Seniors
Consider Tax-Savvy Year-End Gifts to Family PDF  | Print |  E-mail
Thursday, 18 December 2014 14:03

By Gene L. Osofsky, Esq. • Special to the Times

Q: My wife and I are considering making large gifts to our children and grandchildren. Do you have any tax advice for us?

A: Yes. Many people mistakenly believe that you cannot gift more than $14,000 per year without incurring a gift tax. Not so. In fact, individuals can gift more than $5 million during a lifetime without incurring a gift tax. Here is the way gift taxes work:

Annual Exclusion Gifts: No Gift Tax Return Required:

1) $14,000 Per Year: Each of you can gift up to $14,000 per year per recipient without the need to file a Gift Tax Return. Such gifts are called Annual Exclusion Gifts and you can make such gifts to as many persons as you wish each year.

2) “Doubling Up”:  If you and your wife are in a position to do so, together, you can actually double that amount for each gift recipient. So, together, you could gift a total of $28,000 to each recipient for a total of $168,000 to your loved ones ($14,000 x 2 donors x 6 recipients).

3) Year End Straddle: On or after January 1, 2015, you and your wife could do the same thing once again, as you would then be in a different tax year. So, over the course of a period as short as a calendar week — provided that the week straddles both the last days of this year and the early days of next year — the two of you could gift a total of $336,000 ($168,000 x 2 donors) to your loved ones without the need to file a Gift Tax Return or use any of your lifetime exemptions. I call this strategy the Year-End Gift Straddle.

Gifts Above the Annual Exclusion: Gift Tax Return Required

1) Lifetime Exemption: If you choose to make gifts above the Annual Exclusion amount, then you can still make them gift-tax-free by using a portion of your Lifetime Exemption (also called the “Unified Credit” or Lifetime Exclusion).

That Lifetime Exemption is currently $5,340,000 per person for U.S. citizens, and increases to $5,430,000 next year. Annual Exclusion Gifts do not count against this exemption; they can be made in addition to Lifetime Exemption gifts.

Also, by making a timely election, a surviving spouse can opt to preserve the deceased spouse’s unused exemption for the survivor’s own use, thereby effectively doubling it.

2) Gift Tax Return: To the extent that your gifts exceed the Annual Exclusion amounts, you must file a Gift Tax Return even though no actual gift tax would be due. Reason: the IRS wants to track your use of your lifetime exemption, so that it knows how much you have left to use upon death.

Example: if you used $1 million of your lifetime exemption to make excess gifts during life, then your remaining exemption to apply against estate taxes upon death would be $1 million less.

Cautions: Before making large gifts, be sure that you can afford to do so. Lastly, if there is a possibility that either of you may need to apply for a Medi-Cal subsidy for nursing home care in the near future, you should consult a professional with special knowledge about the Medi-Cal program before making those gifts: Gift transfers may adversely affect your ability to qualify for a Medi-Cal subsidy unless those gifts are handled in a very special manner.

Gene L. Osofsky is an elder law and estate planning attorney in Hayward.  Visit his website at www.LawyerForSeniors.com.


 
Shared Housing Can Help Seniors in Many Ways PDF  | Print |  E-mail
Thursday, 18 December 2014 14:01

By Jim Miller • Special to the Times

Shared housing among older adults has gotten a lot of attention lately as more and more people are recognizing that they can use their home to get help with a variety of needs, such as generating income, getting help with household chores, and even finding some much needed companionship.

But home sharing isn’t for everyone. You need to carefully consider the pros and cons of renting out a room in your house, and make a list of what you want (and don’t want) in a housemate/renter.

To help sort this out, the National Shared Housing Resource Center offers a 16-page “Consumers Guide to Home Sharing” that provides a self-questionnaire to those considering renting their home, along with a list of renter’s questions and important points to discuss, and a sample home-sharing lease agreement that lays out the details in writing. This guide costs $10 and can be ordered at nationalsharedhousing.org.

Finding a Renter

After going through the guide, if you want to proceed in finding a renter, a good first step is to contact a home-sharing program in the area that matches adults who are looking for shared housing with older adults who are looking to rent.

These programs handle background checks and other screenings, and consider lifestyle criteria when making matches. They can also help with the leasing agreement that the renter would sign that covers issues like smoking, pets, chores, overnight guests, use of common rooms, etc.

Most home-sharing programs are free to use or request a small donation. Others, however, may charge the homeowner and potential renter a fee for this service.

There are dozens of home-sharing programs throughout the U.S. You can find a list at: nationalsharedhousing.org.

You can also search for housemates through national resources like Let’s Share Housing (letssharehousing.com), the Golden Girls Network (goldengirlsnetwork.com) and Roommates 4 Boomers (roommates4boomers.com). All of these programs offer national internet-based matching programs and charge membership fees that run anywhere between $30 and $39.

If you find someone on your own that you’re interested in renting to, ask the prospective renter to fill out a “rental application” (see rentalleaseagreement.org to download and print one for free) and run a full tenant background check, and then call their references. Background checks can be ordered online through companies like starpointtenantscreening.com and screeningworks.com for a small fee.

Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.



 
Remember When... PDF  | Print |  E-mail
Thursday, 04 December 2014 09:15
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Child Caregiver Needs Help with Medi-Cal Claim PDF  | Print |  E-mail
Thursday, 04 December 2014 09:12

By Gene L. Osofsky, Esq. Special to the Times

Q: When Dad became unable to care for himself, I moved in with him and cared for him for as long as I could. When his care needs increased, we had to place him in a nursing home. He lived there about a year, on a Medi-Cal subsidy, before he passed. Recently, I received a reimbursement  claim from Medi-Cal for about $90,000. Help! Is there anything I can do about this? We would like to fix up and sell his home, as Dad intended.

A: Perhaps, depending upon the facts. Background: Medi-Cal will subsidize the cost of a nursing home stay for individuals who are financially eligible. However, when that person dies, Medi-Cal will generally seek reimbursement from his estate for the amount of benefits paid out.  However, there are exceptions to reimbursement including the following:

(1) Medi-Cal will waive its claim if the beneficiary is survived by a minor, blind or disabled child;

(2) Medi-Cal will defer its claim if the beneficiary is survived by a spouse, but only until the death of the surviving spouse; and

(3) Medi-Cal will waive a portion of its claim, based on hardship, if the beneficiary is survived by a child who qualifies as a “caregiver child.”

To qualify as a “caregiver child” you must have (a) moved in with your father, (b) rendered care to him for at least two years while residing in his home, and, (c) later prove to Medi-Cal, via letters from healthcare providers, that your in-home care actually delayed your father’s entry into a nursing home.

Also, you must continue to reside in your parent’s home through the time of Medi-Cal’s determination on your application for waiver. This exception seemingly recognizes that, by caring for your father and delaying his entry into a nursing home, you have saved the state money and are deserving of a benefit in that he will now have a larger net estate to pass on to you.

Unfortunately, qualification for this exemption is difficult for most child-caregivers, partly because of the requirement that the child providing care must actually reside in the parent’s home during the entire time that care is rendered. If the child also maintains his or her own separate residence, Medi-Cal may deny the claim, forcing the matter to an administrative or judicial hearing with an uncertain outcome.

Also, if a waiver is granted, it would be only as to your proportionate share of your parent’s estate. For example, if you are one of three children designated to receive your parent’s estate, the waiver will be – at best – only as to one-third of the Medi-Cal claim.

If the waiver is denied, remember that the claim is against your father’s estate, and you would not have personal responsibility to pay from your own assets.  Also, there may be other options, such as a voluntary lien with a payment plan.

Had your father been able to take proactive planning steps during his lifetime, lawful strategies could have been implemented to protect the home from a Medi-Cal recovery claim entirely, avoiding the need to apply for waiver.

Unfortunately, many people are not aware that preplanning is often the key to avoiding a Medi-Cal recovery claim. For those parents who wish to pass on as much as possible to their children without burdening their estate with a Medi-Cal recovery claim, know that lawful steps can be taken during lifetime to do just that.

Gene L.  Osofsky is an estate planning and elder law attorney in Hayward.  Visit his website at www.LawyerForSeniors.com



 
Quit Smoking with the Help of Medicare and Other Tools PDF  | Print |  E-mail
Friday, 21 November 2014 15:56

112014sen1By Jim Miller • Special to the Times

Medicare actually covers up to eight face-to-face counseling sessions a year to help beneficiaries quit smoking. And, if you have a Medicare Part D prescription drug plan, certain smoking-cessation medications are covered too. Here are some other tips that can help you kick the habit.

Never Too Late

Of the 46 million Americans who smoke, about 5.5 million are Medicare beneficiaries. According to the Center of Disease Control and Prevention (CDC), about 50 percent of smokers, age 65 and older, indicate they would like to completely quit, but because of the nicotine, which is considered to be more addictive than heroin, it’s very difficult to do.

Tobacco use is the leading cause of preventable illness, responsible for an estimated one-fifth of deaths in the United States each year.

But research shows that quitting, even after age 65, greatly reduces your risk of heart disease, stroke, cancer, osteoporosis and many other diseases.

It also helps you breathe easier, smell and taste food better, not to mention saves you quite a bit of money. A $5 pack-a-day smoker, for example, saves about $150 after one month without cigarettes, and more than $1,800 after one year.

How to Quit

The first step you need to take is to set a “quit date,” but give yourself a few weeks to get ready. During that time you may want to start by reducing the number or the strength of cigarettes you smoke to begin weaning yourself.

Also check out over-the-counter nicotine replacement products — patches, gum and lozenges — to help curb your cravings. And, just prior to your quit day, get rid of all cigarettes and ashtrays in your home, car and place of work, and try to clean up and even spray air freshener. The smell of smoke can be a powerful trigger.

Get Help

Studies have shown that you have a much better chance of quitting if you have help. So tell your friends, family and coworkers of your plan to quit. Others knowing can be a helpful reminder and motivator.

Then get some counseling. Don’t go it alone. Start by contacting your doctor about smoking cessation counseling covered by Medicare, and find out about the prescription anti-smoking drugs that can help reduce your nicotine craving.

You can also get free one-on-one telephone counseling and referrals to local smoking cessation programs through your state quit line at 800-QUIT-NOW, or call the National Cancer Institute free smoking quit line at 877-44U-QUIT.

It’s also important to identify and write down the times and situations you’re most likely to smoke and make a list of things to do to replace it or distract yourself.

Some helpful suggestions when the smoking urge arises are to call a friend or one of the free quit lines, keep your mouth occupied with some sugar-free gum, sunflower seeds, carrots, fruit or hard candy, go for a walk, read a magazine, listen to music or take a hot bath.

The intense urge to smoke lasts about three to five minutes, so do what you can to wait it out. It’s also wise to avoid drinking alcohol and steer clear of other smokers while you’re trying to quit. Both can trigger powerful urges to smoke.

For more tips on how to quit, including managing your cravings, withdrawal symptoms and what to do if you relapse, visit smokefree.gov and nihseniorhealth.gov/quittingsmoking. If you’re a smartphone user, there are also a number of apps that can help like LIVESTRONG MyQuit Coach, Cessation Nation and Quit It Lite.

 

 
Engage Family Members Suffering from Dementia on Holidays PDF  | Print |  E-mail
Friday, 21 November 2014 15:55

112014sen2Whether it’s Mom, Dad, Grandma or Grandpa — or your spouse — holidays can present special challenges for families with a loved one suffering from dementia.

“We have an expectation that loved ones should never change from the person we’ve perceived them to be for years, but everyone changes significantly over an extended period, especially those diagnosed with dementia,” says Kerry Mills, a researcher in best-care practices for people with dementia, which includes Alzheimer’s.

“Dementia encompasses a wide range of brain diseases, which means it’s not the fault of a Grandma if she has trouble remembering things or gets flustered. Empathy for what she’s experiencing on the level of the brain will help your relationship with her. Do not expect her to meet you halfway to your world; you have to enter her world.”

Spouses have a particularly difficult time coping with their partner’s dementia, Mills says. A spousal relationship is a team and is central to the identities of both people. So, while you’re paying special attention to a parent’s or grandparent’s condition, extend it to his or her spouse, she says.

Families tend to have a hard time coping with a loved one’s dementia during holiday gatherings. Mills offers these suggestions for how to interact with a loved one — say, Grandma — whose brain is deteriorating.

• Do not get frustrated. “First, do no harm” — the excellent maxim taught to medical students, is also a great first principle for those interacting with Grandma, who may be experiencing a level of frustration and anxiety you cannot comprehend adequately.

She simply doesn’t have access to certain details, but she is still a conscious and feeling person who has plenty to offer. If you get frustrated, she’ll pick up on it.

• Dedicate someone to Grandma during the gathering. Of course, loving families will want to include Grandma in the group, but be careful not to overwhelm her with attention. Her brain, which has trouble processing some information, could use assistance — a liaison to help her process things. A son or daughter may be the best handler during a gathering.

• Give Grandma purpose; give her a task in the kitchen. Keep her engaged! Simple tasks, such as mashing potatoes or stirring gravy, may be best. Engage her in conversation about the food.

If it’s Grandpa whose suffering dementia, include him in a group. Engage him in a conversation about football, which may allow him on his own terms to recall details from the past.

• Use visual imagery and do not ask yes-or-no questions. Don’t expect someone with Alzheimer’s to remember a specific incident 23 years ago — it may be physically impossible. Direct the conversation; say things to stimulate recollection, but don’t push a memory that may not be there. Pictures are often an excellent tool.

• Safety is your biggest priority. Whether during a holiday gathering or in general, Grandma may commit herself to activities she shouldn’t be doing, such as driving. This major safety concern applies to any potentially dangerous aspect to life.

“Currently, there’s a stigma with the condition,” Mills says. “As with other medical conditions, Alzheimer’s should not be about waiting to die — patients often live 15 years or more after a diagnosis. It should be about living with it.”

 

 
Make Plans Now for Your Trustee Succession PDF  | Print |  E-mail
Friday, 21 November 2014 15:52

By Gene L. Osofsky, Esq. • Special to the Times

Q: I have a Living Trust. I am the original trustee and my children are the successor trustees. Do you have any thoughts about easing the transition of trustee duties from me to my children when the management of my finances has become too much for me?

A: Yes. It is important for that transition to be as seamless as possible, so that your assets can be managed and bills paid without delay. Here are some suggestions:

(1) Simplify Succession “Trigger”: Take a look at your trust to determine what triggers the change of trustees from you to your children.

Typically, it may be the written determination by one, or perhaps two, physicians, reciting your inability to handle your financial affairs.

If your trust requires a letter from two physicians, I suggest changing that requirement to only one. Reason: If you are then residing in a nursing home, where patient care is typically monitored by one physician, it may be difficult to arrange an evaluation for this purpose by a second physician.

Reducing the requirement to only one doctor may save your children much grief with medical logistics.

(2) HIPAA Release. Make sure that your trust, or related document, provides a HIPAA privacy release authorizing your doctor to disclose information about your ability to manage your affairs. Absent a privacy release, some physicians may be reluctant to write a letter regarding your capacity.

(3) Add Co-Trustee. At some point, consider adding one of your children as a co-trustee and recite in your trust, or in an amendment to your trust, that any single trustee has the power to write checks or take other action on behalf of the trust.

This would then authorize your child to gradually take over more responsibility for managing trust assets without a formal certification of your incapacity. Doing so sooner than later also allows you the opportunity to watch your child perform his or her duty, and afford you the opportunity to provide pointers to them based upon your years of accumulated wisdom.

(4) Consider Resignation. Alternatively, when you feel that managing your trust has become too much for you, you might consider the proactive approach of resigning. A formal resignation triggers the succession of trustee duties to your child without a formal finding of incapacity. It, too, can accomplish a smooth transition without the need for doctors’ letters.

(5) Minimize Successor Liability. To encourage a successor trustee to step into the shoes of the predecessor, recite in your trust that the successor is not responsible for any acts or omissions of his predecessor. You might also recite that whoever is serving as trustee is not liable for any action taken in good faith.

These two protective clauses would help induce your designated nominee to assume their duties when appropriate, whether that successor is one of your children or the trust department of your favorite bank.

(6) Inform Your Bank: Make sure that your financial custodians have your list of successors on file, so that when they step forward to assume their duties their identity is known to the bank. You might even introduce your nominees to your bank officers, and suggest that they take a sample signature and make note of the child’s address and driver’s license.

By taking some or all of the above steps, you will have taken proactive steps toward a seamless transition of trustees when the time comes.

Gene L. Osofsky is an elder law and estate planning attorney in Hayward.  Visit his website at www.LawyerForSeniors.com.



 
Finding Affordable Dental Care PDF  | Print |  E-mail
Thursday, 06 November 2014 15:23

110614sen1By Jim Miller • Special to the Times

Finding affordable dental care can be challenging for seniors living on a tight budget. Most retirees lose their dental insurance after leaving the workplace, and original Medicare does not cover cleanings, fillings or dentures.

While there’s no one solution to affordable dental care, there are a number of options that can help cut your costs. Here’s where to look.

Medicare Advantage

While original Medicare (Part A and B) and Medicare supplemental policies do not cover routine dental care, there are some Medicare Advantage (Part C) plans that do. Many of these plans, which are sold through private insurance companies, cover dental care along with eye care, hearing and prescription drugs, in addition to all of your hospital and medical insurance.

If you’re eligible for Medicare, see medicare.gov/find-a-plan to look for Advantage plans in your area that covers dental care.

Dental Discounts

Another way you can reduce your dental care expenses is to join a dental discount network. How this works is you pay an annual membership fee — around $80 to $200 a year — in exchange for a 10 to 60 percent discount on service and treatments from participating dentists.

To find a network, go to DentalPlans.com (or 888-632-5353), where you can search for plans and participating dentists by zip code, as well as get a breakdown of the discounts offered.

Dental Schools

Dental school clinics offer savings opportunities, too. All 65 accredited dental schools in the U.S. offer affordable care provided by dental students who are overseen by their professors. You can expect to pay about half of what a traditional dentist would charge and still receive excellent, well-supervised care.

Another option is to check with local colleges that offer dental hygiene programs. For training purposes, many programs provide teeth cleanings by their students for a fraction of what you’d pay at a dentist’s office.

To search for nearby dental schools or dental hygiene programs visit ada.org/dentalschools.

Veterans Benefits

If you’re a veteran enrolled in the VA health care program, or are a beneficiary of the Civilian Health and Medical Program (CHAMPVA), the VA is now offering a dental insurance program that gives you the option to buy dental insurance through Delta Dental and MetLife at a reduced cost.

The VA also provides free dental care to vets who have dental problems resulting from service. To learn more about these options, visit va.gov/dental or call 877-222-8387.

Low Income Options

If you’re low income, there are various programs and clinics that provide dental care at a reduced rate or for free. To look for options in your area, contact your state dental director at www.astdd.org/state-programs/California/ or phone 916-552-9896.

You may also be able to get discounted or free dental care at one of the federally funded HRSA health centers (findahealthcenter.hrsa.gov, 877-464-4772), or at a privately funded free clinic (nafcclinics.org).

Also, check with the Dental Lifeline Network (dentallifeline.org, 888-471-6334) which provides free dental care for low-income elderly and disabled; Remote Area Medical (ramusa.org) which offers free health, eye and dental care to people in select locations; and Indian Health Service (ihs.gov), which provides free dental care to American Indians and Alaska Natives who are members of a federally recognized Indian tribe.

Also, see toothwisdom.org, a website created by Oral Health America that will help you locate low-cost dental care.

 

 
Improve Your Balance as You Age PDF  | Print |  E-mail
Thursday, 06 November 2014 15:21

Most people don’t think much about practicing their balance, but you should, the same way that you walk to strengthen your heart, lungs and overall health, or you stretch to keep your body limber.

As we age, our balance declines — if it isn’t practiced — and can cause falls. Every year, more than one in three people age 65 years or older fall, and the risk increases with age. A simple fall can cause a serious fracture of the hip, pelvis, spine, arm, hand or ankle, which can lead to hospital stays, disability, loss of independence and even death.

How Balance Works: Balance is the ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling.

It’s determined by a complex combination of muscle strength, visual inputs, the inner ear and the work of specialized receptors in the nerves of your joints, muscles, ligaments and tendons that orient you in relation to other objects.

It’s all sorted out in the sensory cortex of your brain, which takes in the information from those sources to give you balance. But aging dulls our balance senses, and causes most seniors to gradually become less stable on their feet over time.

Poor balance can also lead to a vicious cycle of inactivity. You feel a little unsteady, so you curtail certain activities. If you’re inactive, you’re not challenging your balance systems or using your muscles. As a result, both balance and strength suffer.

Simple acts like strolling through a grocery store or getting up from a chair become trickier. That shakes your confidence, so you become even less active.

Balance Exercises: If you have a balance problem that is not tied to illness, medication or some other specific cause, simple exercises can help preserve and improve your balance. Some basic exercises you can do anytime include:

• One-legged stands: Stand on one foot for 30 seconds, or longer, then switch to the other foot. You can do this while brushing your teeth or waiting around somewhere. In the beginning, you might want to have a wall or chair to hold on to.

•Heel rises: While standing, rise up on your toes as far as you can. Then drop back to the starting position and repeat the process 10 to 20 times. You can make this more difficult by holding light hand weights.

• Heel-toe walk: Take 20 steps while looking straight ahead. Think of a field sobriety test.

• Sit-to-stand: Without using your hands, get up from a straight-backed chair and sit back down 10 to 20 times. This improves balance and leg strength.

For additional balance exercises, visit go4life.nia.nih.gov, a resource created by the National Institute on Aging that offers free booklets and a DVD that provides illustrated examples of many appropriate exercises. You can order your free copies online or by calling 800-222-2225.

Some other exercises that can help improve your balance and flexibility is through tai chi and yoga. To locate a beginner’s class in your area that teaches either of these disciplines, call your local senior center, health club or wellness center, check your yellow pages or try online directory sites like americantaichi.net and yogafinder.com.

If nothing is available near you, there are DVDs and videos that offer tai chi and yoga instructions and routines for seniors that you can do at home. Some good resources for finding them are amazon.com, collagevideo.com and iefit.com, or check with your local public library.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org.


 
Do’s and Don’ts of Disinheriting a Family Member PDF  | Print |  E-mail
Thursday, 06 November 2014 15:19

By Gene L. Osofsky, Esq. • Special to the Times

Q: Regretfully, our son has been a ne’er-do-well for some time. He has been only sporadically employed and would likely squander any inheritance on drugs. My wife and I are thinking of taking him out of our will and leaving everything to our other two children. Any thoughts about how we should go about doing this?

A: I am sure that this decision must hurt both of you deeply. However, since you asked: Yes, I do have some advice, which I call the “Do’s and Don’ts” when disinheriting a child:

1) Do Consider a “Skip Bequest” to His Children: If your son has children, you might leave his share directly to his own children, perhaps in a trust or guardianship arrangement managed by one of your other children. That might be more palatable to both you and your wife, and might very well discourage a will contest by him.

2) Do Consider an Incentive Trust: You might leave your son’s share to an Incentive Trust. This is a trust designed to encourage behavioral changes as a condition to receiving trust benefits.

For example, if your goal is to encourage him to be drug-free, you might specify that he must test free of drugs for a period of 24 months before he receives any benefit from the trust. You could also require that he maintain steady employment and provide proof of same to the trustee.

3) Do Document Your Decision: If you feel there is any possibility that your son might challenge your will on the ground that you lacked capacity, take steps now to help your other children defend against a challenge later.

You might suggest to your attorney that, at the time of signing your will, he or she record an audio or videotape interview with you and your wife, wherein you discuss your reasons for disinheriting your son. Additionally, it might be wise to secure from each of your physicians a letter affirming your capacity to make estate planning decisions.

4) Don’t Overlook Naming Him In Your Will or Trust. If you stay with your decision to disinherit your son, it might be tempting to not even identify him in your estate plan. That would be a mistake.

Were you to omit his name entirely, the law would presume that you just had a memory lapse, and a judge would likely insert him back into your will to take his proportionate share as a pretermitted heir. To protect against this, you should specifically identify him in your plan documents, and only then recite that he is left nothing.

5) Don’t Rely Exclusively on the “No Contest Clause:” While designed to discourage will contests, the common No Contest Clause (“NCC”) often included in wills, standing alone, would likely not work.

The NCC merely says that anyone who unsuccessfully challenges a will receives nothing. It is designed to discourage a beneficiary from trying to get a larger share of one’s estate. However, in your case, you propose to leave nothing to your son at the outset. Thus, he would have nothing to lose — and potentially a lot to gain — by challenging your will.

For this reason, it would be better to leave him something, say, just enough to discourage a will contest. He would then have something at risk, and the NCC would have a greater chance of achieving its purpose.

Gene L. Osofsky is an elder law and estate planning attorney in Hayward.  Visit his website at www.LawyerForSeniors.com.


 
Medicare Covers Mental Health Services PDF  | Print |  E-mail
Thursday, 16 October 2014 14:52

101614senBy Jim Miller • Special to the Times

Medicare recently upgraded its coverage of outpatient mental health services to help beneficiaries with depression and other needs. Here’s how it works.

If you have original Medicare, your Part B coverage will pay 80 percent (after you’ve met your $147 Part B deductible) for a variety of counseling and therapy services that are provided outside a hospital, like individual and group therapy, family counseling and more. They also cover services for treatment of beneficiaries who struggle with inappropriate alcohol and drug use.

You or your supplemental insurance is responsible for the remaining 20 percent coinsurance.

Medicare also gives you the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.

It’s also important to understand that if you decide to see a non-medical doctor (such as psychologists or a clinical social worker), you’ll need to make sure that he or she is Medicare-certified and takes assignment, which means they accept Medicare’s approved amount as full payment. If they don’t, Medicare will not pay for the services.

Medicare will, however, pay for the services of Medicare-certified medical doctors (such as psychiatrists) who do not take assignment, but these doctors can charge you up to 15 percent above Medicare’s approved amount in addition to the 20 percent coinsurance, which you will be responsible for.

To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare’s online Physician Compare tool. Just go to medicare.gov/physiciancompare and type in your zip code, or city and state, then type in the type of profession you want to locate, like “psychiatry” or “clinical psychologist” in the “What are you searching for?” box. You can also get this information by calling Medicare at 800-633-4227.

Medicare Advantage

If you get your Medicare benefits through a private Medicare Advantage plan, they too must cover the same services as original Medicare, but they will likely require you to see an in-network provider. You’ll need to contact your plan directly for the details.

Additional Coverage

In addition to the outpatient mental health services, you should also know that Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic that can assure appropriate diagnosis, treatment and follow-up. Annual depression screenings are covered 100 percent.

Medicare will also cover almost all medications used to treat mental health conditions under the Part D prescription drug benefit. If you’re prescribed an antidepressant or some other medication, and you have a Part D plan, you should call to confirm coverage or you can search the plans formulary (the list of medications they cover) on their website.

For more info, call Medicare at 800-633-4227 and request a copy of publication #10184 “Medicare & Your Mental Health Benefits,” or read it online at medicare.gov/publications/pubs/pdf/10184.pdf.

Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior.”


 
Does My Living Trust Contain a ‘Poison Pill?’ PDF  | Print |  E-mail
Thursday, 16 October 2014 14:50

By Gene L. Osofsky, Esq. • Special to the Times

Q: In past articles you have written about the option of seeking a Medi-Cal subsidy to help pay for the cost of nursing home care if that need arises. I have a Living Trust. Are there provisions that I should include, or some that I should avoid, in order to facilitate Medi-Cal qualification?

A: Great question. While I cannot provide an exhaustive list in the space of this article, I can comment on one that is critically important: a Living Trust-based estate plan should permit amendment or revocation by a trusted agent if the trustor, himself, later becomes incapacitated.

Background: When many people set up trusts, they provide that only they, themselves, are empowered to make amendments or withdrawals from the trust. For persons in robust good health, that restriction makes perfect sense: they understandably do not want others tampering with their trust.

However, when those same individuals age, become infirm and face the need for nursing care, this restriction can become a financial obstacle.

Reason: In order to invoke strategies to accelerate eligibility for a Medi-Cal nursing home subsidy, it is often necessary to first remove assets from the trust. The same is true when the goal is to protect the home or other assets from a Medi-Cal “payback,” or recovery claim, after death.

The problem arises where the infirm trustor does not then have sufficient mental capacity to sign documents to amend or remove assets from his trust.

In that case, his family may be unable to invoke planning strategies to deal with excess resources and qualify him for Medi-Cal. Without help from Medi-Cal, the cost of care could potentially drain the trust estate, to the financial detriment of the trustor and his family.

Check to see if your trust provides that the right of amendment or withdrawal is “personal” to you, as the trustor. If so, you may have a problem. Such a provision might read something like the following:

“The power to revoke or amend this trust is personal to the settlor and shall not be exercisable on the settlor’s behalf by a conservator, an agent under a power of attorney, or any other person or entity.”

If your trust contains a provision like the above, it could be the “poison pill” which later exposes your trust assets to rapid spend down in the event you need nursing care and/or to a substantial Medi-Cal recovery claim after death.

Perhaps a better plan would be to change your trust now to authorize your trusted agent under a Durable Power Of Attorney (“DPOA”) to amend or revoke your trust in certain circumstances, such as if the need for nursing care arises. If you are concerned that such power might be abused, you might build restrictions into its exercise, such as by requiring the written certification of a physician that you need nursing home care, the approval of an attorney who practices in the field of Medi-Cal planning and/or the approval of a judge.

If you do opt to so modify your trust, be sure to include coordinating provisions in your DPOA, a legal requirement that is often overlooked.

Lastly, for those who no longer have capacity to change their trust, know that application can sometimes still be made to the superior court for permission to amend or revoke the trust when need requires, a process which is expensive and the outcome uncertain.

Gene L. Osofsky is an elder law and estate planning attorney in Hayward. Visit his website at www.LawyerForSeniors.com.



 

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