Solving Only One-Half of the Problem
Joe called me because the hospital social worker suggested it. His wife, Mary had been in the hospital but was now ready to be discharged. However, Joe was just now coming to the realization that Mary can’t go home. He just is not capable of caring for her any longer. While he is the healthy spouse of the two he is 85 and physically can’t continue to be Mary’s caregiver. Mary is 83. Joe told me that in recent weeks her dementia has progressed. She needs assistance with at least 3 of the activities of daily living. She can’t bathe, dress or go to the bathroom on her own. She is also having balance issues and often needs assistance walking. The social worker suggested he look at long term care facilities. That’s when Joe got a bit of sticker shock at the cost. His call to us was a cry for help. Joe told me Mary began experiencing the signs of dementia about 3 years ago. That’s when he said he went to an attorney to get his affairs in order. I asked him what he understood that to mean. Joe then explained to me that he wanted to
New Jersey Courts Decide Case Involving Estate Recovery and Elective Share (Part 2)
Last week I told you about a case that was just decided by a New Jersey court in which a family tried to avoid the impact of New Jersey’s elective share as it relates to Medicaid. (See 1/30/17 post for an explanation of the elective share and Medicaid estate recovery). Here are the basic facts. Arthur Brown had been receiving Medicaid benefits for almost 5 years until his death in 2013. Following his death, the State of New Jersey, under Medicaid estate recovery rules sought reimbursement from his estate of $167,000 in benefits it paid out during his lifetime. The State determined that its lien attached to Arthur’s 1/3 elective share interest in his wife, Mary’s estate. Mary had died in 2010. Before her death she executed a will which left her estate to her 3 children, leaving nothing to Arthur. When Arthur was approved for Medicaid in 2008, under Community Spouse Resource Allowance rules Mary was able to keep the couple’s home (Arthur transferred his interest to her) and approximately $70,000. This is essentially what was left in her estate when she died. Mary’s son, Thomas as Executor of her estate notified Medicaid of her death and advised
New Jersey Courts Decide Case Involving Estate Recovery and Elective Share #EstateRecovery
Estate recovery is something I am asked about frequently when it comes to Medicaid, although families rarely pose it in those terms. The question, or some variation of it, goes as follows: “Will Medicaid put a lien on my home?” What we are talking about is the State of New Jersey’s ability to seek reimbursement for benefits it paid out on a Medicaid recipient’s behalf. The law only allows the State to assert the lien after the Medicaid recipient dies. The elective share, on the other hand, is something that families rarely if ever ask me about, simply because the general public is not aware of it. However, where the Medicaid recipient is married and the spouse is not a Medicaid recipient, the question I am asked is “Must that spouse leave the Medicaid spouse anything in his/her will? The answer to that question is impacted by the elective share, a state law that is intended to protect a surviving spouse from being completely “cut out” of a spouse’s will. In New Jersey, unless the surviving spouse knowingly waives this right, (s)he is entitled to 1/3 of the deceased spouse’s estate less what (s)he already has. A surviving spouse
The Importance of a Good Medicare Supplemental Policy (Part 2)
Last week I was telling you about a call I received from Mary. Her husband, John had a heart attack which led to other medical complications. Long story short he had been in the hospital for 4 months and was now close to exhausting his Medicare coverage under Part A, exposing them to hospital bills in the tens of thousands of dollars or more. How is that possible? Let’s look at how Medicare Part A coverage works. Medicare will cover up to 90 days of hospitalization for a single benefit period. There is a deductible of $1316 for days 1 thru 60. Days 61 thru 90 carry a coinsurance charge of $329/day. For the first 90 days of John’s hospital stay the out of pocket cost to Mary and John was $11,186. If a hospital stay lasts more than 90 days, there are an additional 60 days of coverage under a lifetime reserve. As the term “lifetime” suggests, this is a onetime 60 day term. John is in danger of running thru all his lifetime days. These additional 60 days of coverage also come with a coinsurance charge of $658 per day. That totals $39,480 out of pocket. Mary
The Importance of Having a Medicare Supplement (Part 1)
Since a large majority of our clients are over the age of 65 or disabled and receiving Social Security, those clients also receive Medicare benefits. Medicare does not cover long term care so as elder law attorneys we don’t spend much time addressing Medicare questions and problems. However, I do get questions from clients who are turning 65 about what to choose when it comes to sufficient coverage. There are gaps in Medicare coverage so a comprehensive supplemental or “Medigap” policy is important to fill those gaps. We refer these questions to knowledgeable insurance professionals who focus on the Medicare supplement market and are very adept at finding the right policy for clients. A call I received not too long ago highlights the importance of these supplemental policies. Mary called because her husband John, age 75, was in the hospital. He had a heart attack which led to further complications caused by diabetes. The result is that he has been in the hospital for an extended period of time. Mary told me that he has been hospitalized for 4 months now and is within 30 days of using up his Medicare lifetime reserve days. Mary and John have more
What to Do When You Have No One to Help (Part 2)
Last week I presented to you the hypothetical, but very common case, of Jane who is in the hospital and has acute and chronic health issues. She has no family or she is estranged from her family. The immediate problem is that she has no designated person to act on her behalf as agent under her power of attorney or as health care representative under her health care directive. Her current mental and physical state is such that she can’t make the many decisions large and small that the hospital staff – doctors, nurses and social workers – need her to make with regard to her treatment and discharge plan. So to whom can she turn? Before I answer that question let’s talk about what kinds of decisions will need to be made? If Jane is in the midst of a serious medical crisis, doctors and nurses will administer whatever treatment is necessary to stabilize Jane if she is in immediate danger. The need for a decision maker doesn’t stop there, however. If Jane is elderly and has chronic health issues tough questions remain concerning her discharge plan. Can she go home alone or will she need supervised care?