Author Archives: Timothy Loff

We all knew it was coming-rate hikes for Long-Term Care Insurance (LTCI) in Massachusetts. Increases from 10 percent to 40 percent, with increases greater than 10 percent phased in over multiple years have been announced by the Division of Insurance.

The Massachusetts Division of Insurance has been holding off the companies for several years, but something had to give. So either rate hikes, or companies get in financial trouble and/or leave the Commonwealth. But there are some very important things to keep in mind when considering your options if you are faced with a premium increase:

1. If you purchased an LTCI policy before March 15, 1999, that paid at least $50 per day of nursing home benefits, for at least two (2) years, your home may be protected if you need Medicaid (MassHealth in Massachusetts) to pay for your care.
2. If you purchased an LTCI policy after March 15, 1999 that paid at that paid at least $125 per day of nursing home benefits, for at least two (2) years, your home may be protected if you need Medicaid (MassHealth in Massachusetts) to pay for your care.
3. You may be able to drop some benefits in your policy (like inflation riders) to keep the premiums the same, but still maintain the Medicaid protection.

Massachusetts is the only state in the country that has this protection for your home if you have purchased the right amount of LTCI. Before you throw up your hands and give up this valuable protection, talk to your attorney. You may be able to make adjustments to keep the policy affordable, and if you can’t, maybe your children can help. After all, they might be the ones to ultimately benefit from the protection you are paying for.

We get frequent questions about the difference between the various MassHealth programs to provide care to elderly and disabled persons. The following is a brief summary:
MassHealth (what “Medicaid” is called in Massachusetts), pays for health care for certain low- and medium-income people living in Massachusetts. There are two general types of MassHealth that provide persons and services to care for disabled individuals: Community-based Care and Long-Term Care. Like it sounds Community-based MassHealth provides or pays for care in a community setting, such as a private home, apartment, or assisted living residence. Long-Term Care pays for care in a skilled nursing facility (nursing home). What follows is some general information about these programs. Note however that everyone’s situation is different and you should seek out competent counsel before proceeding to apply for any MassHealth program.
Long-Term Care
• Must be considered medically eligible as determined by the local Aging Services Access Point, to include dementia or the inability to do three (3) or more activities of daily living;
• Must be financially eligible: Can have no more than $2,000 in countable assets;
• In 2014 if married, a spouse living in the community can keep the primary residence, a car, and in $117,240 in other assets, plus miscellaneous other lesser assets;
• No income limits, but income less certain deductions goes to pay for care;
• Assets can be transferred between spouses without penalty;
• Any transfers of any more than a nominal amount in the five years (the “five-year look-back period) before eligibility is sought will result in disqualification for a time;
• Eligibility can be retroactive to three months before the application is filed;
• The application process can be long and cumbersome, for example requiring up to five (5) years of bank and financial statements, copies of title documents, and liquidation of assets;
• Denials of eligibility can be appealed, but must be appealed within thirty (30) days of a denial.
Community-Based Care: several sub-programs, most common is the “Frail Elder Waiver”
• Can get up to 24/7 care at home paid for by the state if qualify;
• Must be considered medically eligible as determined by the local Aging Service Access Point: would otherwise be eligible for Long Term Care in a nursing facility;
• Must be financially eligible: Can have no more than $2,000 in countable assets and income of no more than $2,163 (2014);
• Assets can be transferred to a spouse or another person to lower assets, but transfers need to be disclosed and the assets held, in case Long Term Care is needed.

Do you need health insurance in Massachusetts?  Worried that getting it through the Affordable Care Act could result in the state recovering payments made for your care against your estate after you die? Have you wondered whether or not you can protect your estate to pass it on to your children if you should end up in a nursing home? These question are very complicated and do not have easy answers. Believe it or not these questions are also part of the same discussion. State Medicaid programs, such as MassHealth in Massachusetts, have estate recovery rules. These rules allow the state to recover from someone’s estate after they die if they received benefits from Medicaid. Click the link below to read a recent Washington Post Article about how the Affordable Care Act is affecting estate recovery. If you would like to find out more ways to protect your estate, or how the Affordable Care Act may affect you, you should contact us.

http://www.washingtonpost.com/national/health-science/little-known-aspect-of-medicaid-now-causing-people-to-avoid-coverage/2014/01/23/deda52e2-794e-11e3-8963-b4b654bcc9b2_story.html