Articles Posted in Elder law estate planning

With the skyrocketing costs of medical care and nursing homes, few people can afford to pay out of pocket costs to live in a long term care facility in their later years and most will eventually need to qualify for Medicaid to do so. Medicaid has essentially become the default funding source for for nursing home care and the long-term care insurance of the middle class in the United States.

Sources estimate that up to two-thirds of nursing home patients are covered by Medicaid, which was created to act as a safety net to the country’s poorest citizens. The definition of who qualifies as poor under Medicaid varies from state to state. In New York, individuals may only have up to $15,150 “countable assets” such as cash, stocks, bonds, investments, vacation homes, and savings and checking accounts to qualify for institutional or nursing home care. The spouse of the individual applying for Medicaid is allowed to have $123,600 in assets.

Certain assets are not counted towards these eligibility requirements. Some of the most important exemptions are the individual’s personal possessions like clothing and furniture, a single motor vehicle used for transportation, and the individual’s principal residence as long as he or she intends to return there at some point. For those over income an asset limits, New York does offer a variety of programs to help individuals qualify for Medicaid benefits.

The odds are that most of us will end up caring for a relative or close friend at some point, helping to manage their health and wellness and even make important decisions to ensure that person lives a comfortable, dignified life. Whether these tasks include arranging transportation for doctor’s appointments, overseeing finances, performing chores, or helping hands on with hygiene, getting dressed, or meal preparation, caregivers come in all forms and play an important role in the lives of loved ones.

Statistically, long distance caregivers have an average age of 47 and nearly 70 percent are female. Almost all of them provide care to a close relative despite the challenges associated with long distance caregiving, more than half of them make visits at least once a week to the person they care for. Approximately 40-percent visit at least once a month.

Helping loved ones of friends who live close by can be challenging enough but when the person we are responsible for lives greater distances away, the challenges can included unique obstacles, including lengthy travel time, extra costs, an inability to attend medical appointments and questions about how to find help in a different state. Fortunately for these vital caregivers, there are a multitude of community-based resources to help make these tasks easier and help caregivers and their loved ones.

Authorities across the country are warning of new scams targeting elderly Social Security over the phone, where individuals claiming to be government representatives try to collect sensitive information under the guise of a computer glitch causing issues with benefits. The Social Security Administration has made it very clear that under no circumstances will it call or send emails to beneficiaries asking for personal information, such as Social Security numbers, dates of birth or other private information, and advises people to not respond to such messages.

Other scams include callers asserting that beneficiaries need to pay a fee to unlock their Social Security number because of criminal activity and will also need to confirm their Social Security number. The Federal Trade Commission recently confirmed an increase in this type of scam and beneficiaries should be on the lookout for this type of illicit activity.

The AARP Fraud Watch Network recently announced it has had more complaints to its helpline in the past few months from consumers targeted by Social Security impostors than the older IRS scams that harassed thousands, if not millions, of Americans since 2013. According to the office of the Treasury Inspector General for Tax Administration, those IRS scams stole more than $73.6 million from almost 15,000 victims over the past five years.

As of January 1, 2019, approximately 1.2 million seniors across will lose their SilverSneakers coverage on Medicare Advantage plans that give them access to gyms and health centers without any additional membership costs. The controversial business decision will affects plan holders in California, Connecticut, Illinois, Indiana, Iowa, Kansas, Missouri, Nebraska, Nevada, North Carolina, and Utah who have Medicare Advantage plans with UnitedHealthcare.

An additional 1.3 million seniors across nine states with Medicare Advantage plans with Medicare supplemental (Medigap) insurance will also lose their access to the SilverSneakers program. States affected by this move include Arizona, California, Connecticut, Illinois, Indiana, North Carolina, Ohio, Utah and Wisconsin. Although the benefits were optional with UnitedHealthcare, millions of seniors nonetheless took advantage of the option to visit gyms and fitness centers for exercise.

Beginning next year, UnitedHealthcare will instead offer seniors with Medicare Advantage supplemental policies will get 50 percent off memberships at thousands of gyms across the country, telephone access to wellness coaches and access to various online communities and health-related resources. Seniors with UnitedHealthcare Medicare Advantage plans can join Renew Active, the company’s health and fitness program which offers a network of over 7,000 locations members can visit for no additional cost and even qualify for evaluations from personal trainers and online brain-training programs.

The Trump Administration recently unveiled a new plan aimed at curbing drug prices for expensive medicines administered to patients under Medicare Part B and took aim at entities the President claims are responsible for Americans paying more for prescription drugs than citizens in other countries. The 44-page blueprint released by the Department of Health and Human Services is asking for feedback on the plan before it plans to propose it more formally in early 2019 and eventually take effect the following year.

While the proposal would not extend to most prescription drugs that Americans fill at their local pharmacy under Medicare Part D, the plan would instead focus on some of the most high-cost medications administered by physicians, such as those used to treat cancers, autoimmune diseases, and late-stage renal failure. According to government reporting, the Centers for Medicare and Medicaid Studies (CMS) spent $26 billion on Part B drugs in 2015, or about 3 percent of Medicare’s total $647.6 billion budget that year.

These types of drugs, often called “biologics” because they are made from living organisms, are typically manufactured by only one pharmaceutical company which can leave little if any competition to drive prices down. To accomplish the goal of reducing costs the administration has suggested tying the price of some drugs under Medicare Part B to those paid in other countries like France and Germany.

Caring for a child with a disability creates challenges beyond our lifetime and often takes resources beyond what federal safety net programs can offer in order for our loved one to live the most comfortable and dignified life possible. While rules governing these federal programs place certain income restrictions on disabled persons to qualify, there are sanctioned trusts allowed specifically for special needs planning that allow for first party and third party benefits to supplement federal assistance.

In 2010, Congress passed the Achieving a Better Life Experience (ABLE) Act allowing beneficiaries to have up to $100,000 in a 529 special needs trust and retain Social Security Insurance benefits. Beneficiaries can also retain Medicaid coverage so long as the trust does not exceed the amount for a 529 college savings plan. The ABLE Act allows these trusts to be created so long as the beneficiary’s disability is established prior to the age of 26-years old.

Disabled persons can also create and fund their own first party special needs trusts through a (d)(4)(C). Funds for first party special needs trusts often come from sources such as a personal injury settlement, workers’ compensation award, or an inheritance left directly to the beneficiary. An amount equal to the annual federal gift tax exclusion (currently $15,000) can be deposited annually in the account while still maintaining the beneficiary’s eligibility for Medicaid and Supplemental Security Income

Figuring out the best time to claim Social Security benefits is an important part of retirement planning that can have long lasting impacts on the type of lifestyle individuals and their spouses can expect to enjoy in their Gold Years. Depending on when individuals decide to take their Social Security benefits, from the ages of 62 to 67, it can mean the difference of hundreds of dollars per month to thousands of dollars of the course of a lifetime.

While the conventional wisdom is to wait as long as possible to claim benefits, and hopefully reach maximum payouts, for many beneficiaries there comes a time known as the “break even point” when the amount of benefits claimed would be essentially the same regardless of the amount received per month. This happens because the program is designed to give individuals more or less the same payout over their projected lifetimes, known as “actuarial neutrality.”

Determining one’s break even point is a fairly straightforward process but should take into account certain other factors that may artificially inflate any projected payout, namely excluding cost of living adjustments. Including projected cost of living adjustments will only create artificially high numbers that may not end up being actual benefits received.

Most of us would not want to be anywhere else but in our homes as we grow old and enjoy our Golden Years. However, as we age the daily activities and chores we took for granted can become greater burdens or turn into situations where we may suffer serious injury in our own home. Fortunately, it does not have to be like this and there are a number of different modifications that can be made to improve the safety and comfort of the places we live.

While most of the homes in the country were not designed with the foresight of being accommodating to the physical and cognitive challenges many seniors live with and overcome every single day. Stairs, hallways, and other physical barriers can present unique challenges to older Americans but with a few universal modifications seniors can live safely and comfortably in their homes.

One revolutionary thing seniors can take advantage of right away is incorporating smart home products to help control things like the thermostat, turnings lights and televisions on and off, and locking windows and doors. Another great advantage of adopting smart technology throughout the home is being able to monitor what is going on and report to caretakers or relatives any issues with the house.

No one wishes to end up in a nursing home or require assisted living care but for many Americans, it is a reality that will come true and needs to be planned for. When we do enter a nursing home or have our loved ones placed there, we expect the facility will look after residents and provide the appropriate care to ensure elders live their Golden Years in comfort and dignity.

However, because nursing homes and other skilled care facilities are for-profit business that look to maximize their income and payments, particular from federal entitlement programs like Medicaid, they sometimes make decisions that are not in the resident’s best interest. One of the most drastic measures a nursing home can take is evicting a resident and will often employ a variety of measures to see the process through.

Often times, nursing homes will justify an eviction by saying the facility simply cannot meet the resident’s needs. Excuses for why a nursing home cannot take care of a resident include that individual having dementia, being combative, or is non-weight bearing and needs assistance for even the simplest tasks. Other times, nursing homes will reevaluate residents after the facility converts to another type of assisted living facility and focuses only on taking care of patients with different medical and lifestyle needs.

Qualified plans  such as IRAs, 401(k)s, 403(b)s and other deferred compensation are excellent ways to help reach your estate planning goals and ensure your wealth is not depleted by excessive taxes and assisted living costs. IRAs in particular help achieve both of these goals because they are not taxed and if utilized properly, will not count against you when applying for Medicaid to pay for nursing home care.

For estate planning purposes, qualified plans are considered those which individuals make contributions to while working and begin making at least the required minimum distribution (RMD) at 70-years old. IRAs and qualified plans help encourage people to save early and often for their retirements by offering these tax-free incentives and should be taken full advantage of to ensure we can live our our retirement in comfort.

If an individual is already living in a nursing home and applying for Medicaid, the principal amount of the IRA is protected when calculating one’s assets to determine whether or not he or she qualifies for Medicaid as long as that person is taking the RMD. For a Roth IRA, it is not necessary to take the RMD if distributions are being taken.

Contact Information