Estate Planning Blog Articles

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medicare

Will Medicare Cover Everything?

Actually, far from covering all your healthcare needs, Medicare may leave you with thousands of dollars in expenses for which you’ll be responsible.

The recent article in The Mooresville Tribune entitled “3 Reasons Medicare Coverage Isn’t as Comprehensive as You Think” provides three reasons why:

  1. Medicare has expensive deductibles and coinsurance. There are different parts to Medicare. Part A covers hospital care. Part B pays for outpatient care. Each one has deductibles and some coinsurance expenses. Let’s look at these examples:
  • Medicare Part A has a $1,408 deductible per benefit period this year. If you are in the hospital more than 60 days during a benefit period, you’ll owe coinsurance costs starting at $352 per day, based on how long you remain in care.
  • Part B has a $198 deductible in 2020, and you’ll pay coinsurance costs of 20% of the Medicare-approved amount for medical services after you meet the deductible. You’ll also owe monthly premiums.
  • Part C (Medicare Advantage) takes the place of traditional Medicare (Parts A and B) with private insurance. Coinsurance, copay and premium costs vary by plan.
  • Part D (prescription drug coverage) has several plans with varying premiums and coverage rules.

As a result, with only Parts A and B, you could wind up paying thousands of dollars out of pocket. That’s especially true, if you’re hospitalized for a long time during the year or if you need extensive outpatient care.

  1. Coverage exclusions. In addition, there are some items of care that Medicare doesn’t cover at all. For example, Medicare doesn’t cover routine dental care, eye exams, contacts, hearing aids or glasses.
  2. Medicare doesn’t cover long-term care in most circumstances. A major Medicare exclusion is long-term care insurance. Medicare covers care in a skilled nursing facility under a few circumstances, such as after a long hospital stay when you need assistance from a medical professional to recover. However, the program doesn’t pay for “custodial care,” either at home or in a nursing home. Thus, if you require someone to help you with routine aspects of daily living, like getting dressed, eating, or using the bathroom, you’ll have out-of-pocket costs.

It’s important to know that long-term care can be very costly. The median monthly costs of home health aides are roughly $4,300, and a semi-private room in a nursing home costs about $7,500 in 2019, according to Genworth. Since Medicare won’t pay for any of this in most circumstances, you’ll need another way to pay for it.

Don’t assume that Medicare will cover all your needs as a retiree. So, prior to retirement, examine what Medicare will actually cover. That will help you determine the amount you’ll need to save for healthcare costs. You can also consider Medigap or Medicare Advantage Plans or look into long-term care insurance.

Reference: Mooresville Tribune (Aug. 10, 2020) “3 Reasons Medicare Coverage Isn’t as Comprehensive as You Think”

visiting grandparent during pandemic

Visiting Grandma at the Nursing Home

In spots where visits have resumed, they’re much changed from those before the pandemic. Nursing homes must take steps to minimize the chance of further transmission of COVID-19. The virus has been found in about 11,600 long-term care facilities, causing more than 56,000 deaths, according to data from the Kaiser Family Foundation.

AARP’s recent article entitled “When Can Visitors Return to Nursing Homes?” explains that the federal Centers for Medicare and Medicaid Services (CMS) has provided benchmarks for state and local officials to use, in deciding when visitors can return and how to safeguard against new outbreaks of COVID-19 when they do. The CMS guidelines are broad and nonbinding, and there will be differences, from state to state and nursing home to nursing home, regarding when visits resume and how they are handled. Here are some details about the next steps toward reuniting with family members in long-term care.

When will visits resume? As of mid-July, 30 states permitted nursing homes to proceed with outdoor visits with strict rules for distancing, monitoring and hygiene. The CMS guidelines suggest that nursing homes continue prohibiting any visitation, until they have gone at least 28 days without a new COVID-19 case originating on-site (as opposed to a facility admitting a coronavirus patient from a hospital). CMS says that these facilities should also meet several additional benchmarks, which include:

  • a decline in cases in the surrounding community
  • the ability to provide all residents with a baseline COVID-19 test and weekly tests for staff
  • enough supplies of personal protective equipment (PPE) and cleaning and disinfecting products; and
  • no staff shortages.

Where visits are permitted, it should be only by appointment and in specified hours. In some states, only one or two people can visit a particular resident at a time. Even those states allowing indoor visits are suggesting that families meet loved ones outdoors. Research has shown that the virus spreads less in open air.

Health checks on visitors. The federal guidelines call for everyone entering a facility to undergo 100% screening. However, the CMS recommendations don’t address testing visitors for COVID-19.

Masks. The federal guidelines say visitors should be required to “wear a cloth face covering or face mask for the duration of their visit,” and states that allow visitation are doing so. The guidelines also ask nursing homes to make certain that visitors practice hand hygiene. However, it doesn’t say whether facilities should provide masks or sanitizer.

Social distancing. The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, but they don’t provide details. States that have permitted visits, state that facilities enforce the 6-foot rule.

Virtual visits. Another option is to make some visits virtual. Videoconferencing and chat platforms have become lifelines for residents and families during the pandemic. Continued use after the lockdowns can minimize opportunities for illness to spread.

Reference: AARP (July 22, 2020) “When Can Visitors Return to Nursing Homes?”

keep up spirits during the pandemic

How Do I Keep Up My Spirits in the Pandemic?

The coronavirus has created some stressful situations that can bring out the best or worst in us. We must hope that the pandemic will eventually be brought under control, and our loved ones will survive.

AARP’s recent article entitled “Keeping Caregiver Spirits High During the Coronavirus Outbreak” says that there’s no single way to find hope.

Many family caregivers draw on their faith, and others on rely on sheer determination. However, there some other ways to create hope for caregivers and their loved ones in this pandemic.

The article provides some psychological ideas:

Watch your temperament. Through our disposition and upbringing, each one of us is inclined to look at the world as a pessimist or an optimist. These tendencies become more pronounced under the stress of a crisis. To get a sense of your natural tendency, keep a daily journal and record your current preoccupying thoughts. Keep that document and review it in a week. Rereading those entries will quickly let you know where you stand psychologically and let you to see if you need to take steps to better deal with the current pandemic.

Change your mindset. Since optimism is better, make an effort to increase your optimistic thinking. You could bring your attention more fully to some of the unforeseen benefits of this change in our normally hectic lives. Keeping a gratitude journal is another way of heightening your awareness of the good things we still have.

Rearrange your activities. Directing your activities can result in a more hopeful outlook. Don’t watch hours of cable news shows, because it can have a negative effect on your psyche. Keep informed but balance news with engaging in fun activities.

Contact your positive-minded friends. It is more crucial than ever to virtually contact your friends and family members for support by sharing experiences, fears and good wishes. Reach out to those who can sustain a more balanced and realistic view, acknowledging these negative times but also the positive possibilities.

Reference: AARP (March 31, 2020) “Keeping Caregiver Spirits High During the Coronavirus Outbreak”

medicare deadlines

What are the Important Medicare Deadlines?

Here are the important dates for Medicare enrollment:

  • You can initially enroll in Medicare during the seven-month period that begins three months before you turn 65.
  • If you continue to work past 65, sign up for Medicare within eight months of leaving the job or group health plan or penalties apply.
  • The six-month Medicare Supplement Insurance enrollment period starts when you’re 65 or older and enrolled in Medicare Part B.
  • You can make changes to your Medicare coverage during the annual open enrollment period, from Oct. 15 to Dec. 7.
  • Medicare Advantage Plan participants can move to another plan from January 1 to March 31 each year.

Yahoo News’ recent article entitled “Medicare Enrollment Deadlines You Shouldn’t Miss” takes a look at when you need to sign up for Medicare and the penalties that can be imposed for late enrollment.

Medicare Parts A and B Deadline. Individuals who are getting Social Security benefits, may be automatically enrolled in Parts A and B, and coverage starts the month they turn 65. However, those who haven’t claimed Social Security must proactively enroll in Medicare. You can first sign up for Medicare Part A hospital insurance and Medicare Part B medical insurance during the seven months that starts three months before the month you turn 65. Your coverage can start as soon as the first day of the month you turn 65, or the first day of the prior month, if your birthday falls on the first of the month. If you fail to enroll in Medicare during the initial enrollment period, you can sign up during the general enrollment period between January 1 and March 31 each year for coverage that will begin July 1. Note that you might be charged a late enrollment penalty when your benefit begins. Monthly Part B premiums increase by 10% for each 12-month period you delay signing up for Medicare, after becoming eligible for benefits.

If you or your spouse are still working after age 65 for an employer that provides group health insurance, you must enroll in Medicare within eight months of leaving the job or the coverage ending to avoid the penalty.

Medicare Part D Deadline. Part D prescription drug coverage has the same initial enrollment period of the seven months around your 65th birthday as Medicare Parts A and B, but the penalty is different. It’s calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020) by the number of months you didn’t have prescription drug coverage after Medicare eligibility and rounding to the nearest 10 cents. That’s added to the Medicare Part D plan that you choose each year. As the national base beneficiary premium increases, your penalty also goes up.

Medicare Supplement Insurance Plan Deadline. These plans can be used to pay for some of Medicare’s cost-sharing requirements and some services that traditional Medicare doesn’t cover. The enrollment period is different than the other parts of Medicare. It is a six-month period that starts when you’re 65 or older and enrolled in Medicare Part B. During this open enrollment period, private health insurance companies must sell you a Medicare Supplement Insurance plan, regardless of your health conditions. After this enrollment period, insurance companies can use medical underwriting to decide how much to charge for the policy and can even reject you. If you miss the open enrollment period, you’re no longer guaranteed the ability to buy a Medicare Supplement Insurance plan without underwriting, or you could be charged significantly more, if you have any health conditions.

Medicare Open Enrollment Deadline. You can make changes to your Medicare coverage during the annual open enrollment period from October 15 to December 7. During this period, you can move to a new Medicare Part D prescription drug plan, join a Medicare Advantage Plan, or stop a Medicare Advantage Plan and return to original Medicare. Changes take effect on January 1 of the following year.

Medicare Advantage Open Enrollment Deadline. Participants can move to another plan or drop their Medicare Advantage Plan and return to original Medicare, including purchasing a Medicare Part D plan, from January 1 to March 31 each year. You can only make one change each year during this period, and the new plan will begin on the first of the month after your request is received.

Reference: Yahoo News (July 27, 2020) “Medicare Enrollment Deadlines You Shouldn’t Miss”

living longer

Will I Live Longer, if I Babysit the Grandchildren?

There’s a growing body of research that supports the notion that grandparents who babysit a grandchild live longer. Parents with young children can know that their parents and their children are getting benefits from babysitting time together, says Considerable’s June article entitled “Grandparents who babysit a grandchild live longer, study finds.”

Considerable spoke with Dr. David Coall, senior lecturer at Edith Cowan University and a co-author of a 2017 study that found a connection between grandparent caregiving and mortality. Dr. Coall gave some updates in the field and highlighted further connections that still need to be made.

The 2017 study that Dr. Coall co-authored analyzed date from the Berlin Aging Study (BASE), which monitored the health and social conditions of over 500 participants in Germany between 1990 and 2009. The study focused on grandparents who simply provided periodic babysitting, rather than primary caregiving for their grandchildren.

Dr. Coall’s team of researchers found that caregiving grandparents had a 37% lower risk of death than non-caregiving grandparents. The same 37% risk reduction in mortality was found when comparing caregiving grandparents with non-grandparents.

Therefore, the risk of dying over a 20-year period was a third lower for grandparents who provided some level of care for their grandchildren, as opposed to grandparents who provided no care at all.

According to Dr. Coall, “The obvious next question was, ‘Is that purely because healthier grandparents are more likely to babysit and live longer?’”

In August 2017, he used the same BASE data to see if grandparents were healthier due to babysitting, or if they were babysitting, because they were already healthier and able to do so. Dr. Coall found that health only accounted for 22% of the link between helping and longevity. Interestingly, a direct effect of babysitting on longevity still existed in the data.

“So, we continue to look for what could be making this link between helping and living longer.”

Some longitudinal studies have examined if babysitting is linked with a subsequent improvement in grandparental health, with mixed results. The most recent study, a collaboration with researchers in Finland that was published in July, looked at whether an individual who became a grandparent subsequently went on to enjoy improved health.

Dr. Coall said that the research shows “a specific improvement in physical health, but not in emotional or mental health. Maybe this works through increased activity levels looking after grandchildren.”

Reference: Considerable (June 23, 2020) “Grandparents who babysit a grandchild live longer, study finds”

combat social isolation

How Can I Combat the Social Isolation of Coronavirus?

Local and state governments are asking that we socially distance ourselves to prevent the spread of the coronavirus.

The CDC recommends that anyone who’s age 60 and older avoid crowds, and that those in a community with an outbreak remain at home as much as possible.

AARP’s recent article entitled “How to Fight the Social Isolation of Coronavirus” gives us some ideas to keep in mind to decrease the threat of social isolation and loneliness as the pandemic continues:

  1. Social isolation and loneliness are significant health issues. These related conditions impact a great number of adults in the U.S. It is thought of as being the equivalent of smoking 15 cigarettes a day! According to research from the National Academies of Sciences, Engineering and Medicine, 43% of adults over 60 in the U.S. reported feeling lonely.
  2. Prepare and stay in contact. It’s crucial that we talk to family and friends to develop a plan to safely stay in regular touch, as we socially distance ourselves—or if required to self-quarantine for a possible exposure or are in isolation for a COVID-19 infection. This should confirm whom you can contact, if you need help getting food, medicine and other supplies.
  3. Find helpful organizations. Create a list of charitable and other local organizations that you or the people in your plan can contact, if access is needed to information, health care services, support and resources.
  4. Don’t forget about pets. Pets are a great source of love and companionship, and they can help combat loneliness. In fact, some pets have been linked with owners’ longevity. Just as you need to be sure you have enough supplies for you and family, be stocked with food and other supplies for your furry friends.
  5. Keep in mind those who are at the greatest risk for social isolation and loneliness. People with the highest risk of serious illness from COVID-19 and who should be the most aware of social distancing, will also be the most at risk of increased social isolation and loneliness. While planning is important, know that many individuals will likely experience increased social isolation and loneliness.

Reaching out to friends, family, and neighbors can help protect all of us from COVID-19, as well as social isolation and loneliness.

Reference: AARP (March 16, 2020) “How to Fight the Social Isolation of Coronavirus”

caregiver for family member

Can I Get Paid to Be a Caregiver for a Family Member Who’s a Vet?

AARP’s recent article entitled “Can I Get Paid to Be a Caregiver for a Family Member?” says that you may be able to get paid to be a family caregiver, if you’re caring for a veteran. Veterans have four plans for which they may qualify.

Veteran Directed Care. Similar to Medicaid’s self-directed care program, this plan lets qualified former service members manage their own long-term services and supports. Veteran Directed Care is available in 37 states, DC, and Puerto Rico for veterans of all ages, who are enrolled in the Veterans Health Administration health care system and require the level of care a nursing facility provides but want to live at home or the home of a loved one. A flexible budget (about $2,200 a month) lets vets choose the goods and services they find most useful, including a caregiver to assist with activities of daily living. The vet chooses the caregiver and may select any physically and mentally capable family member, including a child, grandchild, sibling, or spouse.

Aid and Attendance (A&A) Benefits. This program supplements a military pension to help with the expense of a caregiver, and this can be a family member. A&A benefits are available to veterans who qualify for VA pensions and meet at least one of the following criteria. The veteran:

  • Requires help from another to perform everyday personal functions, such as bathing, dressing, and eating
  • Is confined to bed because of disability
  • Is in a nursing home because of physical or mental incapacity; or
  • Has very limited eyesight, less than 5/200 acuity in both eyes, even with corrective lenses or a significantly contracted visual field.

Surviving spouses of qualifying veterans may also be eligible for this benefit.

Housebound Benefits. Veterans who get a military pension and are substantially confined to their immediate premises because of permanent disability are able to apply for a monthly pension supplement. It’s the same application process as for A&A benefits, but you can’t get both housebound and A&A benefits simultaneously.

Program of Comprehensive Assistance for Family Caregivers. This program gives a monthly stipend to family members, who serve as caregivers for vets who require help with everyday activities because of a traumatic injury sustained in the line of duty on or after Sept. 11, 2001. The vet must be enrolled in VA health services and require either personal care related to everyday activities or supervision or protection, because of conditions sustained after 9/11. The caretaker must be an adult child, parent, spouse, stepfamily member, extended family member or full-time housemate of the veteran.

Reference: AARP (May 15, 2020) “Can I Get Paid to Be a Caregiver for a Family Member?”

power of attorney rejected

What Happens If Power of Attorney Documents are Rejected?

It is frustrating when a bank or other financial institution declines a Power of Attorney. It might be that the form is too old, the bank wants their own form to be used, or there seems to be a question about the validity of the form. A recent article titled “What to know if your bank refuses your power of attorney” from The Mercury discusses the best way to prevent this situation, and if it occurs, how to fix it.

The most important thing to know is just downloading a form from the internet and hoping it works is always a bad idea. There are detailed rules and requirements about notices and acknowledgments and other requirements. Specific language is required. It is different from state to state. It’s not a big deal if the person who is giving the power of attorney is alive, well and mentally competent to get another POA created, but if they are physically or legally unable to sign a document, this becomes a problem.

There have been many laws and court cases that defined the specific language that must be used, how the document must be witnessed before it can be executed, etc. In one case in Pennsylvania, a state employee was given a power of attorney to sign by her husband. She was incapacitated at the time after a car accident and a stroke. He used the POA to change her retirement options and then filed for divorce.

At issue was whether she could present evidence that the POA was void when she signed it, invalidating her estranged husband’s option and his filing for her benefits.

The Pennsylvania Supreme Court found that a third party (the bank) could not rely on a void power of attorney submitted by an agent, even when the institution did not know that it was void at the time it was accepted. For banks, this was a clear sign that any POAs had to be vetted very carefully to avoid liability. There was a subsequent fix to the law that provided immunity to a bank or anyone who accepts a POA in good faith and without actual knowledge that it may be invalid. However, it includes the ability for a bank or other institution or person to request an agent’s certification or get an affidavit to ensure that the agent is acting with proper authority.

It may be better to have both a POA from a person and one that uses the bank or financial institution’s own form. It’s not required by law, but the person from the bank may be far more comfortable accepting both forms, because they know one has been through their legal department and won’t create a problem for the bank or for them as an employee.

There are occasions when it is necessary to fight the bank or financial institution’s decision. This is especially the case, if the person is incapacitated and your POA is valid.

If there is any doubt about whether the POA would be accepted by the bank, now is the time to check and review the language and formatting with your estate planning or elder law attorney to be sure that the form is valid and will be acceptable.

Reference: The Mercury (July 7, 2020) “What to know if your bank refuses your power of attorney”

long-term care covid infections

Does Long-Term Care Impact COVID-19 Infection Rates?

The National Investment Center for Seniors Housing and Care (NIC) say that research supports the finding that keeping older Americans in apartments of their own may be saving many of them from COVID-19. That’s a summary of results from a survey of more than 100 senior housing and care operators.

Think Advisor’s recent article entitled “LTC Type Has Big Effect on COVID-19 Infection Rates: Provider Survey” explains that some participants provide more than one type of long-term care (LTC) services.

The sample includes 56 assisted living facility managers and 29 nursing home managers, as well as providers of some other types of services.

The assisted living facility managers said that they’d tested 22% of the residents as of May 31, and only 1.5% had confirmed positive, or suspected positive, COVID-19 tests.

The nursing home managers tested 34% of their residents.

Roughly 6.7% of the residents tested had confirmed or suspected positive coronavirus tests.

Analysts at the Foundation for Research on Equal Opportunity believe that, as of June 19, approximately 43% of the people who’ve died from COVID-19 in the U.S. have been in nursing homes and assisted living facilities.

Many seniors with private long-term care insurance (LTCi) policies, short-term care insurance policies, or life insurance policies, or annuities that provide LTC benefits attempt to use the policy benefits to stay at home as long as possible, or to live in the least restrictive possible LTC setting.

The NIC survey results support the finding that access to private LTCi and LTC benefits may have protected some insureds from the COVID-19 outbreak.

Reference: Think Advisor (June 29, 2020) “LTC Type Has Big Effect on COVID-19 Infection Rates: Provider Survey”

funeral planning

Save Your Family Stress and Plan Your Funeral

Making your way through the process of the death of a family member is an extremely personal journey, as well as a very big business that can put a financial strain on the surviving family.

Rate.com’s recent article entitled “Plan Your Own Funeral, Cheaply, and Leave Behind a Happier Family”  notes that on an individual basis, it can be a significant cost for a family dealing with grief. The National Funeral Directors Association found that the median cost for a traditional funeral, with a basic casket that also includes a vault (the casket liner most cemeteries require) can cost more than $9,000. With the cost of a (single) plot and the services of the cemetery to take care of the burial and ongoing maintenance and other expenses,  it can total more than $15,000.

Instead, if you opt for cremation and a simple service, it will run only $2,000 or less. That would save your estate or your family $13,000. Think of the amount of legacy that can grow from your last wishes.

If you want to research it further, it can be difficult. Without your directions, your grieving family is an easy mark for a death care industry that’s run for profit. Even with federal disclosure rules, most states make it impossible to easily comparison shop among funeral service providers, and online price lists aren’t required. However, you can do the legwork to make it easier on your family, when you pass.

Funeral homes also aren’t usually forthright about costs that are required rather than optional. The median embalming cost is $750.However, there’s no regulation requiring embalming. Likewise, a body need not be placed in a casket for cremation. The median cost for a cremation casket is $1,200 but an alternative “container” might cost less than $200.

The best thing you can do for your family is to write it down your wishes and plans and make it immediately discoverable.

It can be a great relief to tell your family everything you want (and don’t want). However, if that’s not feasible with your family dynamics, be certain that you detail of all your wishes in writing. You should also make sure that the document can be easily located by your executor.

Here’s a simple option: Write everything out, place your instructions in a sealed envelope and let your children and the executor know the location of the letter.

This elementary step can be the start to helping their decision-making when you pass away, and potentially provide some extra money to help them reach their goals.

Reference: rate.com (June 21, 2020) “Plan Your Own Funeral, Cheaply, and Leave Behind a Happier Family”