unlikely to be able to comply with the work requirement or purchase coverage on his own. “Without Medicaid going forward, his health would be in jeopardy,” the groups say.

Republicans have long wanted to add work requirements to Medicaid, and Congress tried to do so in its unsuccessful attempts to repeal the Affordable Care Act last year. The Trump administration took matters into its own hands, encouraging states to file waivers that would transform the safety net program. At least nine states are waiting for approval to add work mandates and other provisions, and several governors have recently said that they will make similar requests.

By doing this, the administration has “effectively rewritten the statute, bypassing congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country,” the complaint reads.

A spokesman for the Centers for Medicare and Medicaid Services declined to comment. The agency’s administrator, Seema Verma, has said that work requirements will help recipients gain independence.

Medicaid covers nearly 75 million low-income children, adults, elderly and disabled Americans. The broadening of Medicaid to low-income adults under Obamacare — roughly 11 million have qualified for coverage under the health reform law’s Medicaid expansion provision — further spurred GOP efforts to add work mandates.

The Obama administration did not approve any state waivers that would impose work requirements, saying it was not in keeping with the program’s mission. Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need.

By Howard Gleckman via Forbes.com

Last year, a friend with complex medical needs had multiple stays at a skilled nursing facility (SNF). He was a member of a Medicare Advantage managed care plan and, as a result, could choose among only a handful of in-network facilities within a reasonable distance of his home. The care he received at the available facility was poor and since observing his experience, I wondered whether it was typical for a Medicare Advantage member. A new Brown University study suggests it might be.

Last year, about 19 million Americans, one-third of Medicare participants, were enrolled in MA plans. This model holds the promise of fully integrating health care and long-term services and supports—a great benefit for frail older adults. But critics worry that when managed care organizations are at financial risk for the cost of care, they may skimp on quality to save money. That certainly was my concern when visiting my friend. And a new study in the journal Health Affairs (paywall) suggests that fear may be well-founded when it comes to skilled nursing care.

Quality of care

The research, by David Meyers, Vince Mor, and Momotazur Rahman at Brown University, concludes that seniors in traditional fee-for-service Medicare are more likely to be admitted to high quality nursing facilities than MA enrollees. And they found that members of lower-quality MA plans were the most likely to receive care in the poorest quality SNFs.

The paper used two ways to measure SNF quality: the Centers for Medicare and Medicaid Services (CMS) star rating system (1 is the lowest and 5 is the highest ) and hospital readmission rates.

Many MA plans rely heavily on so-called narrow networks of providers, such as doctors, hospitals, and nursing facilities. Ideally, those networks should be based on value–a combination of quality and price. But there is some evidence that plans may focus primarily on cost. In effect, they send their members to those providers with which they can negotiate the best price. Quality of care is much less important.

By contrast, those in traditional Medicare may pick any facility for post-acute rehabilitation, as long as a bed is available. (Remember, this study is about Medicare post-acute care, not long-term care which is not paid for by either fee-for-service Medicare or managed care).

Limitations

As the authors acknowledge, their study has some significant limitations. One is that the CMS rating system is not an especially good indicator of patient outcomes. The star ratings are based primarily on safety measures rather than on the quality of life that is so important to frail older adults. Similarly, there is little evidence that a facility with, say, a four star rating produces better patient outcomes than one with three stars. Still, the paper raises important questions.

The paper touches on another critical issue: Are MA plans being short-sighted by steering their members to low-quality nursing facilities. In the case of my friend, the poor quality of his SNF care may have led to at least some of his many hospitalizations. And those hospital admissions likely cost the insurance company more than it saved by using a low-cost SNF.

The Health Affairs article shows that members of low-quality MA plans were admitted to SNFs with significantly higher hospitalization rates than those in higher quality managed care plans or seniors in traditional Medicare. But the paper did not look at whether those Medicare Advantage patients themselves were hospitalized more frequently than similar patients in traditional Medicare. That may be the subject for another study.

The lesson for consumers is clear: When deciding whether to choose between traditional Medicare and Medicare Advantage, or when picking among MA plans, take the time to learn which nursing facilities (and, for that matter, hospitals) are in their networks. It may not matter much when you first enroll in Medicare (SNF utilization is relatively low for 65-year-olds) but it may be critically important when you face a health care crisis down the road.

That due diligence won’t be perfect. After all, plans switch network providers all the time. But it may give you some sense of the insurer’s priorities.

By Russ Alan Price via Forbes.com

With the doubling of the federal estate tax exemption levels, a substantial number of wealthy families will no longer need to pay the tax. There are a number of very valuable implications for these families. Also, for many wealthy families who will still need to pay a federal estate tax, there are also steps they might want to consider.

While some professionals argue that the federal estate tax will come back sometime in the future at lower exemption levels, the wealthy – including the super-rich – are already starting to turn to their advisors to restructure their estates to benefit from the new law. According to Pat Rufolo, Chairman of the Private Client Services Group, McElroy, Deutsch, Mulvaney & Carpenter, LLP, “For families who no longer have to pay federal estate taxes, revisiting their estate plans is probably a very good idea. In working with our clients who no longer need to pay this tax, we’re seeing many ways to make their estate plans more efficient, less complicated, and considerably less costly for their families in the long term. For example, one area we’re finding tremendous cost savings concerns the life insurance premiums they’ve been paying for coverage they now no longer need.”

“If there isn’t a need for life insurance to pay estate taxes, then the issue is how clients should best unwind or modify their existing life insurance policies,” says Frank Seneco, president of the advanced planning firm, Seneco & Associates. “The best approach is dependent on the specifics of each situation. Some possibilities include life settlements, converting existing policies into private placement life insurance policies, and adjusting the death benefit thereby lowering the premiums.”

“In deciding on what actions to take, it is important to remember that other taxes might impact the wealth holder at death such as state estate taxes. Additionally, the use of various sophisticated planning strategies can likely provide many of the wealthy with solutions enabling them to achieve their estate planning goals with much less expensive complexity,” says Rufulo.

The new tax law is highly advantageous to the wealthy in numerous ways. By reexamining and reworking their estate plans, many of the rich and even the super-rich will be able to use some highly cost-effective solutions to ensure their loved ones will get meaningfully more of their wealth at their death.