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• W138726080 abstract "LONG-TERM HEALTHCARE PLANNING STRATEGIES Skyrocketing long-term healthcare costs have radically altered estate planning for older clients. Planning can no longer cover only estate taxes and probate--it must consider the significant financial risks of long-term institutionalization. With the average cost of a nursing home running between $25,000 and $50,000 annually, half of all couples with one spouse in a nursing home have lost their life savings within a year. Contrary to popular belief, Medicare does not cover custodial care--the type most nursing home patients require. Private insurance policies alone are not the answer. Standard Medigap supplemental insurance provides practically no long-term nursing home coverage. And while there are a growing number of insurance policies aimed specifically at long-term care, they generally are far too expensive for most older people. WHAT MEDICAID COVERS Medicaid, which provides healthcare coverage for lower-income Americans, does cover long-term nursing home care for those who are at least 65, blind or disabled and meet certain income and asset requirements. To qualify, a person generally must have less income than the nursing home's cost. This limit isn't a problem for most people, but Medicaid's asset limitations can pose difficulties. Senior citizens are required to turn over most of their life savings to pay nursing home bills before Medicaid coverage begins. A nursing home resident and spouse may protect the higher of $12,000 or one-half of their combined life savings up to a maximum of $60,000. (States may raise the minimum.) In addition, a married couple with one spouse in a nursing home may keep certain exempt assets, which generally include the family residence, if a spouse or dependent relative is living there; household goods and personal effects; a car; and up to $1,500 for a burial plot and an additional $1,500 for funeral costs. For unmarried individuals entering a nursing home, the Medicaid asset limits are even more severe. They vary by state, but generally protect only about $2,000 of savings and impose dollar limits for categories of exempt assets. PLANNING ISSUES By taking into consideration clients' income, assets and tax consequences, CPAs can help clients select strategies to protect financial security. Even a simple plan can save thousands of dollars. There are dozens of options. Three of the most common involve transfers of assets to children, transfers to Medicaid qualifying trusts and the use of insurance. TRANSFERS TO CHILDREN Clients can't simply transfer assets the day before entering a nursing home and expect to qualify for Medicaid immediately. Transfers for less than fair market value made within 30 months of a Medicaid application render applicants ineligible for benefits for up to 30 months. The ineligibility period is based on a formula that considers the amount transferred and average nursing home costs. But even if clients haven't planned ahead, asset transfers may be worthwhile since they do enable qualification for Medicaid after 30 months. In making transfers, clients should keep only what they'll need, including yield on assets and additional income (such as Social Security), in order to cover all of their expected expenses for the 30-month period. If a client transfers appreciated assets, such as stocks or the family home, CPAs should consider the transfer's impact on capital gains taxes, particularly the loss of the stepped-up basis available at death. Also, income produced by the transferred assets will be taxed to the client's children at the children's potentially higher rate. Clients should execute a durable power of attorney to ensure they can take advantage of this asset transfer technique. This is the single most important action they can take to protect themselves. Without a durable power of attorney, they may be unable to transfer assets if they become incompetent. …" @default.
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• W138726080 title "Long-Term Healthcare Planning Strategies" @default.
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