Long Term Care Planning means... Having your paperwork in order AND

Transcription

1

2 Long Term Care Planning means... Having your paperwork in order AND knowing what financial options are available to pay for long term care in both pre-crisis and crisis situations.

3 Getting Your Paperwork in Order Legal Document Preparation

4 First step: Legal Document Preparation Having your paperwork in order... Durable Financial Power of Attorney Durable Medical Power of Attorney Mental Health Care Power of Attorney Living Will (Advanced Directives) Estate Planning Portfolio (Living Trust, Wills, Powers of Attorney, Directions letters, Duties, etc.) Deeds Income-only Trust (applicable for ALTCS only)

5 Having your paperwork in order FINANCIAL POWER OF ATTORNEY A document that allows you to appoint someone to handle your financial affairs Choose someone you trust Durable means that the document continues to be legally valid even if you become incapable or unable to handle your finances You can make this document effective immediately or only upon your incapacitation You may want to name one or two back-up agents in case first person is unavailable or unable to act as your agent. Must be witnessed by someone not related to you and notarized

6 Having your paperwork in order MEDICAL POWER OF ATTORNEY A document that allows you to appoint someone to handle your medical care and health care decisions IF you become incompetent or incapacitated Choose someone you trust to honor your personal wishes with regard to your health care and health care treatments Only valid when you are incompetent or incapacitated and unable to express your health care wishes You may want to name one or two back-up agents in case first person is unavailable or unable to act as your agent Must be either witnessed by one person not related to you OR notarized

7 Having your paperwork in order Durable Mental Health Care Power of Attorney A document that allows you to appoint someone to handle your mental health care decisions and admit you into a psychiatric treatment facility IF you become incompetent or incapacitated Choose someone you trust to honor your personal wishes with regard to your mental health care and mental health care treatments Only valid when you are incompetent or incapacitated and unable to express your mental health care wishes You may want to name one or two back-up agents in case first person is unavailable or unable to act as your agent Must be either witnessed by one person not related to you OR notarized

8 Having your paperwork in order Living Will A document that allows you to express, in writing, which medical treatments you want or don t want at the end of your life A document that tells your family and loved ones what YOU want and how you want to be treated at the end of your life Must be either witnessed by one person not related to you OR notarized Pre-hospital Medical Care Directive (DO NOT RESUSCITATE) A document that informs emergency medical personnel and hospital emergency personnel to NOT resuscitate you You are asking emergency personnel to NOT use equipment, drugs, or devices to restart your heart or breathing Must be on letter-sized orange colored paper or wallet-sized orange colored paper to be valid Must attach a picture or complete personal information with physical description Must be signed by you in front of a witness Must be signed by your witness and health care provider

9 Having your paperwork in order Living Trust A trust is a written agreement that sets forth who will manage the assets place in it during your lifetime, in the event of your incapacity, and upon your death. Avoids the cost and delays of probate. Upon your death (and your spouse, if married), your Successor Trustee can distribute the assets almost immediately and with little or no additional expense (other than typical costs such as real estate commissions, etc.) Court supervision is not required. Avoids conservatorship if you become incapacitated. Keeps your estate affairs private. A Will that goes through probate makes all aspects of your estate a matter of public record.

10 Having your paperwork in order Deeds Quit-claim deed Any type of property deed where ownership is changing from one person to another person or from persons to persons or from trust to person or person to trust Beneficiary deed A deed that allows you to name a beneficiary and passes from you and/or spouse, upon death, to a named beneficiary, thereby preventing probate. Deeds to transfer property to/from a trust

11 COMMUNICATION... is the key! Talk about your planning with those you are entrusting to be YOU when you aren t capable of being YOU.

12 NOT having your paperwork in order... Costly in cases involving attorneys these costs can range from $2000 on up Guardianship Done through the court system Court decides if you can be guardian Conservatorship Done through the court system Must have a bond Court must approve expenditures

13 Having your paperwork in order Financial Documents Permanent documents, income, statements, deeds, titles, insurance, bills, tax information Master list to work from and/or Organized in one place (easy-to-find) Keep your t s crossed and your i s dotted

14 Pre-crisis Financial Options To Pay For Long Term Care Self-insurance through financial planning (learning to set aside a portion of your income each month) Long term care insurance Reverse mortgage

15 Self-insurance Long term care planning should be done as part of the preparation for retirement. What will it take to save for this goal: Savings available today: $0 $0 $0 Total amount desired in today s dollars (4 yrs NF cost at ~$69,000 per year): $276,000 $276,000 $276,000 Years available to save: Monthly amount needed to save: Rate of interest expected to earn: 5% $ $ $ Rate of interest expected to earn: 10% $43.64 $ $363.46

16 Long Term Care Insurance Policies may cover... Nursing facility care Home health care Respite care Hospice care Personal care in your home Services in adult care homes or assisted living facilities Adult day care

17 Long Term Care Insurance may be right for you if you... NOT been diagnosed with a long term care illness Have significant assets or income Want to protect some of your assets or income Can pay premiums without financial difficulty Want to stay independent of the support of others Want to have flexibility of care in the setting of your choice (at home, in an assisted living facility or care home, or in a nursing facility)

18 Reverse Mortgage Available to those 62 years or older who have equity in their home Continue to live in your home as long as you want No monthly mortgage payments No income qualifications Easy access to the equity in your home Tax-free** (consult tax advisor) Can be received as one lump sum, regular monthly payments as long as you live in home, regular monthly payments for a fixed period, line of credit, or any combination of these

19 Mortgage Debt Reduction Planning 1. Make extra principal payments as you are able to Even making random extra principal payments to your mortgage can help you to reduce your mortgage debt. The extra payments are applied to your principal amount due and will reduce the total number of payments due to the mortgage company and thus reduce the interest you pay on the home. 2. Make consistent monthly extra principal payments This allows you to reduce principal amount due every month and will reduce the total number of payments due to the mortgage company and thus reduce the interest you pay on the home. 3. Money Merge Account This software along with a HELOC helps you make your monthly income work for you to help reduce your debt without adding extra principal payments out of your pocket.

20 Mortgage Debt Reduction Planning 4. If you will only be in house 5 years or less, consider an interest only loan take difference and invest it for your future. This allows you to use the compounding interest effect to work for you during those years when a traditional mortgage is paying interest only anyway. 5. Debt-stacking This plan allows you to take the regular payment that you were making to another debt (that you paid off) and add it to another debt you are still making payments on. Once that other debt is paid off you add both regular payments you were making and add it to another debt that you still owe. This causes all debts to be paid off faster and thus you eventually are adding that to your mortgage and you haven t affected your monthly budget.

21 Crisis Financial Options To Pay For Long Term Care Medicaid Planning Medicaid/ALTCS Veteran s Benefits Reverse mortgage

22 Medicaid Planning Seek out educated professionals who understand system Attend consultation for evaluation of your particular situation Present information which provides you with all available options to qualify for Medicaid Guidance and planning to preserve some of your assets Position yourself to obtain a successful approval the first time you apply for the program Like tax or investment planning, Medicaid planning permits individuals to legally and ethically correct inequities in the system.

23 Arizona Health Care Cost Containment System Arizona Long Term Care System AHCCCS ALTCS

24 ALTCS ELIGIBILITY CRITERIA NON-FINANCIAL MEDICAL FINANCIAL

25 Medicaid/ALTCS Non-financial & Medical 1. Linked to program 2. Citizenship 3. Identity 4. Social Security Number 5. Marital Status 6. Living arrangement 7. Potential benefits 8. Assignment of rights to other health benefits 9. At risk of institutionalization Financial 1. Below Income Limit ($2022/mo for single cases or $4044/mo for spousal cases) 2. Below Resource Limit ($2000 for single cases or can range from $23,912- $111,560 for spousal cases) 3. No Transfers that affect LTC eligibility

26 AHCCCS Medicare Cost-Sharing

27 Medicare Cost-Sharing Programs QMB Pays for Medicare Part B premium, co-insurance, & deductibles. Go to any providers that accept Medicare. If total gross monthly income < $903.00, a single applicant is potentially eligible. If total gross monthly income < $ , a married couple is potentially eligible. AHCCCS and QMB Pays for Medicare Part B premium, co-insurance, & deductibles. Enrollment in AHCCCS health plan covers medical expenses with small co-pay for prescriptions. If total gross monthly income < $903.00, a single applicant is potentially eligible. If total gross monthly income < $ , a married couple is potentially eligible.

28 More Medicare Cost- Sharing Programs... SLMB Pays for Medicare Part B premium only If total gross monthly income $ $ , a single applicant is potentially eligible. If total gross monthly income $ $ , a married couple is potentially eligible. QI-1 Pays for Medicare Part B premium only If total gross monthly income $ $ , a single applicant is potentially eligible. If total gross monthly income $ $ , a married couple is potentially eligible.

29 AHCCCS & MCS RESOURCE ELIGIBILITY There are no resource (asset) guidelines for the acute AHCCCS*, QMB, SLMB, and QI-1 programs.

30 Benefits through the Veterans Administration VA

31 VETERANS ADMINISTRATION POTENTIAL BENEFITS * If you are a Veteran or widow of a Veteran who served at least 90 days active duty with at least one day served during a war-time period, and you were discharged other than dishonorably, AND... * If your assets (not necessarily including your home and automobile) are just enough to cover 12 months of expenses or less; AND... * If your income each year is less than the threshold set by the VA; NOTE: The actual cost of unreimbursed medical care minus 5% of the MAPR can be used to offset your annual income. Medical care may include, but is not limited to, monthly charges by assisted living or nursing facilities, adult care home, costs of doctor s appointments and non-reimbursed prescription amounts, medical supplies, eye glasses, hearing aids, travel to medical appointments, etc.) THEN... You may be eligible for a cash benefit from the Department of Veterans Affairs (VA). THOSE THAT... * have a medical diagnosis by a doctor (yours and/or the VA doctor) that states that you cannot live independently and need regular assistance and care MAY QUALIFY FOR MORE!!!

32 VETERANS ADMINISTRATION POTENTIAL BENEFITS VA Compensation can pay the Veteran a monthly compensation if the Veteran is at least 10% disabled as a result of military service. VA Pension can pay the Veteran a monthly pension if the Veteran served at least one day within a war-time period, has limited income, as is permanently & totally disabled OR at least 65 years old. VA Dependency and Indemnity Compensation (DIC) can be paid to eligible survivors of service members who died on active duty, Veterans who died from service-related disabilities, and Veterans who were being paid 100% VA Disability when they passed away. Death Pension can be paid to a surviving spouse and dependent children when the death of the war-time Veteran was not serviceconnected. This type of benefit is based on need. Aid and Attendance and Housebound assistance are additional funding that can be obtained when a Veteran or widow of a Veteran requires the assistance of another person with some of their activities of daily living (ADLs) and cannot live independently OR if the Veteran or widow of the Veteran is blind. ADLs include bathing, dressing, grooming, toileting, mobility, transferring, meals, transportation, housekeeping, etc. These benefits are also needsbased; however, VA does reduce the income by the medical expenses incurred by the Veteran or widow.

33 Reverse Mortgages

34 Reverse Mortgages (crisis) Same benefits as with pre-crisis planning Draw the equity out each month to help pay for in-home care services or other monthly expenses AND Still qualify for Medicaid in-home care services

35 Current Staff Members PRINCIPALS George L. Montgomery Long Term Care Planning Consultant, Shareholder, IT, Notary Public 18 years experience (10 years with ALTCS/AHCCCS, 8 years Montgomery and Associates, Inc. consultant) Carol Aragon-Montgomery Founder, Shareholder, Chief Financial Officer, Human Resources, Certified Legal Document Preparer 19 years experience (5 years with ALTCS, 4 years with elder law firm, 1 year private consultant, & 9 years Montgomery & Associates, Inc. consultant) Catherina (Catrina) Ybarra Technical Specialist & Community Liaison 4 years experience with Montgomery and Associates, Inc. Tiffany Aragon Technical Specialist-in-Training & Administrative Assistant, as needed 5 years experience with Montgomery and Associates, Inc. MaryLou Montgomery Helper 2 years experience with Montgomery and Associates, Inc.

36 SERVICES Initial evaluation $ an hour ALTCS / AHCCCS / MCS and VA Application Processes Long Term Care Planning Consulting fee quote based on sliding fee schedule / Flat Rate Mortgage Debt Reduction Planning Legal Document Preparation POAs Financial, Medical, and Mental Health Living Will Estate Planning Portfolio (Living Trust, etc.) Deeds Income-only trust (for ALTCS only)