Elder Care

PLANNING FOR MEDICAL ASSISTANCE

Planning for Medical Assistance, including Preservation/transfer of assets seeking to avoid spousal impoverishment when a spouse impoverishment when a spouse enters a nursing home.

Special Needs Trust and planning for receipt of assets by SSI and Medicaid recipients, including personal injury awards.

Coordination of long term care insurance with assets protection plans.

Disability planning, including proper use of Powers of Attorney, Trusts, Advance Directives (“living wills”) and other means of delegating management and decision-making to another in case of incapacity.

Estate planning, including planning for the management of one’s estate during life and its disposition on death through the use of trusts, wills and other planning documents.

Probate and probate avoidance.

Administration and management of trusts and estates.

Long-term care placements in nursing home and life care communities.

Nursing home issues including questions of patient’s rights and nursing home quality.

NEVER admit anyone to a nursing home without reviewing the inspection history of the facility at Medicare.gov.

NEVER sign as Admission Agreement or Care Contract without a Health Care Power of Attorney!

NEVER apply for Medical Assistance unless you are eligible!

NEVER apply for Medical Assistance without understanding Estate Recovery!

NEVER let a nursing home apply for Medicaid on your behalf!

NEVER purchase a “life care” contract or long-term care and insurance without considering the impact of public benefits.

NEVER surrender your health insurance or admission to a nursing home. In fact you should consider upgrading!

Never, if you are married, apply for or let a nursing home apply for Medical Assistance without thoroughly understanding your rights as a spouse!

NEVER gift money or change the title for your home or other assets without understanding the Deficit Reduction Act.

The $13,000 yearly gift limit does NOT apply.

Be an informed applicant and not a victim; find out what you should ALWAYS do for your loved one and your family.

Veterans Benefits are available to those individuals who entered and served in the United States Armed Services, as well as to their Dependents and Survivors. These benefits are made available through the United States Department of Veterans Affairs (VA). The benefits available include:

Health Care Benefits: Administered by the Veterans Health Administration (VHA), a branch of the VA, the Veterans Health Administration is America’s largest integrated health care system with over 1,700 sites of care, serving 8.3 million Veterans each year.

Vocational Rehabilitation and Employment: The Vocational Rehabilitation and Employment (VR&E) Program is authorized by Congress under Title 38, USC, Chapter 31 and Code of Federal Regulations, Part 21. It is sometimes referred to as the Chapter 31 program. This program assists Veterans with service-connected disabilities to prepare for, find, and keep suitable jobs. For Veterans with service-connected disabilities so severe that they cannot immediately consider work, this program offers services to improve their ability to live as independently as possible.

VA Pensions: Compensation and Pension programs provide direct payments to Veterans, dependents, and survivors as a result of the veteran’s service-connected disability or because of financial need.

Education and Training: Education Programs provide resources to Veterans, servicepersons, reservists, and certain Veterans’ dependents to help with readjustment and restore educational opportunities lost because of service to the country, to extend benefits of higher education to qualified persons who may not otherwise be able to afford it, to aid in military recruitment and the retention of highly qualified personnel, to encourage membership in the Selected Reserve, and to enhance the national workforce.

Home Loan Guaranty: The Loan Guaranty Program provides assistance to Veterans, certain spouses, and service members to enable them to buy and retain homes. Assistance is provided through VA’s partial guaranty of loans made by private lenders in lieu of the substantial down payment and private mortgage insurance required in conventional mortgage transactions. This protection means that in most cases qualified Veterans can obtain a loan without making a down payment.

VA Life Insurance: The Insurance Programs were created to provide life insurance at a “standard” premium rate to members of the armed forces who are exposed to the extra hazards of military service. Veterans are eligible to maintain their VA life insurance following discharge. In general, a new program was created for each wartime period since World War I.

Transition Assistance: A joint effort between the VA, Department of Defense, and the Department of Labor’s Veterans’ Employment and Training Service, the Transition Assistance Program allows veterans to make the transition back to the civilian section a smooth one.

Dependents and Survivors Health Care: The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) allows certain dependents and survivors to receive reimbursement for most medical expenses – inpatient, outpatient, mental health, prescription medication, skilled nursing care and durable medical equipment.

Additionally, there are benefits offered by other Federal agencies. For example, the Internal Revenue Service allows for disabled veterans to claim a federal tax refund based on an increase in the veteran’s percentage of disability from VA, or the combat-disabled veteran applying for, and being granted, Combat-Related Special Compensation, after an award for Concurrent Retirement and Disability. There are numerous other benefits provided by other Federal agencies, which may or may not apply to you based on your particular set of circumstances.

If you are a veteran, we appreciate your service. Additionally, we want to make certain that you can maintain and keep the benefits you earned by defending our freedoms. Contact us today if you would like to evaluate all of your benefits and make certain that you and your loved ones continue to receive them into the future.

We spoke with our colleague, Mr. Jason Eichmiller, branch manager of Equity Loans, LLC, to describe a Reverse Mortgage. Rather than adapt what he said, we’ll present Mr. Eichmiller’s comments here:

Seniors are having a tough time in today’s economy. Oftentimes, fixed income isn’t enough to pay the bills and live comfortably. All of our taxes, grocery and gas bills increase, but fixed income stays, well, fixed. One option that senior homeowners use to make their lives easier is a reverse mortgage.

HECM Reverse Mortgages are federally insured programs for homeowners who are 62 and older. They allow seniors to access part of their home’s equity in tax-free cash, without requiring them to make monthly mortgage payments (however they are required to pay taxes and homeowners insurance). Income and credit score are not qualifying factors; just age and equity. In a nutshell, the older the senior, the more cash they qualify for and vice versa. Homeowners can access their funds as monthly income, a lump sum, line of credit or any combination of the three. The senior stays on the deed, has full ownership of the home, and will pass the property down to his or her heirs.

Seniors have used reverse mortgages to catch up on taxes and pay for in-home care or home modifications. Reverse mortgages can pay off foreclosures, settle bankruptcies, or as a debt relief strategy to pay off unsecured loans like credit cards. The reverse mortgage credit line, which is similar to a home equity line of credit, has a growth feature that some seniors use as a retirement strategy. Surviving spouses can take advantage of the reverse mortgage program as well. If a husband passes away and the wife wants to stay in the home, a reverse mortgage can supplement her income to a point where she can comfortably do so.

Reverse mortgages are not for everyone. Qualifying requires a sufficient amount of equity, and thus not everybody qualifies. There are fees involved, but the majority can usually be financed into the loan amount. In addition, the reverse mortgage can immediately become due if the homeowner permanently leaves the home, does not pay property taxes and homeowners insurance or does not keep up the home’s condition. With this said, a reverse mortgage is a program that scores of seniors are learning about. If this is something that you would like to explore or you would like more information, I would be glad to help.

Medicare is designed in the United States so that, once you become eligible to receive Medicare benefits, whether by reaching the age of 65 or by being a younger person who is approved due to disability or other reason, you will automatically be enrolled in Medicare Part A. Before we go any further, we should describe and define the various parts of Medicare.

Part A: Hospital insurance covering inpatient care, skilled nursing, and at home care. This has no premium attached to it, so long as you paid Medicare taxes while working.

Part B: medical insurance covering outpatient care, doctors’ visits, home health services, and durable medical equipment. There is a monthly premium attached to Medicare Part B, which can be automatically withdrawn from Social Security benefits.

Part C: Medicare Advantage plans, which bundle the services of Parts A & B into one package. There is a monthly premium, and you may also face out-of-pocket expenses.

Part D: Prescription Drug Coverage. This has a monthly premium.

As we said above, Part A of Medicare is automatic as soon as you’re eligible for it. You will have to elect to also receive Parts B or D, or if you’d like to enroll in an Advantage plan of Part C.

Medicare works as health insurance. As long as the facilities you visit accept Medicare, what will happen is that the doctor’s / hospital’s billing administrators will send the bills to Medicare. Medicare will then approve or disapprove of the services. If they approve, Medicare determines the value of the services provided, and will pay 80% of that value. The remaining 20% could be billed to you.

This is where a Medicare Supplement plan, or a “Medigap” plan, comes into play. If you have a supplement plan, you will not have to pay that 20% yourself. Instead, if you have a Medicare Supplement plan, once Medicare pays the 80%, they will pass on the remaining amount to the secondary insurance, to cover the remaining balance.

Medicare Supplement plans do precisely that—they supplement the Medicare coverage that you already have. While Medicare pays their normal 80%, the Supplement plan will cover the remaining 20%. The goal is that you won’t be responsible for the remaining 20% on your own, which, depending on what medical services are performed, could be very expensive. Instead, you can select a Medicare Supplement plan that will have a monthly fee that you pay, instead of having to pay a potentially large lump sum amount to a medical facility.

There are certain things to remember involving a Medicare Supplement plan. Many people describe Supplement plans as, “They pay what Medicare doesn’t.” In the strictest sense, that is true. The Supplement plan will pay the balance left behind when Medicare approves. But what this statement may falsely lead people to believe is that, if Medicare does not approve a medical procedure or service, that the Supplement plan will pay for it instead. This is not the case. A Medicare Supplement plan follows all Medicare guidelines. This means that a Supplement plan will only pay for services if Medicare first approves the charges involved. Medicare does not cover everything, and will not approve certain care, such as long-term, dental, hearing, and vision. There are separate plans that are available for those types of care, however. The general rule of thumb with a Supplement plan is that, if Medicare covers it, the Supplement plan will also cover it. But it’s best to check with Medicare first if you have any doubts if they’ll cover a particular service or procedure.

Two of the most popular providers of Medicare Supplement plans are from AARP Health, underwritten by United Healthcare, and Humana. Both companies offer plans that have differing levels of coverage and corresponding monthly premium payments. There are also plans that will combine both your Part A and Part B Medicare coverage along with Medicare Part D prescription drug coverage. These are not traditional Medicare supplements, however, and are instead called “Plus” or “Advantage” plans. They have different rules and requirements, and frequently have a “network” associated with them, requiring you to visit specific doctors and hospitals.

There are many options available. If you are in the market for a Supplement plan, you should consider the many different options available to you, and select a plan that fits your financial and medical needs.

What is Hospice care?

Hospice care is a type of care that focuses on relieving the pain and suffering of a terminally ill patient’s symptoms. It is an option for patients and families when curative treatment is no longer available, or no longer the patient’s choice. These symptoms can be physical, emotional, spiritual, or social in nature. The goal of hospice care is to focus on the patient, rather than the disease. Hospice care, therefore, also includes psychological and spiritual aspects, in addition to physical.

Hospice care has evolved from a volunteer movement, intended to improve the care of people dying alone or in hospitals to a significant part of the health care system. Modern hospice care provides care for the incurably ill in hospitals, nursing homes, but also provides care to those who would prefer to pass away in their own homes. Care can also be provided in places such as a hospice residence, assisted living facilities, and veterans’ facilities.

One of the most important tenets of hospice care is to improve the quality of life, when extending the length of life is no longer possible, or no longer the choice of the patient.

It is important to note that hospice care is not only for the elderly. Hospice is for all age groups during their final stages of life, including children and adults of all age groups. Additionally, hospice care extends to the family of the patient. The family unit is at the center of all decision making. Hospice recognizes that it takes many caregivers to meet the unique needs of each patient.

Hospice care is not about giving up, or waiting to die. It is not a form of physician-assisted suicide. Rather, hospice is about quality of life and comfort for a patient and their family. Hospice care does nothing to either speed up or slow down the dying process. Pain and symptom management will help the patient to feel better as they reach the end.

Who pays for Hospice care?

Hospice care is a covered service under Medicare Part A. If over the age of 65 and enrolled in Part A, hospice care will be covered. Additionally, hospice care is covered by Medicaid and most private insurance plans.

Additionally, many charities provide for hospice care. There may be organizations whose generous support may allow local hospices to provide care to patients and families regardless of their ability to pay.

What other services are available?

In addition to the care of the patient, many hospice services also provide for grief and bereavement support to the family. Many support groups are provided through hospice organizations, as well as other programs that help to honor and remember loved ones. Many programs are also specifically geared towards children, who may have a more difficult time adjusting to the loss of a loved one.

A funeral home, or funeral parlor, is a business that provides burial and funeral services for the deceased and their families. Services may include a prepared wake and funeral, and the provision of a chapel.

Funeral homes arrange services in accordance with the wishes of surviving friends and families. The funeral home often takes care of the necessary paperwork, permits, and other details, such as making arrangements with the cemetery or crematorium, and providing obituaries to the news media.

There are a few common types of services. A traditional funeral service consists of a viewing, or visitation, a funeral service in a place of worship or the funeral home chapel and a graveside committal service. Direct cremation consists of the funeral home receiving the corpse, preparing it for the crematory and filing the necessary legal paperwork. Direct/immediate burial is the foregoing of a funeral ceremony for a prompt, simple burial. Moving a corpse between mortuaries involves preparing it for shipment in a coffin strapped into an arbitrary or a combination unit. This is usually what happens someone is to be laid to rest in a different location than where that person passed away.

The funeral home often sets aside one or more large areas for people to gather at a visitation. This area may contain a space to display the body in a casket to visitors who may pay their respects. Funeral and memorial services may also take place at the funeral home. Many funeral homes offer prearrangement options for those who wish to prepare their own funerals.

At Planning Transitions, we partner with many Funeral Homes to help if you need to set a loved one to rest, or if you are interested in pre-paying your own funeral while still living. Contact us today if you are interested in either of these.