Archive for October, 2010

Planning for Long-Term Care

Friday, October 29th, 2010

Planning for long-term care helps identify what service options are available in your community, as well as what special conditions may apply for receiving services (e.g., age, cost, payment options). Obtaining this information is good preparation for the time when a person will be needing long-term care. It will help you understand what choices you have, and control over what, where, and how you receive the services you will need.

About 70 percent of people over the age of 65 require some services. The likelihood of needing care increases as we age. Planning is critical because the cost of long-term care services often exceeds what the average person can pay from income and other resources. If you plan ahead, you may be able to save your assets and income for uses other than long-term care.

With effective planning, there is of course greater likelihood of being able to preserve your estate for your loved ones, by minimizing the costs of paying for long-term care. It also translates to less financial stress and emotional wear-and-tear on you and your family. The chances of being able to stay at home as long as possible and within your community will be much greater. Most importantly, it helps ensure a greater degree of independence if and when you need care.

Despite the importance of planning, a lot of people fail to do so. There are many reasons for this shortcoming. People have a natural tendency to avoid thinking of unpleasant things, of being dependent on others as we age. We don’t like to think about getting older, being disabled, becoming less independent, or needing help with our own personal care. There is also a lot of existing misinformation about long-term care needs, as well as their costs and payment options associated with these services.

For example, most people have no idea how expensive long-term care can be, and how it is paid. Many seniors don’t realize that health insurance, Medicare, and/or disability coverage do not pay for most long-term care services. Medicaid (Medi-Cal) pays for some long-term care services, but only if one qualifies due to income  and financial resource limitations.

Planning for long-term care is a difficult subject of conversation in most families. Adult children may hesitate to bring up the subject, for fear that they may be patronizing their parents. They may think that their eagerness to bring up this topic may be misconstrued as not wanting to provide care for their parents “when the time comes.” Parents may not want discuss the details of their financial life with their children. It may also be as simple as not knowing how to go about the planning process itself.

In future posts, we will talk about some of the key information and resources you need to know in order to plan ahead…

The Basics of Medi-cal

Saturday, October 23rd, 2010

Medi-cal (called Medicaid in other states) is a program that helps low income persons and others with limited resources and high medical expenses.

Medi-Cal is different from Medicare Insurance. It is a needs-based program, and eligibility is based on the amount of income and resource a person has.

You should be aware that Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance. Furthermore, there is no Medicare coverage for nursing home care beyond 100 days in any single benefit period. It also only pays for “skilled nursing care,” and therefore does not cover any “custodial care” expenses.

Also, it should be noted that there are a number of other Medi-Cal programs for special categories of consumers. This post focuses on Medi-Cal for long-term care.

Eligibility

To be eligible for Medi-Cal’s long-term care services, you must meet the requirements for: (a) income, (b) assets (real or personal property), (c) residence, and (d) citizenship.

Most of the eligibility requirements relevant to long-term care can be grouped into two general categories:

(1) those classified as categorically needy and therefore qualify for Medi-Cal;

(2) those who are medically needy and may become eligible by incurring medical expenses each month.

These categories include some low-income Medicare beneficiaries who are also eligible for Medi-Cal.

Low income individuals who receive cash assistance from programs like CalWORKS or Supplemental Security Income (SSI) qualify for Medi-Cal automatically. Other eligible groups are those who meet financial criteria but are not receiving cash assistance, including those with specific health needs like dialysis; individuals who are in a long-term care institution; or individuals who would require the level of care provided in a nursing home.

Individuals who are medically needy are those with high medical expenses who may have too much income or property to qualify as categorically needy. However, they must meet the cash assistance requirements (e.g., age, blindness, disability) to be eligible. These individuals may be eligible with or without a “share of cost.” This refers to the amount of medical expenses an individual must incur before Medi-Cal kicks in. Share of cost is determined by income.

Once you pay your monthly share of cost towards your medical expenses, you will receive a Medi-Cal card, which you can then use to pay for Medi-Cal covered services. Share of cost works like an insurance deductible. It is determined by the Medi-Cal Office and is generally defined as the difference between your gross monthly income, minus deductions and the need standard.

Veterans Pension Benefits – Part 3

Saturday, October 16th, 2010

Income Requirements.

In order to be eligible to receive any of the non-service connected pensions, the veteran must meet income and net worth requirements.

First, the annual maximum pension amount is decreased, dollar for dollar, by the veteran’s countable income. Income that is countable is generally defined as:  all the veteran’s income, including that of any dependents, minus unreimbursed medical expenses.

Unreimbursed medical expenses include doctor’s fees, dentist’s fees, prescription glasses, Medicare premiums and co-payments, prescriptions, insurance premiums, transportation to physicians’ offices, and the costs of assisted living facilities or in-home aides.

For example, if a veteran has $20,000 in income and $10,000 in unreimbursed medical expenses, their countable income is $10,000. This $10,000 countable income is deducted from the Maximum Annual Pension Rate (MAPR) of $11,830 for a benefit of $1,830. (This example assumes that the veteran has no spouse or child.)

The other MAPR categories and corresponding dollar amounts are as follows: With One Dependent, $15,493; Housebound Without Dependents. $14,457;  Housebound With One Dependent, $18,120.

Here’s another example. Suppose the veteran is in a nursing home (and therefore qualifies for the additional pension for aid and attendance) and has an income of $50,000. If their unreimbursed medical expense for the nursing home is $5,000 per month, or $60,000, the veteran’s countable income is negative $10,000. Any negative income is counted as an income of zero.

In this case, the veteran will be eligible for the monthly maximum Special Monthly Pension for Aid and Attendance of $19,736. This amount is the MAPR for “A & A Without Dependents.” In the category “A&A With One Dependent,” the amount is $23,396.

What about net worth?

Here’s what the VA has to say about this issue:

“Net worth means the net value of the assets of the veteran and his or her dependents.   It includes such assets as bank accounts, stocks, bonds, mutual funds and any property other than the veteran’s residence and a reasonable lot area.    There is no set limit on how much net worth a veteran and his dependents can have, but net worth cannot be excessive.    The decision as to whether a claimant’s net worth is excessive depends on the facts of each individual case.   All net worth should be reported and VA will determine if a claimant’s assets are sufficiently large that the claimant could live off these assets for a reasonable period of time.   VA’s needs-based programs are not intended to protect substantial assets or build up an estate for the benefit of heirs.”

As you can see, the VA has not specifically defined “excessive” net worth. However, a general guide is that the veteran must have a general net worth lower than $50,000 if single or $80,000 if married.

Veterans Pension Benefits – Part 2

Friday, October 8th, 2010

What are Aid and Attendance and Housebound benefits?

Aid and Attendance (A&A) is a benefit paid in addition to monthly pension.   To get the A&A benefit, you must first be eligible for pension.   A veteran may be eligible for A&A under the following conditions:

The veteran requires the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting himself/herself from the hazards of his/her daily environment, OR,

The veteran is bedridden, in that his/her disability or disabilities requires that he/she remain in bed apart from any prescribed course of convalescence or treatment, OR,

The veteran is a patient in a nursing home due to mental or physical incapacity, OR,

The veteran is blind, or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less.

Housebound is paid in addition to monthly pension.    Like A&A, Housebound benefits may not be paid without eligibility to pension.   A veteran may be eligible for Housebound benefits when:

The veteran has a single permanent disability evaluated as 100-percent disabling AND, due to such disability, he/she is permanently and substantially confined to his/her immediate premises, OR,

The veteran has a single permanent disability evaluated as 100-percent disabling AND, another disability, or disabilities, evaluated as 60 percent or more disabling.

A veteran cannot receive both Aid and Attendance and Housebound benefits at the same time. 

Veterans Pension Benefits – Part 1

Friday, October 1st, 2010

In the previous post, we talked about the service-connected disability compensation.  Another veterans benefit that is important for seniors to know is the Non-Service-Connected Disability Pension.

pension is a benefit for veterans with low incomes who are permanently and totally disabled, when that disability is not related to military service. This is sometimes referred to as a “Special Monthly Pension” (or sometimes an “Improved Pension”).

A veteran will be considered permanently and totally disabled if they are:

1) a patient in a nursing home for long term care because of a disability

2) receiving Social Security disability benefits

3) unemployable as a result of a disability that is reasonably certain to continue throughout their life, or

4) suffering from a disease or disorder that renders them permanently disabled as determined by the Secretary of the Department of Veterans Affairs.

Currently, the maximum disability pension rate for a veteran with no dependents is $11,830, or $985 per month. The rate for a veteran with one dependent, or for two veterans marriedd to each other is $15,493, or $1,291 per month. Each additional dependent child adds $2,020, or $168 per month, to the pension.

(It should be noted that the Aid and Attendance benefit is paid in addition to the basic pension rate.)

Eligibility.

Veterans who satisfy all of the following four conditions may be eligible:

1) You were discharged from service under conditions other than dishonorable.

2) You served at least 90 days of active military service 1 day of which was during a war time period.

3) Your countable family income is below a yearly limit set by law.  “Countable income,” for VA pension eligibility purposes, includes earnings, disability and retirement payments, interest and dividends, and net income from farming or business.

4) You are 65 or older, or, you are permanently and totally disabled, not due to your own willful misconduct.

Calculation of Pension Benefit.

The annual pension is calculated by first getting a total of one’s countable income. Any applicable deductions are then subtracted from this total. The remaining countable income is deducted from the appropriate annual pension limit which is determined by the number of dependents, if any, and whether or not you are entitled to housebound or aid & attendance benefits. This amount is then divided by 12 and rounded down to the nearest dollar. This is the monthly pension amount.

Part of the complexity of  this calculation has to do with understanding  the exclusions to income or deductions that may be made to reduce countable income, which in turn can increase the amount of monthly benefit received.

If you need to obtain more information about this topic, don’t hesitate to call our office at (562) 920-6100. We’re here to help. Ask for Sean McGuire, our Veterans Benefits expert…