Understanding Medicare’s Hospice Benefit

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits and can be extremely helpful to both the terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which means helping people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs while also supporting the terminally ill individual’s independence, access to information, and ability to make choices about health care. 

To qualify for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A, and a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely. The beneficiary must also agree to give up any treatment to cure his or her illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It’s possible to revoke the benefit and reelect it later, and to do this as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on-call 24 hours a day, 7 days a week, to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit provides for:

• Physician and nurse practitioner services
• Nursing care
• Medical appliances and supplies
• Drugs for symptom management and pain relief 
• Short-term inpatient and respite care 
• Homemaker and home health aide services 
• Counseling 
• Social work service 
• Spiritual care 
• Volunteer participation 
• Bereavement services 

Services are considered appropriate if they are aimed at improving the beneficiary’s life and making him or her more comfortable.

Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:

• Treatment to cure the beneficiary’s illness. 
• Prescription drugs other than for symptom control or pain relief. 
• Care from a provider that wasn’t set up by the hospice team, although the beneficiary can choose to have his or her regular doctor be the attending medical professional. 
• Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term inpatient care or respite care services, Medicare will cover a stay in a facility. 
• Care from a hospital, either inpatient or outpatient, or ambulance transportation unless it arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness. 

To download Medicare’s booklet on the hospice benefit, click here.  

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Feds Release 2019 Guidelines Used to Protect the Spouses of Medicaid Applicants

The Centers for Medicare & Medicaid Services (CMS) has released the 2019 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep, as well as related Medicaid figures.

In 2019, the spouse of a Medicaid recipient living in a nursing home (called the “community spouse”) may keep as much as $126,420 without jeopardizing the Medicaid eligibility of the spouse who is receiving long-term care. Called the “community spouse resource allowance,” this is the most that a state may allow a community spouse to retain without a hearing or a court order. While some states set a lower maximum, the least that a state may allow a community spouse to retain in 2019 will be $25,284.

Meanwhile, the maximum monthly maintenance needs allowance for 2019 will be $3,160.50. This is the most in monthly income that a community spouse is allowed to have if her own income is not enough to live on and she must take some or all of the institutionalized spouse’s income. The minimum monthly maintenance needs allowance for the lower 48 states remains $2,057.50 ($2,572.50 for Alaska and $2,366.25 for Hawaii) until July 1, 2019.

In determining how much income a particular community spouse is allowed to retain, states must abide by this upper and lower range. Bear in mind that these figures apply only if the community spouse needs to take income from the institutionalized spouse. According to Medicaid law, the community spouse may keep all her own income, even if it exceeds the maximum monthly maintenance needs allowance.

The new spousal impoverishment numbers (except for the minimum monthly maintenance needs allowance) take effect on January 1, 2019.

For a more complete explanation of the community spouse resource allowance and the monthly maintenance needs allowance, click here.

Home Equity Limits:

In 2019, a Medicaid applicant’s principal residence will not be counted as an asset by Medicaid unless the applicant’s equity interest in the home is less than $585,000, with the states having the option of raising this limit to $878,000.

For more on Medicaid’s home equity limit, click here.

Income Cap:

In order to qualify for Medicaid, a nursing home resident’s income must not be above a certain level. Most states allow individuals to spend down their excess income on their care until they reach the state’s income standard. But other states impose an “income cap,” which means no spend-down is allowed.

In 2019, the income cap in these states will be $2,313 a month.  For more on the income cap, click here.

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Reasons to Plan Other Than Money

Did you know that estate planning is about more than just stuff?

Rights to Manage Your Affairs       

Designate who will manage your legal, financial, and healthcare affairs if you can’t.  If you don’t, then a court will appoint somebody.  You deserve to control your own destiny.

Healthcare

Part of estate planning is setting up your Healthcare Power of Attorney for medical decisions.  Without this document, even your spouse can’t speak for you if you are unconscious or otherwise incapable (like on heavy doses of pain killers) of making medical decisions on your own.

Without a Medical Information Release (HIPAA Waiver), doctors and other healthcare workers can’t speak to anybody about your condition or treatment.

Court

Without a Durable Power of Attorney and Healthcare Power of Attorney, you family will have to go get a court order in order to manage your financial, legal, and healthcare affairs.

Children

If you have children under 18, you need to name guardians for them in a Last Will and Testament.  If you don’t then the Probate Judge has no guidance from you on who you wanted.  Even if you are divorced, you should name a guardian.

If you have special needs children, they deserve special planning to provide for them, protect them, and protect their benefits.

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Breaking News

Failing to have a will is one of the worst financial mistakes you can make

Failing to have a will is one of the biggest errors you can make when it comes to personal finances, according to CBS News business analyst Jill Schlesinger. It’s one of the topics she discusses in her new book, “The Dumb Things Smart People Do With Their Money.”

Click Here to Read More

https://www.cbsnews.com/news/failing-to-have-a-will-is-one-of-the-worst-financial-mistakes-you-can-make/

2017 Miss Teen Universe dies at 20 after suffering heart attack

Lotte van der Zee, a Dutch model who was 2017 Miss Teen Universe, has died after suffering from cardiac arrest, her parents posted on Instagram. She was 20.

Click Here to Read More

https://www.cbsnews.com/news/lotte-van-der-zee-has-died-dutch-model-and-2017-miss-teen-universe-was-20-cause-of-death-cardiac-arrest-2019-03-09/

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Guns and Dementia: Dealing With A Loved One’s Firearms

Having a loved one with dementia can be scary, but if you add in a firearm, it can also get dangerous. To prevent harm to both the individual with dementia and others, it is important to plan ahead for how to deal with any weapons.

Research shows that 45 percent of all adults aged 65 years or older either own a gun or live in a household with someone who does. For someone with dementia, the risk for suicide increases, and firearms are the most common method of suicide among people with dementia. In addition, a person with dementia who has a gun may put family members or caregivers at risk if the person gets confused about their identities or the possibility of intruders. A 2018 Kaiser Health News investigation that looked at news reports, court records, hospital data and public death records since 2012 and found more than 100 cases in which people with dementia used guns to kill or injure themselves or others.

The best thing to do is talk about the guns before they become an issue. When someone is first diagnosed with dementia, there should be a conversation about gun ownership similar to the conversation many health professionals have about driving and dementia. Framing the issue as a discussion about safety may help make it easier for the person with dementia to acknowledge a potential problem. A conversation about guns can also be part of a larger long-term care planning discussion with an elder law attorney, who can help families write up a gun agreement that sets forth who will determine when it is time to take the guns away and where the guns should go. Even if the gun owner doesn’t remember the agreement when the time comes to put it to use, having a plan in place can be helpful.

What to do with the guns themselves is a difficult question. One option is to lock the weapon or weapons in a safe and store the ammunition separately. Having the guns remain in the house–even if they are locked away–can be risky. Another option is to remove the weapons from the house altogether. However, in some states, there are strict rules about transferring gun ownership, so it isn’t always easy to simply give the guns away. Families should talk to an attorney and familiarize themselves with state and federal gun laws before giving away guns.

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Planning to Avoid Pain

You know that touching a red-hot stove burner hurts and it’s not something you would do.

Would you knowingly do something to cause you and your loved ones pain and hassles?

If you could do something to save them from unnecessary hassles and discomfort, would you?

Not having any estate plan can cause pain and hassles for you and your loved ones.

How bad can it be if you don’t have a plan?

Probate and Your Family

You can’t take it with you. If you don’t have a plan, the State has made one for you and their plan decides who gets what, how much, and when.

• Your final affairs will be overseen by an impersonal Judge in Probate Court – on the Public Record
• The State has already decided who gets how much and when. You’ll lose control of your final affairs.
• Your family just wants to quickly transfer the property, but Probate is an expensive, time-consuming hassle
• Your family will have the strain of Probate Court on top of the strain of losing a spouse or parent.
• It will take at least 8 months to get done and involves multiple steps that have to be done in the right order

With proper planning

• Probate is avoided
• Your family gets a quick distribution
• Your heirs are protected
• Your and your family’s private affairs remain private

Incapacity

While not something we want to think about, who will mange your affairs if you can’t?

Who will have the legal authority to manage your affairs if you can’t?

Who in your family will have to step up and go to court and get a guardianship if you don’t plan?

If your spouse has dementia or can’t manage their affairs, who will help them out if you can’t?

Without a plan, your family will require a court order to manage your affairs. If they are dependent on you, will they be able to legally access the funds they need?

With proper planning, you decide who that is, and nobody must go to court and get a guardianship order. You avoid hardships on you and your family by being prepared.

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Window Closing for Couples to Use ‘Claim Now, Claim More Later’ Social Security Strategy

Spouses who are turning full retirement age this year are the last group who can choose whether to take spousal benefits or to take benefits on their own record. The strategy, used by some couples to maximize their benefits, will not be available to people turning full retirement age after 2019.

The claiming strategy — sometimes known as “Claim Now, Claim More Later” — allows a higher-earning spouse to claim a spousal benefit at full retirement age by filing a restricted application for benefits. While receiving the spousal benefit, the higher-earning spouse’s regular retirement benefit continues to increase. Then at 70, the higher-earning spouse can claim the maximum amount of his or her retirement benefit and stop receiving the spousal benefit. To use this strategy, the lower-earning spouse must also be claiming benefits. Workers cannot claim spousal benefits unless their spouses are also claiming benefits.

A 2015 budget law began phasing out the strategy. If you were 62 or older by the end of 2015, you are still able to choose which benefit you want at your full retirement age. You do not have to make the election in the year you turn full retirement age. If your spouse is still working, you can wait to collect benefits until your spouse begins collecting. For example, if your spouse does not begin collecting benefits until you are 68, you can wait to collect benefits and file a restricted application at age 68. However, when workers who were not 62 by the end of 2015 apply for spousal benefits, Social Security will assume it is also an application for benefits on the worker’s record. The worker is eligible for the higher benefit, but he or she can’t choose to take just the spousal benefits and allow his or her own benefits to keep increasing until age 70.

The budget law’s phase-out of the claiming strategy does not apply to survivor’s benefits. Surviving spouses will still be able to choose to take survivor’s benefits first and then switch to retirement benefits later if the retirement benefit is larger.

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Picking the Right Estate Planning Attorney for You

Choose an attorney who specializes in estate planning.  

Other attorneys simply don’t have the knowledge, skill, judgment or experience to plan your estate properly.

Choose an attorney you trust. 

Nothing is more important in a lawyer/client relationship than having a lawyer you trust.

Choose an attorney who creates your estate plan himself. 

If the attorney has an assistant create your estate plan, then why hire the attorney?  Note, it’s not uncommon for lawyers in solo practice to ask a funding coordinator to transfer property into your trust.  Even so, funding is a fairly routine function and you are well protected as long as the lawyer supervises the process.

Choose an attorney who provides excellent service.  

Anything less is not acceptable.

Choose an attorney who welcomes your questions

Who structures meetings by allowing enough time to answer your questions.  High-volume practices have short appointments so they can move clients quickly through the process.  I don’t know about you, but this is not the level of service I expect when I hire a lawyer.

Choose an attorney who will return your phone calls quickly.  

You should never hire a lawyer who won’t respond promptly to your needs.

Choose an attorney who has roots in the community.  

This attorney cares about his reputation and is more likely to be available in the future when you need help.

Choose an attorney who is a respected source of information

One who has dedicated his practice to helping people understand their estate planning alternatives.

Choose an attorney who charges fair fees. 

At best, you get what you pay for.  Most people do not shop for the cheapest doctor.  Instead, they focus on the doctor’s qualifications and experience.  You should apply the same principle when selecting an estate planning attorney.  If the fee is too low, the lawyer may be leaving something out.  Make sure the fee you pay and the services you receive are of equal value.

Choose an attorney who offers free initial consultations. 

Shouldn’t you be able to talk with the lawyer for free before you decide whether to hire him?

Also, ask specific questions about your estate and your objectives, such as:  “How do I protect my children from abusive relatives if something happens to me?”  “Can I keep my kids from controlling their entire inheritance at age 18?”  “Can I protect my children’s money from creditors?”  “How can I leave money for my child’s education?”

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Why do I Need a Power of Attorney?

What is a Power of Attorney?

A power of attorney is a legal document in which you name somebody else (agent or attorney-in-fact) to manage your legal and financial affairs for you.  You can limit the power or make it unlimited.  You can also set a time limit or other conditions which make the power of attorney inactive.

Why a Power of Attorney?

Military Deployment

Before deploying for military service, you will want to sign a power of attorney so your family or spouse can take care of your local financial and legal affairs.  Without this, your family may not be able to do simple things like renew your care insurance.

Travel

If you travel frequently for your work, you will want a power of attorney for the same reasons as somebody on active military deployment.  Your spouse or family should be able to handle your local affairs.

Preventative

You should have a power of attorney on file in case of sudden mental incapacity.  This isn’t the same as dementia.  This would be in the case of an accident or healthcare incident like a stroke or heart attack.  You can setup a power of attorney so that it is only active after your incapacity, not before.

 

 

 

 

 

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Can I Give My Kids $15,000 a Year?

If you have it to give, you certainly can, but there may be consequences should you apply for Medicaid long-term care coverage within five years after each gift.

The $15,000 figure is the amount of the current gift tax exclusion (in 2019), meaning that any person who gives away $15,000 or less to any one individual in one particular year does not have to report the gift to the IRS, and you can give this amount to as many people as you like. If you give away more than $15,000 to any one person in a single year (other than your spouse), you will have to file a gift tax return. However, this does not necessarily mean you’ll pay a gift tax. You’ll have to pay a tax only if your reportable gifts total more than $11.4 million (2019 figure) during your lifetime.

Many people believe that if they give away an amount equal to the current $15,000 annual gift tax exclusion, this gift will be exempted from Medicaid’s five-year look-back at transfers that could trigger a waiting period for benefits. Nothing could be further from the truth.

The gift tax exclusion is an IRS rule, and this IRS rule has nothing to do with Medicaid’s asset transfer rules. While the $15,000 that you gave to your grandchild this year will be exempt from any gift tax, Medicaid will still count it as a transfer that could make you ineligible for nursing home benefits for a certain amount of time should you apply for them within the next five years. You may be able to argue that the gift was not made to qualify you for Medicaid, but proving that is an uphill battle.

If you think there is a chance you will need Medicaid coverage of long-term care in the foreseeable future, see your elder law attorney before starting a gifting plan.

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Elder Law Attorney – What do they do?

Types of Power of Attorney

What is a Power of Attorney?

Simply put, a power of attorney is a document (contract) that allows somebody else to do business for you and make decisions for you. It is written authorization to represent a person or act for them in private matters without the need for a guardianship.

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Medicaid Home Care

Traditionally, Medicaid has paid for long-term care in a nursing home, but because most individuals would rather be cared for at home and home care is cheaper, all 50 states now have Medicaid programs that offer at least some home care. In some states, even family members can get paid for providing care at home.

Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers care in a nursing home for those who qualify. Medicaid home care services are typically provided through home- and community-based services “waiver” programs to individuals who need a high level of care, but who would like to remain at home.

Medicaid’s home care programs are state-run, and each state has different rules about how to qualify. Because Medicaid is available only to low-income individuals, each state sets its own asset and income limits. For example, in 2019, in New York an applicant must have income that is lower than $845 a month and fewer than $15,150 in assets to qualify. But Minnesota’s income limit is $2,250 and its asset limit is $3,000, while Connecticut’s income limit is also $2,250 but its asset limit is just $1,600.

States also vary widely in what services they provide. Some services that Medicaid may pay for include the following:

In-home health care
Personal care services, such as help bathing, eating, and moving
Home care services, including help with household chores like shopping or laundry
Caregiver support
Minor modifications to the home to make it accessible
Medical equipment

In most states it is possible for family members to get paid for providing care to a Medicaid recipient. The Medicaid applicant must apply for Medicaid and select a program that allows the recipient to choose his or her own caregiver, often called “consumer directed care.” Most states that allow paid family caregivers do not allow legal guardians and spouses to be paid by Medicaid, but a few states do. Some states will pay caregivers only if they do not live in the same house as the Medicaid recipient.

To find out your Medicaid home care options, you should check with your elder law attorney.

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