Medicare

Clients are frequently confused over the differences between Medicare and Medicaid. Though their names are very similar, the programs are quite different. Medicare is an entitlement program, a federal health insurance program in which most people enroll when they turn 65 years old. There are no financial qualification rules. Medicare has two primary parts: Part A and Part B.

Medicare Part A covers in-hospital care, extended care after a hospital stay, some home health care services, and hospice services. The rules for nursing home coverage are very strict and, in fact, Medicare pays for less than 9 percent of nursing home care in this country.

New Jersey Medicaid

Medicaid, is a joint federal-state program, subject to certain federal requirements, each state implements its own regulations on how the program is managed. Medicaid is not an entitlement program like Medicare, but rather a form of welfare. Medicaid eligibility is determined after the proper application is submitted to the state. There are many Medicaid insurance programs available in New Jersey, from basic medical coverage to nursing home programs.

We assist seniors and their families in making the tough decisions regarding long-term care planning, including whether Medicaid eligibility may be an option.

Many families struggle to provide necessary care for aging or disabled Veterans or their surviving spouses. Unfortunately, most of these families are unaware of an important benefit available through the Department of Veterans Affairs to which their loved ones may be entitled. It is called Aid and Attendance.

For qualifying veterans, Aid and Attendance is paid in addition to the basic pension rate for seriously disabled wartime veterans who have limited or no income, and who are age 65 or older, or, if under 65, who are permanently and totally disabled.

Some key things to know about the Aid and Attendance benefit:

*Aid and Attendance is a pension benefit and is not dependent upon service-related injuries.
*Wartime veterans and their surviving spouses may be eligible.
*Certain medical and financial requirements must be met.
*Aid and Attendance can help pay for care in the home, nursing home or assisted living facility.

The Application Process

Application for Aid and Attendance Benefits is a complex and lengthy process. The forms are available for you to do this yourself, but be advised that if you apply and your application is denied, you must wait a year before you can reapply. For these reasons, many people seek assistance in completing the application. Note: It is illegal for anyone to charge you a fee to help complete the application or file for benefits.

Our office can assist with you with this process – at no cost to you.
The Aid and Attendance Benefit – How Much Could You Receive?

The cost of assisted living, nursing home or home health care can be substantial. In fact, a 2015 survey conducted by Genworth Financial found that the national median monthly rate for a one-bedroom apartment in an assisted living facility runs $3,600, the national median daily rate for a semi-private nursing home room is $220, and the national median hourly rate for a licensed home health aide is $20. Aid and Attendance Benefits could help defray these types of costs for qualified veterans and their surviving spouses.
The 2016 Maximum Benefits

Maximum Monthly Benefit for Surviving Spouse: $1,149*
Maximum Monthly Benefit for Single Veteran: $1,788*
Maximum Monthly Benefit for Married Veteran: $2,120*
Maximum Monthly Benefit for Married Veteran Couple: $2,837*

*Note: these maximum benefit amounts may fluctuate and the actual benefit that is approved may be less.
Who is Eligible to Receive Aid and Attendance Benefits?

There are three aspects of eligibility – Service, Medical and Financial.

Service. The basic service qualification is that the veteran must have served at least 90 days of active military duty, with at least one of those days during wartime (as defined by the Veteran’s Administration). Additionally, the veteran must have received a discharge that was other than dishonorable.

Medical. The veteran or surviving spouse must show that they require the “aid and attendance” of another person to perform the basic activities of daily living. The VA defines the need for aid and attendance as:

Requiring the aid of another person 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
Being blind or nearly blind, or
Being 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
Being a patient in a nursing home due to mental or physical incapacity.

Financial. Qualifying under the asset test can be tricky. The basic requirements state that the person requesting the benefit must have a financial need. Each application is evaluated individually. Although you may hear or read that having up to $80,000 in assets (exclusive of a home and a car) is acceptable, consider this merely a general rule of thumb. In contrast to Medicaid eligibility, there are no set asset limits when it comes to Aid and Attendance eligibility. The final decision regarding the asset test depends on the VA reviewer. In addition to the asset test, there also is an income test. As with the asset test, there is no specified income limit. However, the VA considers what it refers to as IVAP – Income for VA Purposes. IVAP is equal to your gross income from all sources, less a portion of unreimbursed medical expenses. If your IVAP is not less than the annual benefit amount, you will not be eligible for benefits.
How Can I Qualify for Aid and Attendance Benefits?

What if you are service and medically eligible, but have too many assets or too much income to qualify? You may consider rearranging your assets and/or income to qualify, which may include re-titling or giving away assets, or establishing a Veterans Administration Aid and Attendance Pensions Benefits Trust. Making these types of changes is perfectly legal, but doing so properly can be complicated. Beware that some actions taken to qualify for VA benefits could create a penalty period, or perhaps even disqualify you entirely from receiving Medicaid benefits should they be needed.
Business Resources for Returning Veterans

American Hometown Heroes was founded to assist Veterans who are looking to start a new business. Through this initiative, independent yellow page publishers have banded together to provide professional advice and marketing assistance to any returning veteran with a desire to start a new business in their hometown (or has recently started a local business) – all at no charge to them! The program includes a comprehensive advertising program for an entire year.

Probate and estate administration are the processes through which estate assets are transferred after death. When probate avoidance planning has not been implemented prior to death, the state will require a probate court proceeding if the deceased was a resident or owned assets in the state. Probate can be supervised or unsupervised. In an unsupervised probate, the appointed estate administrator manages assets, pays any debts, files required tax returns and various court documents, and distributes the estate assets. However, the court may at any time require the process to be supervised (usually when someone expresses concern about the estate administration). In a supervised probate, the probate judge must approve every detail of the estate administration.
Probate Avoidance

Because probate can be a lengthy, costly and public process, many people choose to avoid it. There are a number of legal strategies that will allow you to pass property to another person after death, without going through probate.

Joint Tenancy & Tenancy by the Entirety. Adding another person to your assets as a joint owner or “joint tenant with rights of survivorship” will allow your property to pass to them upon your death without going through probate. There are pitfalls to this strategy, however, to include subjecting such assets to any claims (such as lawsuits) against the co-owner and making them available to the co-owner’s creditors — all while you are still alive and planning on using the assets yourself
Beneficiary Designations. New Jersey allows Transfer on Death (TOD) or Pay on Death (POD) beneficiary designations to be added to bank accounts. Beneficiary designations like these are preferable to joint tenancy in that they allow you to transfer property only upon your death without giving away current ownership. One of the drawbacks, however, is that it can be difficult to obtain an equitable distribution of property among your heirs by utilizing beneficiary designations. Additionally, understand that if you have beneficiaries listed on your assets, those assets will be distributed upon your death to the listed beneficiaries, even if your last will and testament states otherwise.
Revocable Living Trust. A Revocable Living Trust is a legal document that allows you to establish a separate entity (the trust) to “hold” legal title to your assets while you are alive, and to name trustees to manage those assets according to the trust terms. Typically, you serve as the trustee while you are alive, managing your assets for your own benefit. Upon your disability or death, the trust terms appoint your successor trustee who then continues to manage — or distribute — the assets held in trust. A properly drafted trust can accomplish many goals, including guardianship and probate avoidance for your estate and bloodline, marital and creditor protection for your children.

New Jersey Estate and Trust Administration

A properly drafted and funded trust will generally avoid probate. The trust need not be filed with the probate court. Nonetheless, there are still steps necessary to administer the trust: beneficiaries must be contacted; assets must be gathered, valued and managed; potential creditors must be notified; debts, taxes and final expenses must be paid; and, ultimately, any remaining income and assets must be distributed in compliance with the trust terms. Successor trustees often lack the time, resources or knowledge to personally administer the trust, and therefore may call upon legal, accounting and investment professionals for assistance. Oftentimes, a corporate fiduciary (e.g., a trust company) is an excellent alternative to relying solely on busy family members or friends to serve as trustee. We can help your successor trustee(s) deal with the complexities of administering your trust. Please call our office and we will be happy to schedule a consultation, whether or not our office has drafted the original trust.

There are many legal strategies involved in estate planning, including wills, revocable living trusts, irrevocable trusts, durable powers of attorney, and health care documents. New clients often say that they do not have an estate plan. Most people are surprised to learn that they actually do have a plan. In the absence of legal planning otherwise, their estate will be distributed after death according to New Jersey’s laws of intestacy. Of course, this may not be the plan they would have chosen. A properly drafted estate plan will replace the terms of the State’s estate plan with your own.
More About Estate Planning Services:
Your Last Will and Testament

Your last will and testament is just one part of a comprehensive estate plan. If a person dies without a Will they are said to have died “intestate” and state laws will determine how and to whom the person’s assets will be distributed. Some things you should know about wills:

A will has no legal authority until after death. So, a will does not help manage a person’s affairs when they are incapacitated, whether by illness or injury.
A will does not help an estate avoid probate. A will is the legal document submitted to the probate court, so it is basically an “admission ticket” to probate.
A will is a good place to nominate the guardians (or back-up parents) of your minor children if they are orphaned. All parents of minor children should document their choice of guardians. If you leave this to chance, you could be setting up a family battle royal, and your children could end up with the wrong guardians.

Trusts: Revocable Living Trusts, Irrevocable Trusts, Testamentary Trusts, Special Needs Trusts, etc.

Trusts come in many “flavors,” they can be simple or complex, and serve a variety of legal, personal, investment or tax planning purposes. At the most basic level, a trust is a legal entity with at least three parties involved: the trust-maker, the trustee (trust manager), and the trust beneficiary. Oftentimes, all three parties are represented by one person or a married couple. In the case of a revocable living trust, for example, a person may create a trust (the trust-maker) and name themselves the current trustees (trust managers) who manage the trust assets for their own benefit (trust beneficiary).

Depending on the situation, there may be many advantages to establishing a trust, including avoiding probate court. In most cases, assets owned in a revocable living trust will pass to the trust beneficiaries (or heirs) immediately upon the death of the trust-maker(s) with no probate required. Certain trusts also may result in tax advantages both for the trust-maker and the beneficiary. Or they may be used to protect property from creditors, or simply to provide for someone else to manage and invest property for the trust-maker(s) and the named beneficiaries. If well drafted, another advantage of trusts is their continuing effectiveness even if the trust-maker dies or becomes incapacitated.
Powers of Attorney

A power of attorney is a legal document giving another person (the attorney-in-fact) the legal right (powers) to do certain things for you. What those powers are depends on the terms of the document. A power of attorney may be very broad or very limited and specific. All powers of attorney terminate upon the death of the maker, and may terminate when the maker (principal) becomes incapacitated (unable to make or communicate decisions). When the intent is to designate a back-up decision-maker in the event of incapacity, then a durable power of attorney should be used. Durable Powers of Attorney should be frequently updated because banks and other financial institutions may hesitate to honor a power of attorney that is more than a year old.
Health Care Documents (or Advance Directives)

An advance directive is a document that specifies the type of medical and personal care you would want should you lose the ability to make and communicate your own decisions. Anyone over the age of 18 may execute an advance directive, and this document is legally binding in New Jersey. Your advance directive can specify who will make and communicate decisions for you, and it can set out the circumstances under which you would not like your life to be prolonged if, for example, you were in a coma with no reasonable chance of recovery.

A document that goes hand-in-hand with your advance directive is an authorization to your medical providers to allow specified individuals to access your medical information. Without this authorization, your doctor may refuse to communicate with your hand-picked decision maker.

There are several types of trusts to assist with these special planning challenges. The most common types are Support Trusts and Special Needs Trusts.

Support Trusts: Support Trusts require the Trustee to make distributions for the child’s support in areas like food, shelter, clothing, medical care, and educational services. Beneficiaries of Support Trusts are not eligible to receive financial assistance through Supplemental Security Income (SSI) or Medicaid. If your child will require SSI or Medicaid, you should avoid a Support Trust.

Special Needs Trusts: For many parents, a Special Needs Trust is the most effective way to help their child with a disability. A Special Needs Trust manages resources while also maintaining the child’s eligibility for public assistance benefits.

There are two types of Special Needs Trusts:

Third-Party Special Needs Trust: Created using the assets of the parent(s) as part of an estate plan; distributed by a Will or Living Trust.

Self-Settled Special Needs Trust: Generally created by a parent, grandparent or legal guardian using the child’s assets to fund the Trust (e.g., when the child receives a settlement from a personal injury lawsuit and will require lifelong care). If assets remain in the Trust after the child’s death, a payback to the state is required, but only to the extent the child receives public assistance benefits.

Special Needs Trusts are a critical component of your estate planning if you have loved ones with disabilities for whom you wish to provide after your passing. Generally, Special Needs Trusts are either stand-alone trusts funded with separate assets (like life insurance) or they can be sub-trusts in existing living trusts.

The Activities of Daily Living are generally uniform across the Country, both to determine the need for governmental benefits, but also to trigger benefits from Long Term Care Policies. They include, unassisted, transferring (the ability to get from a bed to a chair, or a chair to sitting up), bathing (the ability to bathe oneself safely which can include personal hygiene of grooming, dental hygiene, nail and hair care), toileting (the ability to get to and use the toilet, use appropriately, and clean oneself), continence (the ability to “hold it in,” – control bladder and bowel function), feeding (the ability to feed oneself, and dressing (the ability to select appropriate cloths and to put the clothes on).