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Further Thoughts on Long-Term Care Insurance

Monday, March 17th, 2014

Our recent post (see below) entitled, “Is Long-Term Care Insurance Worth the Cost?” has generated a lot of discussion.

We’d like to clarify a few points:

  • Long Term Care (LTC) insurance pays for expenses associated with chronic illnesses, such as home care, assisted living and nursing homes. On a long-term basis, these expenses are not covered by Medicare, which covers mainly short term rehabilitation.
  • In many cases, long-term care insurance enables policy holders to protect their financial assets.
  • Premiums for LTC insurance are based on a variety of factors, including the person’s age, health, medical history and policy benefits.  The earlier you buy, the less expensive the policy will be.

Whether and when a particular individual should purchase a LTC policy is a complex issue and the answer to the question posed in the original post can differ by individual, age, family situation, income and assets.  There really is no bright line test. LTC insurance should be considered by all as part of the estate planning process.

Before purchasing a LTC  policy:

  • Familiarize yourself with the benefits as well as the limitations
  • Have a thorough understanding of your financial situation and goals

Work with a reputable agent who specializes in LTC insurance.  In addition, speak to an elder law attorney and discuss the terms of the policy, the costs, the associated benefits as well as the financial strength of the insurer.

 

Is Long-Term Care Insurance Worth the Cost?

As the cost of a nursing home stay has increased, so has the cost of long-term care insurance, causing many seniors to reassess the value of such insurance.

Many people’s financial planning for retirement includes a combination of Social Security retirement benefits, other sources of income such as a pension, and savings and investments. On the expenses side, many costs are stable and predictable, with one serious risk being the need for nursing care for a long period of time. Since the annual cost of care in an Alzheimer’s unit can reach $100,000 or more, it is no wonder that many consider long-term care insurance. However, it is important to think about whether such protection is right for you.

First, keep in mind that many nursing home stays are not covered by such policies. Most long-term care policies do not cover the first 90 days, and two-thirds of nursing home stays are for less than 90 days, so insurance will not help at all in these cases. In the case of an extended stay, many policies will cover only a certain dollar amount and only for the period of time covered, often three years.

For many seniors entering a nursing home for an indefinite stay, Medicare will provide for the cost, with assets being used to offset the cost until they are exhausted, when Medicaid will kick in. Therefore, for a single person with no heirs, long-term care insurance may not be necessary. For a married couple, if one spouse requires an extended stay in a nursing home, the healthy spouse may keep the house, one vehicle, and assets of about $116,000 (the amount varies by state), and still qualify for Medicaid for the nursing home expenses.

One view is that long-term care insurance may be unnecessary either if a couple’s assets are less than $116,000 exclusive of the home and one vehicle, such that they will be eligible for Medicaid, or if assets are above about $700,000, in which case the couple can probably self-fund a nursing home stay. Within that window between roughly $116,000 and $700,000, long-term care insurance may be useful.

 

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How Divorce and Remarriage Affect Social Security Retirement Benefits

Tuesday, March 11th, 2014

People considering divorce as their 10-year wedding anniversary approaches should know that delaying the split until after the decade mark can result in higher Social Security retirement benefits for a spouse with a lower earning record.

Taking the example of a divorced couple where the ex-husband had a higher earnings record, if the couple was married for 10 years or more, then the ex-wife can receive higher benefits based on his record, provided she is age 62 or older and has not remarried.

Even if the ex-husband has not applied for retirement benefits, the ex-wife may receive benefits based on his record, provided they have been divorced for more than two years. If the woman remarries, then she would no longer be able to collect the benefits unless the later marriage ends.lawyer-or-notary-with-cl

Recent years have seen a rise in both marriages and divorces later in life, and statistics suggest that divorcing couples may take retirement benefits into account, as there is a measurable increase in divorce after the 10-year mark. As might be expected, the effect is most pronounced for couples nearing retirement age. A recent study found that for people 55 and older, there is an 11.7 percent increase in the likelihood of divorce at about the decade mark. For couples age 35 to 55, that drops to a 6 percent increase in likelihood of divorce at 10 years, and for people under age 35, there is almost no effect.

Other researchers are skeptical that many people take retirement benefits into account in their divorce decisions, pointing to studies that show that only 13 percent of people are very knowledgeable about how Social Security benefits are calculated.

Whether divorcing couples currently consider retirement benefits in timing their divorce, many advisers agree that they should. Divorcing just short of the 10-year mark could result in thousands of dollars in lost benefits, so it may be worthwhile for some to delay the process.

Financial considerations are often part of making decisions about divorce, so it is important to be aware of how Social Security benefits can be affected.

 

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Retirement Benefits: How Social Security, Medicare and Retirement Accounts Change in 2014

Thursday, January 30th, 2014

Medicare, Social Security retirement benefits, and individual retirement accounts all change in small but important ways in 2014, and people too young for Medicare will have new health insurance options. Here is what is changing.

First, thanks to the Affordable Care Act, people retiring before age 65 can now purchase health insurance on the new state health insurance exchanges. People can no longer be denied health insurance because of a pre-existing condition, and subsidies may be available for low and middle income earners.

For people on Medicare, the Part D prescription coverage gap has lessened in effect. Once a Medicare beneficiary has spent $2,850 on medication, then there is a gap until catastrophic coverage kicks in after $4,550 in costs for medication. In that gap, beneficiaries were required to pay 79 percent of drug costs, but that decreases to 72 percent in 2014.

Social Security benefits go up by 1.5 percent in 2014, due to the annual cost-of-living increase. The average increase will be $19 per month for individuals and $31 per month for couples who are both receiving benefits.

Social Security taxes increase for some in 2014. Workers usually pay 6.2 percent of their income into the system until they reach the $113,700 tax cap for the year. For 2014, that cap rises to $117,000.

Finally, the income limits for those eligible to contribute to individual retirement accounts (IRAs) and 401(k)s have increased. Investors who have workplace 401(k)s and also want an IRA can claim a tax deduction for IRA contributions until their adjusted gross income (AGI) reaches between $60,000 and $70,000, an increase of $1,000 over last year. For married couples, the income limits are now between $96,000 and $116,000. The income phaseout range for investors whose spouses have a 401(k) is up $3,000 from last year, to between $181,000 and $191,000. For Roth IRAs, the income phaseout range increased by $2,000, to between $114,000 and $129,000, or for married couples between $181,000 and $191,000.

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New Program Enlists Doormen to Watch for Elder Abuse

Friday, December 13th, 2013

A new program in New York City is training doormen who work in apartment buildings to watch for elder abuse.

The Harry and Jeanette Weinberg Center for Elder Abuse Prevention, part of the Hebrew Home at Riverdale, developed the program, which offers free training for doormen, porters, concierges and other building staff, at the building where they work.

Joy Solomon, the director of the Weinberg Center, said that many elderly people who were being abused did not come forward on their own, so advocates realized they would have to reach out to others who might be likely to spot the signs of abuse. The center has already helped to educate people such as estate lawyers, speech therapists, and those who deliver hot meals to seniors. Now building staff are being enlisted to help as well.

Many buildings in the city have a growing population of elderly residents. An analysis of census data by Queens College found that by 2040, an estimated 21 percent of adults in New York City will be age 60 or older, an increase from 17 percent in 2010.

At a training she led recently, Ms. Solomon told of an elderly resident of an Upper East Side apartment building, who was taken advantage of by a woman. Building staff witnessed the woman removing valuables from the man’s apartment, but did not step forward, perhaps because they did not want to overstep their bounds. Solomon said that when a staff member knows that something is wrong, it is important to take action. Several older apartment building residents said they would much prefer that building staff say something about a situation that does not appear right, rather than staying quiet out of a fear of prying into someone else’s business.

For elderly residents who do not have frequent visits from friends and family, a doorman may be the first person to notice an injury, signs of confusion, or other evidence that the person needs help.

Solomon said that the training would be provided initially to buildings with large populations of older people, but would eventually be available to anyone requesting it.

 

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Mobile Lifestyle Can Have A Legal Impact

Monday, June 17th, 2013

By Bernard A. Krooks, Esq.

Many New Yorkers have embraced a decidedly mobile lifestyle. They think nothing of seasonal migrations in search of temperate weather. Their families may be far-flung, prompting frequent out-of-state visits or they may be trying out a potential retirement spot. We account for the highest percentage of Florida’s temporary residents, often opting to call it home.

But while it’s simple to buy a plane ticket and have the mail forwarded, legal documents don’t always cross state lines so easily. Differences in state law can have big implications for estate planning and long-term care. In some cases, one jurisdiction may not even recognize documents drafted elsewhere due to differences in execution requirements. And you could face unexpected tax bills as governments struggle to fill their depleted coffers.

Generally speaking, spending 183 or more days per year in a location will make you subject to local residency requirements. If you maintain your legal residence in one state for purposes of voting and taxation, but spend significant time elsewhere, it pays to do some contingency planning.

At a minimum, you should discuss your residency situation when you meet with your attorney to review your will, trusts and other important estate planning instruments. It may be wise to consult an attorney in each state to ensure that you’re in compliance with all regulations and that you take full advantage of any favorable differences. I’ve had an increasing number of clients ask about the benefits of having attorneys collaborate across jurisdictions. Parents had begun spending more time in Florida, or due to frailty, were moving back to New York to be closer to family, and they didn’t want to suddenly discover that careful estate planning had been rendered invalid.

While a well-drafted trust can stipulate that it be administered according to the laws of the originating state, it may not be advisable to have one state interpret the statutes of another. Other documents may prove even more challenging. An advance directive can become entangled by something as seemingly trivial as the number of witnesses to your signature. As a result, doctors and hospitals may fail to respect living wills or health care proxies. Banks may not recognize financial powers of attorney. The result could be chaos when you’re least prepared to cope.

Probate, the procedure through which property is transferred to heirs, poses more questions. This process typically takes place where the decedent was domiciled, but if real estate is owned in more than one state, probate must be initiated in each location, possibly involving different deadlines. Even if the decedent was legally resident elsewhere, states have been known to claim estate taxes when local ties were extensive enough.

Over 70 percent of New York nursing home expenses end up being covered by Medicaid, but eligibility and covered services vary by state. So it pays to understand how to navigate the system where ever you or your parents plan to spend your senior years. In addition, there’s growing interest in “filial responsibility” loans, under which adult offspring could be held accountable for the older generation’s expenses. So if Mom or Dad suddenly requires nursing home care that isn’t covered by Medicaid-even for a few months- a son or a daughter could suddenly become liable for huge bills. While New York does not currently hold adult children liable for their parents’ nursing home costs, in a recent case in Pennsylvania, a court held an adult son responsible for his mom’s nursing home expenses.

Since Florida has no state income tax, it could be tempting to declare yourself a resident if you pass the 183-day test, but New York is particularly aggressive about claiming taxes from individuals with connections here. You need to take steps to relinquish your New York residency, including the divestiture of real estate holdings. New York residency audits are on the increase, and you’ll bear the burden of proof, including documentation of how long you’ve spent where. Failure to present a compelling case could leave you responsible for state taxes.

Don’t let legal snarls complicate your chosen lifestyle. A second home and carefree travel are often the fruit of a lifetime’s effort. With a little research and planning, you can avoid untimely complications.

 

For more information, visit www.elderlawnewyork.com.

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When Medicare Covers Nursing Home Care

Tuesday, May 28th, 2013

Many Americans of various income levels expect to make use of Medicare for health care costs after age 65. However, it is important to note that Medicare does not pay for care at a nursing facility except in certain circumstances.

First, let’s review what Medicare does cover. Medicare Part A covers care in a hospital and Part B covers outpatient services. For these benefits, there is a choice between traditional Medicare or a network plan, Medicare Part C or Medicare Advantage, in which the government pays for private coverage. Finally, Medicare Part D covers outpatient prescription medications.

So where does nursing home care fit in? Nursing home care is only covered for a limited time if it is necessary after a hospital stay. If a patient is hospitalized for three consecutive days or more and is then admitted to a nursing home within 30 days and a doctor certifies that the patient needs care that can only be provided on an inpatient basis at a nursing facility, then Medicare will cover a stay of up to 100 days. Only facilities approved by the Centers for Medicare and Medicaid Services (CMS) can be covered. If the stay lasts longer than 100 days, then patients are expected to pay for the care out-of-pocket until the point that they become eligible for Medicaid.

The rules above are confusing enough, but their interpretation can get even more complicated. Some families have been denied Medicare coverage for a nursing home stay because the hospital deemed their stay an “observation” rather than an “admission.” In other cases, because a hospital day is usually measured as midnight-to-midnight, patients may believe they have been in the hospital for three days, but find that the hospital measures their stay as less than three days.

To monitor Medicare charges, CMS employs private contractors who receive contingency fees based on the overcharges that they discover, so they are motivated to deny coverage whenever they can.

For a doctor to certify that treatment in a skilled nursing facility is required, the patient must need rehabilitation services for at least five days a week, or skilled services for seven days a week. Services such as, for instance, tube feedings would qualify for nursing home admission. Other services, such as rehabilitation services that could be given 3 or 4 times a week on an outpatient basis, would not be covered.

Even if Medicare covers a nursing home stay, there is only full coverage for the first 20 days. After that, a co-payment is required. These co-payments, and the cost of a nursing home after 100 days, may be covered by Medicare supplemental insurance, if the patient has such insurance and submits a claim.

Many middle-class families, facing the prospect of seeing an older loved one’s life savings consumed by nursing home costs, are turning to trust planning to protect their assets while still allowing them to be eligible for Medicaid. An elder law or estate planning attorney can create a trust for an older person to transfer assets, thus reducing the person’s wealth level enough to become eligible for Medicaid. Another strategy for dealing with nursing home and other long-term health care costs is long-term care insurance. With proper planning, families can manage the costs of a stay in a nursing home.

 

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New York Medicaid and Medicare Part D: Working Together

Wednesday, May 8th, 2013

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.”

While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in New York must receive their prescription drugs via Medicare Part D.

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each  medication. If an individual has full Medicaid coverage and resides in a nursing home, he or she will not be required to pay anything for covered prescription drugs.

Medicare’s State Pharmacy Assistance Program (SPAP) for prescription drug coverage is determined by each state.  New York State’s Medicare’s State Pharmacy Assistance Program may determine that a patient should receive additional coverage when they join the Medicare Prescription Drug Plan, or may require the patient to enroll in a separate state program for prescription payment assistance.

Clients of New York Regular Medicaid must receive health care services through their managed care plan. Regular Medicaid in New York is available to single adults, childless couples at lower income levels, caretaker adults, the elderly, the disabled, and children, subject to some restrictions. Regular Medicaid may also provide retroactive coverage.

 

For more information, visit www.elderlawnewyork.com.

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Medicaid Patients Could Face Higher Costs

Tuesday, March 5th, 2013

The Obama administration is trying to convince states to expand Medicaid, but a proposed policy intended to make that easier may result in millions of people paying more for health insurance.  The policy would allow states to charge higher premiums and co-payments for medical services, including prescription medicine and “nonemergency use” of hospital emergency departments.

As a result of the health care law passed in 2010, Medicaid was extended to adults without children and other people who had not been eligible before, but the Supreme Court ruled that the expansion was optional for states.  The administration is encouraging states to take that option by making it easier for states to charge patients more and thus hold down the cost to states.  Under the proposed policy, a three-person family with a $30,000 yearly income could pay up to $1,500 in co-payments and premiums.

Critics contend that it will be difficult for low-income families to bear the extra cost, and that the “nonemergency use” of emergency services is not well-defined.  Medicaid patients may have a reasonable belief that a particular condition constitutes an emergency, but this may not be borne out in the diagnosis.

Approximately 60 million people are covered by Medicaid, and that is expected to increase by more than 11 million as new patients qualify under the 2010 health care law.  More than half of Medicaid costs are paid for by the federal government, and it will pay an even greater share for the newly eligible patients.

For more information, visit www.elderlawnewyork.com or www.littmankrooks.com.

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Some New York Nursing Home Evacuees Still Displaced

Tuesday, February 5th, 2013

After Hurricane Sandy, hundreds of disabled and elderly New Yorkers were evacuated from assisted living facilities and nursing homes near the coast.  Now, more than two months after the storm hit, some evacuees are still getting by in temporary quarters.

The evacuees were moved to places like Brooklyn’s Bishop Henry B. Hucles Episcopal Rehabilitation and Skilled Nursing Center.  The center was already operating at capacity before the storm hit and is now packed with more than twice the number of residents it is licensed to care for.  One hundred ninety patients from the Rockaway Care Center in Queens, which flooded due to the storm, have had to sleep on cots in multi-purpose rooms and in the center’s chapel.

About 160 residents of an assisted living facility in Queens called Belle Harbor Manor had to be evacuated to the grounds of the Creedmor Psychiatric Center, a partly-unused mental health facility.  The evacuees complained of being mixed in with patients suffering from severe mental disorders, and losing freedoms such as the ability to have visitors in their rooms.

According to New York’s Health Department, more than 6,200 people were evacuated from 47 different nursing homes and assisted living facilities as a result of Hurricane Sandy, and storm damage has meant that about a dozen were still closed two months later, with others only able to accept a limited number of residents back.

The majority of patients were evacuated after the storm, under flood conditions, and were unable to bring extra clothing and personal belongings.

Officials said it may be weeks before facilities with some of the worst flood damage are able to re-open.

For more information about our elder law services, visit www.elderlawnewyork.com.

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Elder Law Attorney Bernard A. Krooks to Speak at Heckerling Institute

Monday, January 7th, 2013

White Plains, New York (January 10, 2013) – Bernard A. Krooks, Esq., a founding partner of Littman Krooks LLP, will be a guest speaker at the 47th Heckerling Institute on Estate Planning on January 14, 2013, at the Orlando World Center Marriott Resort and Convention Center, in Orlando, Florida.

Mr. Krooks will be speaking about the “graying” of Baby Boomers and their need for elder law services. Mr. Krooks will also discuss “Later Life Law” and how elder care attorneys can assist their clients with Medicaid options as well as other areas of elder care planning including retirement accounts, long-term care insurance and tax considerations and the use of trusts in elder law and special needs planning.

The Heckerling Institute on Estate Planning is known as the premiere U.S. conference for estate planning professionals, including attorneys, accountants, trust officers, insurance advisors and wealth management professionals. The program offers lectures and special sessions with comprehensive coverage of estate planning techniques and strategies, designed to allow attendees to customize their educational experience.

Mr. Krooks has been included among The Best Lawyers in America® for each of the last six years. He has been selected as a “New York Super Lawyer” since 2006. Krooks has received his AEP accreditation from the National Association of Estate Planners & Councils. He is a member of the Real Property, Probate & Trust Law Section and Tax Section of the American Bar Association. He is a sought-after expert on estate planning and elder law matters and has been quoted in leading publications such as The Wall Street Journal, The New York Times and Forbes, among others.

About Littman Krooks

Littman Krooks LLP provides sophisticated legal advice and the high level of expertise ordinarily associated with large law firms along with the personal attention and responsiveness of smaller firms. These ingredients, which are the cornerstone of effective representation and are necessary to a successful lawyer/client relationship, have become the foundation of the firm’s success.

Littman Krooks LLP offers legal services in several areas of law, including elder law, estate planning, special needs planning, special education advocacy, and corporate and securities. Their offices are located at 399 Knollwood Road, White Plains, New York; 655 Third Avenue, New York, New York; and 300 Westage Business Center Drive, Fishkill, New York. Visit the firm’s website at http://www.elderlawnewyork.com.

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