Massachusetts Estate Planning & Asset Protection Blog

What will 2017 bring to Seniors and Persons with Disabilities? - Part II

Posted by Dennis Sullivan & Associates on Tue, Jan 24, 2017

What will 2017 bring to Seniors and Persons with Disabilities? - Part II

In last week's blog 'What will 2017 Bring to Seniors and Persons with Disabilities? - Part I' we discussed some of the key issues to watch out for in 2017 including Medicare and Medicaid reform. In Part II of the blog we continue our review of potential impacts on legislation that affects seniors and persons with disabilities.

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Affordable Care Act

Republicans are already moving to repeal and replace Obamacare. The question is: How much will be repealed? There are several programs included in the ACA, not related to traditional health insurance, that are important to elder law attorneys and their clients. For example, Medicaid expansion, a kind of Medicaid reform, is part of the ACA.

The ACA also includes programs that work toward ending the institutional bias in Medicaid. One is Community First Choice, a state plan that provides home- and community-based services. Currently it has an extremely low-income threshold so it’s a limited population, but it’s a start.

Another is Money Follows the Person, which pays for transition services. For example, it could provide extra funds to help someone leave a nursing home, by paying for a housing coordinator to find an apartment, a roommate, buy basic furniture and so on.

We are moving toward home- and community-based service, which many people favor. How will that interact with Medicaid reforms? Because they are optional, some fear that with per capita caps, these services will be among the first to go. There may be more opportunities to expand these services through block grants because they allow more flexibility in what is offered. Along this line, Senator Chuck Schumer (D-NY) has introduced a bill called the Disability Integration Act, which would make home- and community-based services a civil right.

Other Medicaid-Related Issues to Watch

Limiting home equity: This proposal, H.R. 1361, would take away the state option to expand the cap for single individual home owners. It would not impact people who have a community spouse living in the home or if you have a disabled child or a dependent under 21. 

Medical liability reform: This could impact whether individuals get adequate access to personal injury settlements and funds that can be put into a special needs trust.

Long-Term Care Reform

There has been a lot of discussion on Capitol Hill about picking up the pieces on long-term care. After a decade, the market has completely collapsed. John Hancock just withdrew, and Genworth was bought out by a Chinese private equity firm. Republicans and Democrats agree on the problem, but there doesn’t seem to be common ground yet on a solution. The Senate Aging Committee is starting the process, which is a positive step. There are calls for catastrophic coverage, at least on the back end, and probably some sort of front-end coverage for two or three years. There may be some long-term care reform as part of Medicaid reform.

VA Benefit Rules

The new rules have been delayed again until at least April, 2017. Fixing the VA is a Trump priority. An important piece to what will happen with the VA is who Trump names to head the VA and Veterans Benefit Administration (VBA). 

Nursing home binding arbitration rules

Nursing homes must comply with binding arbitration rules to have access to Medicare or Medicaid funds. NAELA has been working with others to push CMS to ban pre-dispute binding arbitration. The for-profit nursing home industry association is fighting it and recently won a preliminary injunction in a Mississippi district court (American Health Care Association et al v. Burwell). We do not yet know if the Trump Administration will appeal this ruling and continue with banning binding arbitration for nursing home contracts. 

In Kindred Nursing Centers Limited Partnership v. Clark in Kentucky, the issue is whether federal arbitration acts overrule the state’s arbitration acts. The state of Kentucky has a law that says in order to waive the principal’s constitutional right to a jury trial, the agent must be given that specific authority within the power of attorney. Whether this is overturned is likely to hinge on President Trump’s pick to fill Justice Scalia’s vacancy on the Supreme Court.

 Conclusion

There are a number of issues that will be addressed in 2017 that can have significant impact on seniors and their loved ones, Veterans, and persons with disabilities. If you have questions or would like to discuss any of the issues raised here, please don’t hesitate to contact us.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops. Call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

 

Tags: disabled, seniors, Affordable Health Care Act, Veteran, VA benefits, VA, Medicaid, Nursing Home, Estate Planning, Elder Law, elder care, New estate tax law, new regulations, trusts, Nursing Home Costs, social security

What will 2017 bring to Seniors and Persons with Disabilities? - Part I

Posted by Dennis Sullivan & Associates on Thu, Jan 19, 2017

What will 2017 bring to Seniors and Persons with Disabilities? - Part I

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Donald Trump’s election and Republican majorities in both houses of Congress surprised much of the nation. With control of legislative and executive branches of government, the expectation is Republicans will finally be able to push through long-awaited legislation, as well as follow through on promises made by candidate Trump. And they are expected to move quickly.

We will summarize some key issues to watch out for in 2017 that affect seniors and persons with disabilities and continue to provide updates throughout the year.

What the Election Outcome Means in Congress

The House has remained in Republican control—about 45% Democrat and 55% Republican. The majority rules, so while the Democrats may have loud opposition, they don’t have a lot of power. Currently, Republicans are mostly united, but those in the Freedom Caucus (Tea Party Republicans) are deciding how they will interact with the Republican establishment. If they split, votes may be needed from Democrats to pass legislation.

The Senate is 48 Democrats and 52 Republicans. 60 votes are needed to prevent a filibuster (where senators can talk for hours and delay votes). But with budget reconciliation, only a simple majority (51) is needed to pass legislation in the Senate. Because they are all budget-related programs, the Republicans will try to reform Medicaid, Medicare and the Affordable Care Act (Obamacare) through budget reconciliation. Individual Republican senators will have a lot of power, as some may insist on additions or deletions to secure their vote. If the Republicans do not stick together for the majority, votes may be needed from Democrats. (Note: Budget reconciliation was used to pass the Deficit Reduction Act of 2005 and OBRA 93, which enacted big cuts that changed elder law—the lengthening of the transfer penalty, the change in the time of when that penalty applies, the move from trust.)

One thing to watch is who is going to run Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration, especially considering how much is related to Supplemental Security Income (SSI). The people now in charge of staffing these agencies are conservative. For example, the person in charge of staffing the political positions at the Social Security Administration has called for privatizing Social Security in the past. Donald Trump has repeatedly said he doesn’t want to change Medicare and Social Security, but that may be changing. (See below.)

Tax Policy

Tax changes are expected as part of the budget reconciliation process. We are not sure yet if 2017 will bring major tax reform or just tax cuts, but tax rates are expected to decrease for both individuals and businesses. Candidate Trump called for elder care and child care tax deductions and/or credits. He has also stated his plan to eliminate the federal estate tax, then charge capital gains tax on everything over $10 million, with exemptions for family farms and small businesses.

We may also see some changes to the ABLE Act (Achieving a Better Life Experience), which passed in December 2014 and amended Section 529 Plans. Currently, ABLE allows people with disabilities developed before the age of 26 and their families to set up tax-exempt savings accounts, which can be used to cover qualified disability expenses such as, but not limited to, education, housing and transportation. Revisions in 2017 may raise the age to 46, allow those working to put in more money, and allow rollovers of these accounts. 

Medicare Reform

President-elect Trump started by saying he was going to protect Medicare and Social Security. After meeting with House Speaker Paul Ryan, he said he will modernize Medicare. Reince Priebus, incoming chief of staff, recently insisted that Mr. Trump won’t meddle with Medicare or Social Security. Instead, he has said he will focus on 1) improving the economy, which will reduce the debt and ease entitlement concerns and 2) save Medicaid, Medicare and Social Security without cuts while eliminating fraud, waste and abuse. 

But he is already encountering resistance from Republicans, who for years have claimed that a major overhaul to Medicare and other entitlements are needed to ensure they don’t go bankrupt; that entitlement reform is critical to reducing debt; and the longer they wait, the harder it becomes to solve the problems. Obama administration officials warned just last year that a central Medicare trust fund is projected to run out of money by 2028.

Yet Republicans are also encouraged by what some of the President-Elect’s Cabinet picks could mean for future entitlement reform. Representative Tom Price (R-GA), who replaced Paul Ryan as Budget chairman and sought to overhaul entitlement programs, is Trump’s pick for Health and Human Services secretary. Representative Mick Mulvaney (R-SC), a fiscal hawk and Freedom Caucus co-founder, will lead his White House budget office.

So, we will have to wait and see if President-elect Trump, his Cabinet members and leading Republicans will find a way to agree. Some reforming of Medicare may be part of the 2017 budget reconciliation, but with ObamaCare repeal and replace, tax reform and infrastructure as the immediate priorities, solving the decades-long problem of deficits in Medicare and Social Security will likely have to wait until after 2017.

In the meantime, we are seeing a tilt toward Medicare Advantage plans. These managed care plans (offered through HMOs) often have lower costs and provide benefits not covered by traditional Medicare and Medicare Supplement Plans, such as health club memberships and preventative educational programs for those with diabetes and other chronic diseases. 

A long-term goal for Medicare, which has been around since its founding in 1964, is premium support. Basically, the consumer would choose a plan from those offered through an exchange. The government would provide subsidies to companies, they would lower the premiums and then people would choose their plans. It’s not likely that this will replace Medicare as we know it, but it is an idea being discussed.

Medicaid Reform

President-elect Trump has called for block granting Medicaid. House Speaker Paul Ryan has called for it, too, and Republicans are looking at whether they can reform Medicaid through budget reconciliation.

Those who want to reform Medicaid are focusing on the FMAP, the federal percentage match that states receive through federal funding. This is based on per capita income of the state. For example, a rich state like New Jersey is a 1:1 ratio, while a poor state like Mississippi is about a 3:1 ratio. This means for every one dollar that Mississippi spends on Medicaid, they will receive three free extra dollars from the federal government. This can impact states’ budget decisions. For example, if the governor of Mississippi needs to cut costs, he will more likely cut education or infrastructure by one dollar, rather than cut Medicaid spending by one dollar and lose the three free extra dollars.

The idea of block grants has been around for about 30 years. They are attractive because there are fewer federal rules to comply with and the states can use the money however they wish. But block grants shift more costs onto the states, and governors tend to oppose that.

Another idea floating around is a per capita cap, which would give the states a fixed dollar amount per individual, based on Medicaid standard lines (the blind, aged, and disabled children and adults). It was first proposed by President Clinton, who also wanted block grants. A per capita cap may force the states to control Medicaid costs over time, but there is also a demographic shift to consider—the medical needs and costs for an 85-year-old are much greater than for a 65-year-old. Nursing homes and aging disability provider groups have a huge stake in this and would likely oppose it, as would some governors.

The cost changes may not be felt right away, but they will be noticeable ten years from now and that’s what Congress must plan for. There may be increased waiver flexibility for the states and provider taxes to offset states’ losses. We may also see reforms to make it easier to manage care.

We will be following changes in legislation very closely and will keep you informed as to how these changes affect seniors and persons with disabilities. Check back next week for Part 2 of this blog where we will discuss more anticipated changes in the law including the Affordable Care Act and VA Benefit Rules!

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

To learn more about elder care and how changes in the law may affect you,attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Nursing home care is more than $180,000 per year! Attend this FREE educational seminar to learn:

  • How to protect your home and assets from the costs of long-term care
  • How to stay out of the nursing home and access in-home care
  • How to make sure your spouse is not left financially ruined if you need nursing home care
  • How to access Veterans benefits to pay for long-term care

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop 

 

Tags: Medicare, Medicaid, seniors, disabled, Elder Law, Affordable Health Care Act, social security, trusts, Estate Planning, New estate tax law, new regulations, retirement plans, Nursing Home, Nursing Home Costs

MA Lags Behind on Dementia Care

Posted by Dennis Sullivan & Associates on Wed, Mar 18, 2015

Massachusetts Lags Behind on Dementia Care Compliance | Massachusetts Elder Care Attorney

 

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Arlene Germain, the president of Massachusetts Advocates for Nursing Home Reform, said that once the new rules are implemented, they could substantially improve the lives of nursing home residents across the state. She also added, “strong oversight and greater nursing home participation are critical to ensure that the law’s benefits are meaningful and widespread.”

Massachusetts has been slow with its work on updating the process for dementia care compliance checks. The state only handed out its dementia special care checklist for inspectors in December, almost six months after the rules were officially adopted.

The Boston Globe article, titled Dementia care lacks oversight in Mass., data show,” says that despite the delays, state regulators are not conducting spot checks for compliance; they’re already just too busy with routine monitoring of more than 400 nursing homes. The state health department recently announced that its inspectors would now review dementia care during their annual visits to each facility. This is a step in the right direction, but the reality is that many nursing homes will still not be subject to these compliance checks for months.

The president of the state’s Advocates for Nursing Home Reform says the new rules, once fully implemented, could substantially improve the lives of nursing home residents. Increased oversight and greater nursing home participation will be needed to ensure that the law’s benefits are meaningful. Nevertheless, nursing home administrators say they are struggling to comply with the rules due to its expense.

The Massachusetts Senior Care Association reports that many members have spent as much as $30,000 on the required staff training. Those rules, in addition to other general training requirements, are intended to close a loophole that allowed nursing homes to advertise dementia units without providing added training for their workers, specialized resident activities, or safety measures to prevent residents from wandering. Massachusetts is lagging behind the rest of the country on requiring these protections. The original article reports that according to a federal report written in 2005, that 44 other states were already requiring governing training, staffing, and security for facilities that provide specialized dementia care. Regulators believe it was important to mandate the training, because over half of the state’s 41,000 nursing home residents have dementia.

 

For additional guidance, please see The Seniors and Boomer's Guide to Health Care Reform and Avoiding Nursing Home Poverty the book provides important information for families on resources for quality care and protection for loved ones.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Homes, Nursing Home, dementia, 2015, new regulations

VA is Proposing a 3 Year Look Back Together with a Penalty of Up To 10 Years

Posted by Dennis Sullivan & Associates on Mon, Feb 23, 2015

VA is Proposing a 3 Year Look Back Together with a Penalty of Up To 10 Years | Massachusetts Elder Law Attorney

 

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On January 23, 2015, the VA took the initiative in proposing new regulations that would hit wartime veterans and their spouses with a penalty of up to 10 years for making gifts, if they wish to qualify for the VA’s Aid and Attendance program.

As readers of this blog know, the Aid and Attendance program is a non-service connected pension can provide as much as $2,120 per month in tax free income to help pay the cost of long term care.  This program is means tested with an asset limit of about $80,000.  Currently, there is no look back period like Medicaid has, so that transfers for less than fair value to individuals or trusts do not result in a waiting or penalty period for benefits.

Federal legislators have introduced two bills since 2012 seeking to impose a 3 year look back. Neither bill has managed to pass both houses of Congress yet though. The VA however, is sick of waiting and is trying to take matters into its own hands.  They have proposed a penalty of up to 10 years that would result from uncompensated transfers. The penalty itself would be calculated by dividing the amount of the transfer by the claimant’s pension rate. 

Other changes include a net worth standard of $119,220 including annual income. In other words, an applicant would need to have no more than $119,220 in assets and annual income combined in order to qualify.  The higher the applicant’s income, the lower the amount of assets they can keep.

Under the proposal, expenses related to independent living facilities would not count as care costs.  This would mean that veterans with dementia, or other degenerative diseases who can no longer safely live in their own homes but who don’t yet need assistance with the activities of daily living will not be able to include the cost of that facility in an effort to qualify for the VA benefit. Daily living activities are things like such as bathing, dressing, eating, toileting and transferring. Finally, the applicant’s home will remain an exempt asset towards the net worth limitation only if the lot on which it sits is less than 2 acres.

These changes will dramatically reduce the ability of many veterans to qualify for this important benefit.  The new regulations have been submitted for public comment.  To fight these changes, everyone who cares about veterans must respond no later than March 24, 2015.  You can send your comments through http://www.regulations.gov or by mail to Director, Regulation Policy and Management (02REG), Department of Veterans Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420 or by fax to (202) 273-9026.  Comments should include that they are in response to “RIN 2900-AO73, Net Worth, Asset Transfers and Income Exclusions for Needs-Based Benefits”.

 

Click here to access our free report on Aid and Attendance Benefits.

At the Estate Planning & Asset Protection Law Center, we provide a unique education and counseling process which includes our unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

 Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: long term care, Nursing Homes, veterans benefits, Nursing Home, wartime veteran, Veteran, federal, look-back, VA benefits, penalty, 2015

Times Are Changing, So Are Tax Laws

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Aug 26, 2014

The Tax Game Has Changed | Massachusetts Estate Planning Attorney

 

Tax planning, estate tax, trust, congress

 

The Old Ways Don’t Work Anymore

For years, estate planners have done what is considered traditional estate planning. They drafted plans primarily concerned with minimizing future estate tax liability and gave minimal attention to income tax consequences.

This was perfectly fine years ago when the estate tax was much more severe than the potential for income tax. This was attributable to relatively high estate tax rates, low estate tax exemption that was not indexed for inflation, and comparatively low capital gains rates.

However, Congress has tinkered with the tax system in a huge way. Accordingly, the income tax impact of estate planning is taking on greater significance, especially for Massachusetts residents.

 

The Tax Man Cometh

More attention shall now be directed toward the importance of income tax basis considerations in estate planning due to the narrowing between the estate tax rates and the income tax rates. In fact, in most estates worth less than $5.34 million, estate taxes are no longer an issue. Now, income taxes loom large, primarily because of the lack of attention on the income tax basis (i.e. cost or adjusted basis) of capital assets. Also state estate taxes have become critically important because of the lower $1 million threshold for estate taxes in states like Massachusetts.

 

Failing to Update Could Cost You

The bad news for most middle-class taxpayers is that for years they've been fed a steady diet of estate tax minimizing wills and trusts. Worse yet, they hang onto outdated documents for many years, thinking they are done with their estate planning and not wanting to be bothered. Sadly, these old documents will no longer serve their intended purpose of estate tax minimization. A major problem is also created when federal estate tax minimization plans, unless they are updated, will cause a completely avoidable Massachusetts estate tax for a married couple. While there may be no federal estate tax savings with these documents, because very few middle-class taxpayers will ever pay estate tax, the documents will increase income taxes for their heirs upon sale of appreciated assets. Moreover in Massachusetts, there may not only be a completely avoidable estate tax on an additional 1 million dollars, but it may also trigger a large, completely avoidable Massachusetts estate tax on the first death.

 

What to Do About a Completely Avoidable Massachusetts Estate Tax

Bottom line:  the game starts anew. Let's focus on income tax minimization for most taxpayers and forget about estate tax minimization. Unless your estate is worth more than $5.34 million, your biggest risk is Massachusetts estate tax as well as overpaying income taxes due to inattention to income tax basis planning in your wills and trusts.  Don't make that mistake. Review your documents today so that you eliminate these lurking tax problems

 

At the Estate Planning & Asset Protection Law Center, we provide a unified education and counseling process which uses a unique 19 Point Trust, Estate and Asset Protection Review to help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones, click here for more information. We provide clients with a unique approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: massachusetts estate planning strategies, trusts, Nursing Home Costs, Mistakes, Tax on IRAs, Massacusetts Estate Tax, social security, Tax Savings, tax deductions, tax liability, tax exemption, tax reform, taxes, Massachusetts estate tax, transfer of assets, tax, trust, Nursing Home

Three Ways to Pay for Long Term Care part 2

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Fri, Aug 15, 2014

Three Ways to Pay for Long Term Care continued

Long term care insurance, IRA, trust

In our last post we were discussing the difficulties in funding long term care through either insurance or Medicaid.  Most insurance companies seem to be getting out of the long term care market entirely or drastically raising premiums.  Medicaid, the primary government program that covers long term care, is still a fall back for many.  But, there are gaps in terms of what it will and will not cover, and it is increasingly difficult for many to navigate the Medicaid system.

This is especially so given the two objectives most of our clients want to achieve: making sure they have enough money to meet their own needs as well as passing on a legacy to their children and grandchildren.  Without proper planning for long term care, however, the first objective may overwhelm the second, making it unachievable.

That’s where long term care insurance has sometimes helped.  It’s also where our specialty of setting up 5 year planning using trusts, has also helped.  But, sometimes there is no long term care insurance, it’s too late to get it and the legal solution can only go so far.

Self-funding with asset based long term care financial products just might be the answer.  As some insurance companies have left the long term care insurance market, others are now offering alternative ways to fund the care, such as life insurance or annuities.

These products allow your money to grow tax deferred.  It can then be used to pay for long term care and, unlike traditional long term care insurance you don’t have to worry about “using it or losing it”.  A death benefit is paid to your heirs if you don’t use it (or only use some).

The longer you wait until you start drawing out the investment, the more time to build up the account value for use as long term care.  While these investments don’t return the higher rates that can be gained in the market, they also don’t put your principal at risk, meaning you won’t lose any of it if there is another 10 to 30% market correction.  For those who have their money sitting in CDs and cash earning less than 1%, the higher rates are a clear bonus.

Many of these products do not have the same underwriting requirements that exist for long term care insurance.  Whereas a diagnosis of dementia or being age 75 or older would preclude Long Term Care Insurance entirely, these asset based products may still be an option, even as late as age 85.

For our clients with large IRA accounts who want to protect some of that account for loved ones, moving the money to a trust results in a large income tax bill because the account can no longer remain tax deferred.  However, purchasing asset based long term products within the IRA can allow the account to remain tax deferred, increase the income value significantly if long term care is needed, and provide a death benefit for your loved ones if not needed.

 

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: Nursing Home Costs, long term care, veterans benefits, VA benefit, VA benefits, Massachusetts, Nursing Home, Veteran, VA, Nursing Home, long term care insurance

There Are Three Ways to Pay for Long Term Care

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Tue, Aug 12, 2014

The Three Ways to Pay for Long Term Care

VA Long Term Care

As we always explain to people, there are 3 ways to pay for long term care:  The first way is to use your own money.  The second source is long term care insurance and the third is government benefits, primarily Medicaid and the VA Aid and Attendance program.

We have written before in this blog about government benefits, especially Medicaid.  Because long term care is so expensive and so many people run out of money, Medicaid, as a last resort, must always be considered. Unfortunately, the economy is still struggling and tax revenues, which provide the funding for Medicaid, are down.  State and Federal governments are always looking for ways to cut costs and Medicaid is likely to continue to be a target for them.  The VA Aid and Attendance benefit, which has been a help to some, is not a total solution by itself and is also likely to be more restrictive.  Of course, VA benefits have never been an option for the non-Veteran senior population.  As we see fewer World War II veterans, there are fewer Korean veterans behind them, and still fewer Vietnam veterans coming behind them.

Long term care insurance is an important piece as well, unfortunately, all too often we find that too many people don’t have it, and when they do seriously consider purchasing the insurance, just as they start to think that they just might need long term care, it’s too late. They are now too old or too ill to pass insurance underwriting requirements.

What we have also seen, and what we have written about in the past, is the change occurring as a result of an aging population and poor forecasting by the insurance industry.  Many companies have dropped out of the long term care market altogether.  Others have presented their policyholders with large premium increases with the promise of more to follow each year.  America’s seniors are faced with the choice of paying the increases or cutting their coverage.

So, what other options are there for seniors looking for coverage?  Let’s go back to the first way to pay for care, self-funding or using your own money.  We see so many seniors who fall into one of two categories:  Some have their savings heavily invested in the stock market and other investments that are too risky for someone who could need large amounts of principal to pay for long term care.  If the market drops by 25% or more again like it did a few years ago, many seniors won’t have the ability to hold on till their investments recover. Others have gone the other way and put their savings in bank accounts and CDs that earn less than 1%.  The principal is safe from market fluctuations but they are getting a next to nothing rate of return.  Coupled with Social Security and small pensions, most seniors today have income in the $2000 to $4000 per month range; not enough to meet their monthly expenses without dipping into the principal.

So, is there are another way?  The answer, happily, is yes.  With asset based long term care products, there is a way to self-fund the cost of long term care and have something left for your spouse, children and loved ones.  We’ll tell you more about it in our next blog post, so be sure to watch for it.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Click Here to Register For Our Trust, Estate & Asset  Protection Workshop

Tags: massachusetts estate planning strategies, Nursing Home Costs, long term care, Nursing Homes, VA benefit, VA benefits, Massachusetts, Nursing Home, incapacity, senior, Veteran, VA, Nursing Home, long term care insurance

Early Signs That You May Be Getting Alzheimer's | Massachusetts Alzheimer's Attorney

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Mon, Jan 13, 2014

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Alzheimer's: Just hearing the word strikes fear into anyone over 50.

 The statistics are chilling. Already, more than five million Americans have Alzheimer's. And by the time the last Baby Boomer passes away, that figure will be over ten million.

Prior to the past few decades, it was simply called dementia. It wasn't until recent years that Alzheimer's became classified as a disease in itself...and as just one of a number of forms of dementia.

Most of us tend to think of memory loss as the chief distinguishing characteristic of Alzheimer's. And, realistically, it probably is. But it's often not the first way in which Alzheimer's manifests itself. In fact, there are a number of signs - prior to any noticeable memory loss - which could indicate the onset of this disease.

Unfortunately, most of us (and, often, even doctors) miss these early signs - because we're too focused on memory loss as the most significant indicator.

 In 2011, research in Spain indicated that more than a third of adults who go on to develop early-onset Alzheimer's (before age 65) display a number of other symptoms, before memory loss becomes obvious. Interestingly, they're also the same symptoms that often appear first in patients who develop the disease after 65.

 In Part 2, we'll give you the list of early symptoms which could possibly indicate the onset of Alzheimer's.

 With all this talk about Alzheimer's and dementia, it's wise to remember that estate planning isn't something you do after you become sick. It's something to do before you ever get sick!

 

We can help. We've been planning Massachusetts families' estates for the past 25 years.

 

We can help your family, too. We're just a phone call away.

To gain free online access to our Senior and Boomers Guide to Healthcare Reform and Avoiding Nursing Home Poverty, which contains care tips as well as other useful information , please Click the link here:

Seniors and Boomers Guide 

At the Estate Planning & Asset Protection Law Center of Dennis Sullivan & Associates, we help people and their families concerned with losing their homes and life savings to increasing medical and nursing home costs, taxes and the costs and time delays of probate. We also protect clients from losing control of their own health and financial decisions.

We encourage you to attend one of our free educational workshops to learn more about our process and what you can do to enhance the security of your spouse, home, life savings and legacy. To register for a seat at an upcoming workshop call (800) 964-4295 (24/7) or register online at www.SeniorWorkshop.com

Tags: Alzheimer's Disease, Alzheimers Disease, alzheimer's activities, Alzheimer's, alzheimers, Nursing Home, 2014

Massachusetts Elder Law Attorney | Eyes On Washington: Future of Medicaid In Question?

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Wed, Jan 16, 2013

Talks of the national budget and debt are dominating Washington.  There have been a number of questions raised regarding the long term viability of the Medicaid Program.  Many groups, like AARP and our firm, believe that preserving the Medicaid Program is critically important. 

Currently about 9 million people qualify for both Medicaid and Medicare.  These people make up only 15% of Medicaid Enrollees, but account for 39% of the Medicaid spending.  Medicaid is also the primary payer for 67% of all nursing home patients. 

Two Main Issues Being Raised About Medicaid 

First is the fcat that the program will be expanded by the Affordable Care Act (FOR MORE INFORMATION ON HOW THE AFFORDABLE CARE ACT IMPACTS SENIORS AND BOOMERS CLICK HERE).  Eligibility rules will be loosened and as a result, more people will be able to recieve Medicaid benefits. 

The second issue is government spending on the program.  As the Medicaid program is expanded, the federal government is going to pay 100% of the costs for 3 full years.  After the 3 years, federal spending will be gradually reduced to 90% of the costs, with states picking up the other 10%.  Many states are still unsure whether or not to accept the deal. Experts warn however, that lowering federal costs will only shift the burden to other payers and will result in a decrease in care provided.

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

 

elder law, senior, alzheimer's, massachusetts, estate planning

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Tags: Nursing Home Costs, long term care, Medicare, Medicaid, medical expenses, medicaid qualification, senior, Nursing Home, Fiscal Cliff

Massachusetts Elder Law Attorney | My Dad's In a Nursing Home...

Posted by Massachusetts Estate Planning & Elder Law Attorney, Dennis B. Sullivan, Esq., CPA, LLM on Thu, Dec 13, 2012

My Dad's In a Nursing Home...And Constantly Losing His Glasses, Wallet, And Dentures. What Can We Do?

Well, the first thing I tell clients in this situation is to remember why he's there in the first place - he may have memory problems.

Then, I advise them to speak with the director of his unit, and find out why this keeps happening. Then you have to determine whether the item is worth replacing. Obviously, glasses and dentures need to be replaced. But other items may not need to be.describe the image

Wallets, for example, may be more of a comfort/reassurance item to him than anything else. And, if that's the case, you don't have to replace each one with a fancy wallet; an inexpensive one may do. In fact, it may pay to keep a few on hand.

Replacing lost or broken items can be expensive. But there are still ways you can save. For example, you can compromise on the frame of his glasses. Or, if he just uses them for reading, perhaps an inexpensive pair of reading glasses - available at any drug store - would suffice.

Even with dentures - which are obviously a necessity - it may be possible to save some money. If they're broken, consider fixing them rather than replacing them. And if they're lost, chances are, they'll be lost again. It's conceivable that they just don't fit right...and your loved one may be removing them. If that's the case, a dentist may suggest alternative measures...including re-fitting the dentures to; make them more comfortable.

If your loved one's in a nursing home, you probably have a million questions - every day. But we can help.

To gain free online access to the Complete Alzheimer's Resource Kit, which contains care tips as well as other useful information on Alzheimer’s disease, please visit www.BostonMemoryLawyer.com

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones.  We provide clients with a unique educational and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.

We encourage you to attend one of our free educational workshops, call 800-964-4295 and register to learn more about what you can do to enhance the security of your spouse, home, life savings and legacy.

Tags: family, Nursing Home, Elder Law, Alzheimer's

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