News & Resources: Blog

Looking at Long-Term Care Options

Published: June 23, 2022

It’s more crucial than ever to take stock of your life and your health care planning. Americans continue responding to the ever-present threat of COVID-19 in its many iterations, and we are identifying that which is most important in our lives to preserve our health and financial future best.

For many, the mere mention of long-term care health insurance conjures up images of twilight years seemingly far removed from our daily lives. However, the reality is that you may find yourself in need of long-term care due to a sudden disease or illness or as the result of an accident. The US Department of Health and Human Services statistics currently show that about seventy percent of individuals over the age of 65 will require some long-term care during their lives. Genworth’s latest statistics show that a full thirty-seven percent of these long-term care recipients are, in fact, under sixty-five years of age.

Regardless of your age or cause, when long-term care becomes a requirement, it is important to know and plan for your options regarding funding the care you need, and where and how you prefer to receive it. Your planning today can make a huge difference in your financial solvency and those caregivers (mostly family) who participate in the financial burden of your care.

Naturally, the best scenario is having prepared for the future by having healthy balances saved in your retirement programs and health savings accounts. If the funding is available to cover long-term care costs for yourself or a loved one, it is prudent to do so. Perhaps you can only make part of the funding happen, in which case you may have to ask loved ones for help. They may have the financial where with all to finish covering premium costs. Paying some out-of-pocket for an aging parent early on means less of a toll emotionally, physically, and financially, should a family member have to assume becoming a full-time caregiver.

The IRS considers long-term care insurance as a medical expense. As long as the policy is qualified, it is deductible. IRS rules state the policy must have been issued on or after January 1, 1997, and adhere to certain requirements. Policies purchased before this date may qualify to become grandfathered if the state’s insurance commissioner approves the selling of the policy. The IRS rules from 2021 to 2022 are little changed, most notably in age categories from sixty to seventy years old the IRS reduced the deduction by ten dollars.

Note these tax deductions are, for the most part, not available in hybrid policies. These policies combine life insurance and annuity policies with a long-term care benefit. Hybrid policies are becoming particularly popular because if long-term care is not a requirement, the individual’s heirs may receive a death benefit. Your medical expenses need not exceed a certain percentage of your income to be tax-deductible. As long as you earn a profit, you may take the amount of your long-term care insurance as a deductible.

Public programs are becoming more heavily leveraged for lower-income individuals to plan for long-term care services. There is nothing wrong with taking advantage of these programs; however, most Americans do not understand the differences between Medicare and Medicaid, what and who they fund, and for how long. The answers are complex as there are physical and financial thresholds to qualify for benefits, and these may vary from state to state. Here is a general overview of qualifications and limitations in coverage and choices of care facilities.

Sometimes referred to as Medicaid crisis planning, an elder law attorney can guide you through the process of sheltering some of your assets. Medicaid is a federal/state program helping low-income seniors with limited income and assets afford healthcare and long-term care. Many seniors believe their only option to qualify for the program is to “spend down” their assets. While this is true in some cases, proactive Medicaid planning can protect a substantial portion of your assets if done correctly.

The program’s eligibility rules are complicated, as is the application process, so it is best to navigate the process with a specialized Medicaid planning elder law attorney well before you need to tap the benefits. Always seek professional legal advice when creating your long-term care strategy using Medicaid. Applications are rarely successful as a do-it-yourself project, and mistakes can have devastating long-term consequences on a family and their finances.

Options for long-term care exist; however, finding the best solution for your financial circumstances is complex. It behooves us all to look to the future of our healthcare and prioritize proactive planning, ensuring there will be a plan in place when we encounter the likelihood of a long-term care requirement. We hope you found this article helpful. If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

CLIENT Testimonial

Our family had the good fortune to find Scott Bloom.  He was invaluable helping us set up our trust. We had an unexpected health crises and realized that we had nothing in place to protect our children.  Scott explained our options and got the necessary paperwork ready for us to hand to our family, accountant and banks. Scott was absolutely the right attorney at the right time for us. We would highly recommend him and his team.
- Tricia B., Hamilton, New Jersey

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It can be quite confusing to determine which Medicare plan is best for you. There are several types of plans, and each has its own advantages and disadvantages. Understanding some basic features will help you decide how to maximize your healthcare dollars and choices. You should review your choice periodically, especially as elements of the Inflation Reduction Act of 2022 change prescription medication and vaccine policies. Coverage can also change from year to year..

There are three basic types of plans:

  1. Original Medicare
  2. Medicare Advantage
  3. Medigap

Original Medicare

Medicare is a government health insurance plan for people 65 and older. Original Medicare, sometimes called traditional Medicare, comes in several parts. Each part covers different things and has various associated costs. 

Most people do not pay for Part A as it was deducted from their taxes paid while working. It is primarily for hospital visits and nursing care. However, there are many fees associated with being in a hospital that Medicare does not cover, which you still might have to pay out of pocket.

Part B requires monthly premiums, which can be deducted from your social security. You can elect to enroll in part B through Original Medicare. It covers a portion of doctors' visits, durable medical goods, and more. 

Part D covers the cost of many prescription medications. You can add it to Original Medicare or purchase it as part of a Medicare Advantage plan.

Medicare Advantage

Medicare Advantage is offered through private insurance companies that Medicare approves. Most plans include Parts A, B, and D of Original Medicare with some variations from the original. There are a wide variety of Medicare Advantage plans, including Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO). PPOs tend to have higher premiums and offer more choices than HMOs. Medicare Advantage HMOs and PPOs often have higher premiums than traditional Medicare because they usually cover more expenses, including prescription drug costs, vision, hearing, and dental.

However, the overall costs, premiums, plus out-of-pocket expenses for Advantage plans can be lower than Original Medicare because the private insurers manage patient care and limit choices. They assemble networks of hospitals and physicians to control their costs and reduce their customer's premiums. They also restrict access to certain providers and increase the cost of care obtained out-of-network.

Traditional Medicare allows people to seek care from any provider participating in Medicare, which includes virtually all hospitals and physicians.

Medigap

Medigap is a co-insurance or supplement to Original Medicare. You can enroll when you first enroll in Part B. It is also available through Medicaid, a union, or a former employer when you qualify for both programs. You can’t have both Medicare Advantage and Medigap plans. Medigap helps cover expenses that Original Medicare does not cover, such as co-pays and deductibles. Due to the enrollment restrictions, you should strongly consider Medigap when you first become eligible.

The Right Choice for You

With all the different plans, parts, choices, and restrictions, it is crucial to consider your priorities for care. Limited access to doctors and hospitals may become important if you need specialized medical care, such as cancer treatment. Before enrolling, consider what specialty hospitals are included in Advantage plans. Likewise, Advantage plans can make it difficult to see a specialist for ongoing and chronic conditions due to limitations in long-term care services. An estate planning lawyer or elder law attorney can help address long-term care planning and the potential to qualify for Medicaid when necessary.

The Kaiser Family Foundation has put together a cost analysis to help you determine when Medicare Advantage would save you money. As you can see, the longer you stay in the hospital, the less advantageous an Advantage plan becomes.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

A Guide in Choices after 65

Enrolling in the right Medicare coverage is one of many decisions that will affect your quality of life in your senior years. We are here to help you navigate a wide variety of choices.

If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

- Medigap, Medicare Advantage, and Traditional Medicare

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