The Medicaid Medically Needy “Spend-Down Program” – What You Need to Know – Annapolis and Towson Estate Planning

If you’ve been denied Medicaid benefits because you have too many assets or too high an income, don’t give up. There are available programs that may enable you to qualify for Medicaid benefits, despite this setback. Each state may offer different programs, and the Affordable Care Act (ACA) has added new ways to obtain coverage. This article addresses the “spend down program” offered in every state.

Medicaid Spend-Down Program – The Basics

To qualify for Medicaid benefits, your income and assets may not exceed a certain amount set by law. If these items do exceed the legal limits, you may still qualify after a spend-down period. The medically needy spend-down program helps individuals over the age of 65, and some younger individuals with disabilities. To be eligible for this program, you must not be receiving public financial assistance.

Exempt & Non-Exempt Assets

It is not necessary to sell off everything you own to qualify for the spend-down program. You may keep a certain amount of “exempt assets,” such as the home you live in, your car (used for transportation), household furniture, clothes, jewelry and other personal items. None of these assets affect your eligibility, regardless of their value (unless you have high equity, say $1 million in an asset, in which case you may need to spend that down).

Non-exempt assets, on the other hand, do affect your eligibility for the spend-down program. These assets include bank accounts, stocks, investments, and cash over $2,000 for an individual or $3,000 for a married couple.

Amount of Income You Can Have to Apply

It does not matter how much income you have when you apply. The more income you have, though, the more medical expenses you must incur before your coverage can start. The way you spend down this income is by spending it on medical expenses, until you reach the income requirements for Medicaid. Interestingly, you just need to incur medical costs. You don’t have to actually pay them.

In addition, you can pay down accrued debt to spend down your income. Therefore, paying down credit card bills, car payments, or mortgage debt can count towards your spend down. Another tactic you can use, is to pay excess monthly amounts on old medical bills.

Seeking Professional Assistance

Medicaid programs are different in each state, and the laws change frequently. If done wrong, you could end up incurring penalties instead of obtaining benefits. It may be a good idea to enlist the help of a Medicaid specialist or elder law attorney to walk you through the process in a way that will avoid these types of penalties.

Resources:

National Council on Aging. “Benefits Checkup” (Accessed November 28, 2019) https://www.benefitscheckup.org/fact-sheets/factsheet_medicaid_la_medicaid_spend_down/#/

U.S. News and World Report. “How a Medicaid Spend Down Works.” (Accessed 28, 2019) https://money.usnews.com/money/retirement/baby-boomers/articles/how-a-medicaid-spend-down-works

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Having “The Talk” – Resources to Help You Talk About End of Life Needs – Annapolis and Towson Estate Planning

When it comes to thinking about the end of our lives, it can be uncomfortable. Perhaps you’ve thought a lot about how you want the end of your life to look, but you’re having trouble initiating a conversation with your loved ones. Perhaps you’re the adult child of aging parents who have not mentioned their end-of-life wishes. This is a conversation that should not be put off any longer. This article provides resources to get the conversation started, so that you and your loved ones are on the same page regarding end-of-life issues.

Preparing for the Conversation

We often don’t talk about difficult things with family, because we don’t know where to start or we don’t have the words to broach the subject. It can be helpful to sit down and outline what your goals are in the conversation. For example,

  • Putting finances in order
  • Ensuring a family member or pet is taken care of
  • Alerting loved ones to an important or upsetting health issue
  • Informing loved ones, as to who you want as your health care proxy

This list can get pretty long, so it’s essential to write things down in advance to help keep you on track. One resource we’ve found that is useful at this stage is The Conversation Project’s Conversation Starter Kit. This 11-page guide consists of fillable forms designed to help you plan and guide the conversation with your loved ones.

Educating Loved Ones

Sometimes, priming yourself and your loved ones can provide a starting point for the end-of-life conversation. Podcasts are a popular way for people to learn new things. -Why not end-of-life care options? Here’s a list of several popular podcasts addressing end-of-life issues that you can subscribe to and share with your friends and family:

Finding the Words

Whether you are thinking about your own future or the future of an aging loved one, it can be hard to find the right time and the right words to begin a conversation. The truth is, this doesn’t have to be one single, heavy conversation. You can lead up to longer, more in-depth discussions using a few smaller conversations that can happen at any time. Consider these conversation-starters:

  • “I was thinking about what happened to Aunt Sally, and it made me realize…”
  • “My friend Louis died suddenly last month, leaving his wife and daughter reeling. I’m worried that might happen to you and dad.”
  • “You know, I’m okay right now, but I’m worried that _____, and I want to be prepared.”
  • “I need your help thinking about the future.”
  • “Remember when Uncle Fred died and everyone said it was a ‘good death’? How can we make sure yours is too?”

Talking about end-of-life issues can be difficult. However, it’s a conversation worth having to ensure you face your last years, months, days and hours on your own terms.

Resources:

The Conversation Project. “Starter Kits.” (Accessed November 28, 2019)  https://theconversationproject.org/

ARRP. Org. “Caregiver Life Balance.” (Accessed November 28, 2019) https://www.aarp.org/caregiving/life-balance/info-2017/talk-end-of-life-care.html

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Alternatives to Medicaid – A Short Primer on Long-Term Care Insurance – Annapolis and Towson Estate Planning

Medicaid is a state-run program that caters to those surviving on less than 125% of the official poverty level. Many elderly individuals forego purchasing long-term care insurance, in favor of relying on Medicaid to cover their expenses. Unfortunately, after bankrupting themselves to qualify for Medicaid nursing home coverage, many of these same individuals find themselves dismayed at the lack of choice and care options.

Qualifying for Medicaid Long-Term Care

To obtain long-term care benefits through Medicaid, you must meet the income and asset requirements. In addition, you must be unable to perform at least two of the following six activities of daily living:

  • Feeding
  • Bathing
  • Walking
  • Transferring
  • Toilet Use
  • Dressing

If you qualify, you may be able to get all or most of your care covered, but you don’t have as many options when it comes to choice of facility. Medicaid also doesn’t typically cover adult daycare, assisted living, respite care, or in-home care.

Alternatives for Medicaid Long-Term Care – Not Medicare

With Medicare covering about 1/5th of nursing home care in the U.S., elderly individuals are forced to look at alternative means to cover skilled nursing and other long-term care needs. As it stands, Medicare Part A covers up to 100 days of skilled nursing care. Requirements to qualify are stringent, and few people have the time or understanding to correctly navigate the Medicare system.

Long-Term Care Insurance

If you’re insurable and can afford the premiums, long-term care insurance may be the best option for your long-term care needs. Coverage will vary based on your insurance company and plan options. Be sure to get coverage for all you anticipate you’ll need.

In 2019, the average cost of a semi-private room in a nursing home was $7,513 per month. Private rooms average over $8,000 per month. Even if you don’t anticipate needing that level of care, you should be aware that a one-bedroom apartment in an assisted-living facility costs over $4,000 a month. With inflation, this will likely increase. You don’t want to come up short on coverage.

If long-term care insurance is an option for you, be sure to start planning early. Insurance companies are known to reject more applicants, the older they get. Review your plans each year to ensure your policy still meets your anticipated needs. Make changes if necessary, and never stop paying your premiums, unless you want your insurance to lapse.

Resources:

ElderLawAnswers. “Alternatives to Medicaid: A Long-Term Care Insurance Primer” (Accessed November 28, 2019)  https://www.elderlawanswers.com/elder-law-guides/5/a-long-term-care-insurance-primer

Investopedia. “Medicaid vs. Long-Term Care Insurance: What to Know” (Accessed November 28, 2019)  https://www.investopedia.com/articles/05/031005.asp

Investopedia. “Strategies to Help Pay for Eldercare” (Accessed November 28, 2019)  https://www.investopedia.com/articles/personal-finance/102014/top-5-elder-care-strategies.asp

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Caring for Parents – 4 Alternatives to Nursing Home Care – Annapolis and Towson Estate Planning

As our parents continue to advance in years, questions about how best to care for them often come up, especially around the holidays. Maybe they’re slowing down a bit. Perhaps their memory is slipping. Is it time to shop for nursing homes? Maybe. However, there are alternatives to consider, when it comes to caring for aging parents.

Alternative #1 – In-Home Care

According to studies of aging Americans, this population prefers to remain in their own homes, if possible. They want to retain their personal autonomy, have familiar surroundings, and mostly—they don’t want to be filed away and forgotten. Most seniors that choose to remain in the home are cared for by family, and to a lesser extent, professional home healthcare workers.

While in-home care can be less expensive than a semi-or private-unit in a nursing home, it does have its downsides. This is particularly true, when it is a family member that is providing care. A sense of inequality often arises in the family dynamic, when one person is taking on all of the caregiving duties. When considering in-home care, it is critical to communicate with all family members and come up with an agreement, as to the division of labor for mom and dad.

Alternative #2 – Adult Daycare

Adult daycare may be used as an alternative to nursing home care, or in concert with in-home care. These types of centers enable elderly members to maintain a sense of community. These community centers are growing in popularity, due to the reduced cost of care, which is more than 50% less, according to the MetLife National Study of Adult Day Services. Studies have also shown that these types of facilities improve quality of life in older adults and their caregivers.

Adult daycare centers provide social activities, door-to-door transportation services, meals and snacks, assistance with activities of daily living and other therapeutic services, as needed. There are even specialized facilities for people with dementia or other developmental disabilities.

Alternative #3 – Assisted Living Communities

If the family home has become a hazardous environment for your aging parents, the next step could be an assisted living community. This type of facility offers some of the autonomy that the older “young-at-heart” family members still crave, while offering a scaled level of service onsite. These communities can provide:

  • Transportation
  • Medication Management
  • Healthcare monitoring
  • Entertainment
  • Community Activities
  • Help with Activities of Daily Living
  • Housekeeping
  • Laundry Services

These facilities are more affordable than nursing homes and offer active older people the assistance they need, while encouraging autonomy.

Alternative #4 – Accessory Dwelling Units

Bridging the gap between in-home care and other offsite care facilities, the accessory dwelling unit can be a viable option for those with property that will accommodate an extra unit. Also referred to as “granny flats,” these smaller dwellings provide privacy and autonomy for an aging parent, while also providing proximity of family and caregivers.

Depending on the layout of your property, units may be built over garages or adjacent to the family home. Costs vary by location, property and needs. However, in the long-run it may be less expensive than full-time nursing home care.

Before deciding to place family members in a nursing home, do your research. There are plenty of alternatives out there that may be more affordable and socially-preferable to nursing home life.

Resources:

ElderLawAnswers. “Alternatives to Nursing Home Care” (Accessed November 28, 2019) https://www.elderlawanswers.com/elder-law-guides/7/alternatives-to-nursing-home-care

National Adult Day Services Association. “Comparing Long Term Care Services” (Accessed November 28, 2019) https://www.nadsa.org/

Caring on Demand. “7 Alternatives to Nursing Homes” Accessed November 28, 2019) https://www.caringondemand.com/blog/alternatives-nursing-homes

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Can You Explain the Concept of Step-Up Basis? – Annapolis and Towson Estate Planning

If you inherit assets—especially real property—you need to understand the step-up in basis rules. These rules can save you a lot of money on capital gains and depreciation recapture taxes.

Motley Fool’s recent article on this subject asks “What is a Step-Up in Basis?” The article explains that step-up in basis has significant implications for inherited property. When an asset is inherited because the original owner has passed away, in many cases, it’s worth more than when it was first purchased. To avoid a huge capital gains tax bill when the inherited property is sold, the cost basis of the asset is modified to its value at the time of its owner’s death. This is called a step-up in basis. Note that this only applies to property transferred after death. If a property was gifted or transferred before the original owner dies, the original cost basis would transfer to the recipient.

This is a gigantic tax benefit for estate planning, regardless of whether you go ahead and sell the inherited asset immediately or hold on to it for a time. While a step-up in basis can let heirs avoid capital gains taxes, it doesn’t allow heirs to avoid estate taxes that apply to big inheritances.

The estate tax this year is imposed on property in excess of $11.4 million per individual and $22.8 million per married couple. Therefore, if you and your spouse leave a $25 million estate to your heirs, $2.2 million of this will still be taxable, even though your heirs’ cost basis in assets they inherited will be stepped up for capital gains tax purposes.

There are many strategies that a qualified estate planning attorney can advise you on to avoid estate taxes, but step-up in basis doesn’t exclude the value of inherited property from a taxable estate all by itself.

There are two significant ramifications of stepped-up cost basis regarding inherited real estate assets. First, like with other assets, you don’t have to pay capital gains on any appreciation that occurred before you inherited the property. Selling an investment property after years of holding it, can mean a massive capital gains tax bill. Therefore, a stepped-up cost basis can be a very valuable benefit. A step-up in basis can also give you a larger depreciation tax benefit. The cost basis of residential real estate can be depreciated (deducted) over 27½ years: a higher number divided by 27½ years is a greater annual depreciation deduction than a smaller number would produce.

Estate transfers are pretty complicated, so work with a qualified estate planning attorney.

Reference: Motley Fool (November 21, 2019) “What is a Step-Up in Basis?”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

What Happens to Estate Tax Benefits After 2025? – Annapolis and Towson Estate Planning

You may recall that the 2017 Republican tax reform legislation roughly doubled the estate and gift tax exemption.

This means starting in 2019, people are permitted to pass on, tax-free, $11.4 million from their estate and gifts they give before their death. Couples can pass on twice that amount, or $22.8 million.

These higher levels expire in 2026, but those who make large gifts while the exemption is higher and die after it goes back down, won’t see the estate tax benefit eroded, the IRS announced recently via new regulations.

“As a result, individuals planning to make large gifts between 2018 and 2025 can do so, without concern that they will lose the tax benefit of the higher exclusion level once it decreases after 2025,” the agency said in a press release.

Yahoo Finance’s recent article, “IRS Says Millionaires Can Keep Estate Tax Benefits After 2025,” says that the exemption increase was a big priority for Republicans in the 2017 tax overhaul.

This exemption decreased the number of individuals who’d be subject to the 40% estate tax by about two-thirds.

The exemption was $5.5 million prior to the law change.

However, Democrats are looking to reverse those changes, if they sweep the House, Senate and White House in the 2020 national elections.

Nearly every Democratic presidential candidate would like to see the estate tax apply to a greater number of wealthy families.

Senator Bernie Sanders has called for the estate tax, to begin when fortunes are worth at least $3.5 million. He has also proposed rates as high as 77%.

Reference: Yahoo Finance (November 22, 2019) “IRS Says Millionaires Can Keep Estate Tax Benefits After 2025”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Simple Mistakes to Avoid in Estate Planning – Annapolis and Towson Estate Planning

There’s so much information available today, good and bad, that it is not always easy to know which is which. Just as we should not perform surgery on ourselves, we are asking for problems if we try to manage our estate planning without professional help. That’s the good advice from the article “Examining three common mistakes of estate planning” from The News-Enterprise.

For one thing, the roles of power of attorney agent and executor are often confused. The power of attorney agent acts in accordance with a document that is used when a person is living. The power of attorney appointment is made by you for someone to act on your behalf, when you cannot do so. The power of attorney expires upon your death.

The executor is a person who you name to handle matters for your estate after your death, as instructed in your last will and testament. The executor is nominated by you but is not in effect, until that person is appointed through a court order. Therefore, the executor cannot act on your behalf, until you have died and a court has reviewed your will and appointed them to handle your estate.

Too many people opt for the easy way out, when it comes to estate planning. We hear that someone wants a “simple will.” This is planning based on a document, rather than planning for someone’s goals. Every estate plan needs to be prepared with the consideration of a person’s health, family relationships, and finances.

Many problems that arise in the probate process could have been prevented, had good estate planning been done.

Another mistake is not addressing change. This can lead to big problems while you are living and after you die. If you are healthy, that’s great—but you may not always enjoy good health. Your health and the health of your loved ones may change.

Family dynamics also change over time. If you only plan for your current circumstances, without planning for change, then you may need to make many updates to your will.

The other thing that will occur, is that your estate plan may fail. Be realistic, and work with your estate planning attorney to plan for the many changes that life brings. Plan for incapacity and for long-term care. Make sure that your documents include secondary beneficiaries, disability provisions, and successor fiduciaries.

Create an estate plan that works with today’s circumstances, but also anticipates what the future may bring.

Reference: The News-Enterprise (Nov. 18, 2019) “Examining three common mistakes of estate planning”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

I’ve Inherited an IRA – Now, What about Taxes? – Annapolis and Towson Estate Planning

Inheriting an IRA comes with several constraints. As a result, it can be tricky to navigate. You are at an intersection of tax planning, financial planning and estate planning, says Bankrate’s article “7 inherited IRA rules all beneficiaries must know.” There are a number of choices for you to make, depending upon your situation. How can you figure out what to do?

Whatever your situation, do NOT cash out the IRA, or roll it into a non-IRA account. Doing this could make the entire IRA taxable as regular income. Do nothing until you have the right advisors in place. For most people, the best step is to find an estate planning attorney who is experienced with inherited IRAs.

Here’s what you need to know:

The rules are different for spouses. A spouse heir of an IRA can do one of three things:

  • Name himself as the owner and treat the IRA as if it was theirs;
  • Treat the IRA as if it was his, by rolling it into another IRA or a qualified employer plan, including 403(b) plans;
  • Treat himself as the beneficiary of the plan.

Each of these actions may create additional choices for the spousal heir. For example, if a spouse inherits the IRA and treats it as his own, he may have to start taking required minimum distributions, depending on his age.

“Stretch” or choose the 5-year rule. Non-spouse heirs have two options:

  • Take distributions over their life expectancy, known as the “stretch” option, which leaves the funds in the IRA for as long as possible, or
  • Liquidate the entire account within five years of the original owner’s death. That comes with a hefty tax burden.

Congress is considering legislation that may eliminate the stretch option, but the proposed law has not been passed as of this writing. The stretch option is the golden ticket for heirs, letting the IRA grow for years without being liquidated and having to pay taxes. If the IRA is a Roth IRA, taxes were paid before the money went into the account.

Non-spouse beneficiaries need to act promptly, if they want to take the stretch option. There is a cutoff date for taking the first withdrawal, depending upon whether the original account owner was over or under 70 ½ years old.

There are year-of-death distribution requirements. If the original owner has taken his or her RMD in the year that they died, the beneficiary needs to make sure the minimum distribution has been taken.

There might be a tax break. For estates subject to the federal estate tax, inheritors of an IRA may get an income-tax deduction for the estate taxes paid on the account. The taxable income earned (but not received by the deceased individual) is “income in respect of a decedent.”

Make sure the beneficiary forms are properly filled out. This is for the IRA owners. If a form is incomplete, doesn’t name a beneficiary or is not on record with the custodian, the beneficiary may be stuck with no option but the five-year distribution of the IRA.

A poorly drafted trust can sink the IRA. If a trust is listed as a primary beneficiary of an IRA, it must be done correctly. If not, some custodians won’t be able to determine who the qualified beneficiaries are, in which case the IRS’s accelerated distribution rules for IRAs will be required. Work with an estate planning attorney who is experienced with the rules for leaving IRAs to trusts.

Reference: Bankrate (Nov. 19, 2019) “7 inherited IRA rules all beneficiaries must know.”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Tips for Choosing a Fiduciary – Annapolis and Towson Estate Planning

One of the important tasks in creating a complete estate plan is selecting people (or financial institutions) to represent you, in case of incapacity or death. Most people think of naming an executor, but there are many more roles, advises the article “What to consider when appointing a fiduciary?” from The Ledger.

Here are the most common roles that an estate planning attorney will ask you to select:

  • Executor or personal representative, who is named in your will and appointed by the court to administer your estate.
  • Agent-in-fact (under a durable power of attorney) who manages your financial affairs while you are living, if you are unable to do so.
  • Health care surrogate who makes health care decisions on your behalf while you are living, if you are incapacitated.
  • Trustee of a trust document; administers the trust that you have created.
  • Guardian: a person who makes health care and financial decisions on your behalf, if the court determines that other roles, like health care surrogate or agent-in-fact, are not sufficient.
  • Guardian for minor children: person(s) who make decisions for your children, if you are not able to because of death or a loss of capacity before the children reach adulthood.

The individuals or financial institutions who take on financial roles are considered fiduciaries; that is, they have a legal duty to put your well-being first. Their responsibilities may include applying for government benefits, managing and investing your assets and income, deciding where you will live and working with your attorneys, financial advisors and accountants.

Many people name their spouse or eldest child to take on these roles. However, that’s not the only option. A few questions to consider before making this important decision include:

  • Does this person have the experience, skill and maturity to manage my financial affairs?
  • Does this person have the time to serve as a fiduciary?
  • Would this person make the same health care decisions that I would make?
  • Can this person make a difficult decision for my health care?
  • Does this person live near enough to arrive quickly, if necessary?
  • How old is this person, and will they be living when I may need them?
  • What kind of response will my family have to this person being named?
  • Are my assets substantial enough to require a financial institution or accountant to manage?

These are just a few of the questions to consider when choosing fiduciaries or health care agents in your estate plan. Speak with your estate planning attorney to help determine the best decision for you and your family.

Reference: The Ledger (Oct. 16, 2019) “What to consider when appointing a fiduciary?”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys

Should I Use a Bank as My Executor Instead of a Family Member? – Annapolis and Towson Estate Planning

You can choose anybody you like to be the executor of your will but consider who will do the best job.

Executors are legally responsible for several tasks, including identifying everything in the estate, collecting all the assets and paying the debts and liabilities. Finally, the executor makes distributions to beneficiaries, in accordance with the terms of the will.

nj.com’s recent article on this topic asks “Should I choose a bank to be the executor of my will?” The article explains that there are a few advantages to designating a bank as an executor.

Banks are in the business of managing money and are experienced in administering estates.

This typically means they may be able to settle the estate more quickly and efficiently than a family member.

Banks have policies and procedures in place to make certain that the assets are protected from mismanagement and theft.

Banks are impartial parties that cannot be influenced by beneficiaries. This can be a big headache for a family member asked to be executor. Relationships can deteriorate over the enforcement of the terms of a will, especially when one sibling is named executor and has the authority over the administration of the estate—perhaps to the detriment of her brothers and sisters.

One distinction from using a family member is that while an executor is entitled to compensation, family members frequently waive this. However, banks charge fees for serving as executors, and these fees may be higher than you’d expect.

For example, the bank’s fee might be up to 4% of the first $100,000, then decrease incrementally until it’s just 0.5% of values over $9 million.

One other note to keep in mind is that many banks won’t serve as executor, unless the estate is substantial enough to meet the minimum fees charged by the bank to serve as the executor.

Reference: nj.com (November 5, 2019) “Should I choose a bank to be the executor of my will?”

Sims & Campbell, LLC – Annapolis and Towson Estate Planning Attorneys