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December 2006 
The Elder Law Report

Important Updates for Seniors and their Advocates
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We are proud to send you the latest issue of The Elder Law Report, a monthly e-newsletter full of the latest legal developments and other trends of vital interest to seniors and their advocates. We hope you enjoy reading and sharing the helpful articles you will find within. In particular, the lead article this month is an in-depth look at how the new Congress will affect key issues facing seniors today - a must read for all seniors and their advocates!

Please continue to send your comments and questions to Info@ElderLawAssociates.com. We love hearing from you and would like to include your question in an upcoming Reader Questions & Comments column.

 How Will the New Congress Affect Key Elder Law Issues?
 

Capitol Bldg The Democratic Party's takeover of both houses of Congress is likely to have financial implications for the elderly and their families, although how profound these changes will be remains to be seen.

Of greatest interest to elder law attorneys and their clients is what the change in leadership on Capitol Hill will mean for the fate of the Deficit Reduction Act of 2005 (DRA). The DRA is particularly important to the elderly because it severely restricts their ability to transfer assets before qualifying for Medicaid coverage of nursing home care. Democrats in Congress maintain that the law is unconstitutional because the version passed by the Senate and signed by President Bush was different from the version passed by the House.

After President Bush signed the measure last February, Democrats in the House fought to have the DRA's two differing versions reconciled and voted on again, while Republican leaders said they were content to rely on the courts to straighten the matter out.

"We're going to keep pressing on this," Brendan Daly, a spokesman for Nancy Pelosi (D-CA), told ElderLawAnswers at the time. "It could be [resolved legislatively] if they wanted to do it. It wouldn't be that difficult a thing; they could just fix it and then call for a revote, but they don't want to do that because it's a controversial bill."

When the Democrats got nowhere legislatively, eleven Democratic House members filed suit to have the law overturned.

Pelosi's office has not yet commented on whether the Democrats will force a revote on the DRA once the new Congress is in session. But The Hill quotes a spokesman for Pelosi that Democrats will be monitoring the administration’s application of the DRA's Medicaid provisions.

“We are concerned about various regulations that the administration may issue and are concerned with the implementation of provisions in the Deficit Reduction Act,” deputy press secretary Drew Hammill wrote in an e-mail.

Added incoming House Energy and Commerce Committee Chairman John Dingell (D-MI) in a written statement, “Democrats are concerned about the substantial changes in benefits and out-of-pocket costs that could be imposed on families under the new Deficit Reduction Act provisions. These matters will be explored in greater detail next Congress.”

Other areas of interest to the elderly and their advocates include:

The estate tax: A Democratic Congress spells the death of efforts to repeal the "death tax," as it is referred to by its critics. But while Democrats have opposed full repeal of the estate tax, many support increasing the exemption amount, which currently stands at $2 million and will rise to $3.5 million in 2009 before the current law expires.

Social Security privatization: The election means the final nail in the coffin for President Bush's efforts to allow Social Security beneficiaries to set up private accounts.

Prescription drugs: Drug prices could fall as a result of the Democratic victory, and drug company stock prices have already dipped in anticipation. Rep. Pelosi, who will be the new House Speaker, says changing Medicare to allow the federal government to negotiate drug prices is a top priority. But President Bush would likely veto any bill that mandates negotiations. Look for Democrats to attempt other fixes to Medicare Part D as well, although their changes will have to be moderate enough to garner bipartisan support and avoid a presidential veto.

For USA Today's analysis of the impact of Democratic control on various policy areas, click here.


 Medicare Preventive Services: What is Covered?
 

Doctor As the saying goes "an ounce of prevention is worth a pound of cure," and as you get older, taking preventative measures can keep you healthy. And if you are a Medicare beneficiary, there are a number of preventive services available to you. Anyone with Medicare Part B has access to the following preventive services:



  • Initial physical exam. If your Medicare Part B coverage begins on or after January 1, 2005, Medicare will cover a one-time "Welcome to Medicare" preventive physical exam within the first six months that you have Part B. Additionally, those at risk for abdominal aortic aneurysms may be referred for a one-time ultrasound at their initial exam.
  • Cardiovascular screening. Medicare covers one test every five years to check your cholesterol and other blood fat levels.
  • Cancer tests. Medicare covers breast cancer screening (mammograms) once a year for women over age 40; cervical and vaginal cancer screening (pap test and pelvic exam) once every two years for all women; colon cancer screening (colorectal) every year to every four years, depending on the test; and prostate cancer screening (PSA) every year for men.
  • Shots. Medicare covers flu, pneumococcal, and Hepatitis B immunizations.
  • Bone mass measurements. For women, Medicare covers bone mass measurements to check if you are at risk for fracture due to osteoporosis. The test is covered once every 24 months.
  • Diabetes. Medicare covers up to two diabetes screenings per year. In addition, it covers glucose monitors, test strips, and lancets for individuals with diabetes and offers self-management training.
  • Glaucoma tests. One glaucoma test is covered each year for people at high risk for glaucoma. For some of these tests, beneficiaries in regular Medicare pay nothing; for other tests, Part B's 20 percent copayment applies.
For more information from Medicare.gov about what preventive services are covered, click here.


 Book Review: The Parent Care Conversation
 

Parent Conversations Dan Taylor, The Parent Care Conversation: Six Strategies for Transforming the Emotional and Financial Future of Your Aging Parents (Penguin Books, New York, NY, 2006. 262 pages).

One of the hardest things for aging parents and their adult children to do is sit down and have a frank discussion about the future. Such conversations are difficult for two principal reasons: they involve acknowledging the realities of aging and mortality, and financial details must be shared. But putting off these conversations until it's too late can have catastrophic consequences, both financial and emotional.

Dan Taylor, an attorney and financial planner, has written this book to help adult children broach the subject of future planning with their parents and, once the conversation gets rolling, to provide a useful framework for discussion. Taylor presents a system that grew out of his experience with his own dad's care.

For Taylor, the "Parent Care Conversation" is comprised of six separate conversations: The Big Picture Conversation (the parents' overall vision for their future); The Money Conversation (financial planning needs and strategies); The Property Conversation (how to distribute property and possessions); The House Conversation (what to do with the family home); The Professional Care Conversation (the parents' preferences for care, should they need it); and The Legacy Conversation (a summing up of the parents' journey).

In this way, Taylor allows children of aging parents to cut issues down to size and often turn potential obstacles into opportunities. The book is filled with case studies, tips and checklists and includes a special section on executing legal documents.

The book's wise counsel, however, is somewhat undercut by some gratuitous and completely false comments about the consequences of Medicaid transfers -- comments that seem aimed simply at scaring the elderly and their families into avoiding Medicaid planning at all costs. Taylor implies that elders could be accused of "defrauding" Medicaid merely for transferring assets within Medicaid's lookback period, and that they could be subject to "civil and criminal charges and fines" for doing so. Such terror-inducing statements have no basis in reality. Taylor makes a strong enough case for advance planning without having to resort to them.


 Cost of Private Nursing Home Room Tops $75,000 a Year
 

Money The average daily cost of a private room in a nursing home in the United States is $75,190 a year, or $206 a day, according to the 2006 MetLife Market Survey of Nursing Home and Home Care Costs. This is a 3.9 percent increase over last year, when the average daily rate for a private room in a nursing home was $74,095 a year, or $203 a day, according to MetLife.

Once again, the highest rates for a private room in 2006 were found in Alaska, where the cost is $578 a day on average. The lowest rates were again found in Shreveport, Louisiana, at $111 a day, a $4 drop from last year.

The survey also reports on the cost of a semi-private room, which now averages $183 a day, or $66,795 a year, also a 3.9 increase over last year.

The study also found that the cost of a home health care aide averaged $19 per hour nationally, the same as last year, while homemaker/companion care averages $17 per hour, also unchanged. The lowest costs for both home health care aides and homemaker companions are $12 per hour in Shreveport, while Rochester, Minnesota, had the highest costs for a home health care aide at $29 an hour.

For the full 2006 report, including a list of average daily nursing home and home health care costs in selected cities, click here. (The report is available in PDF format. If you do not have the free PDF reader installed on your computer, download it here.)


 IRS Issues Long-Term Care Premium Deductibility Limits for 2007
 

Paperwork The Internal Revenue Service has announced the 2007 limitations on the deductibility of long-term care insurance premiums from taxes.

Premiums for "qualified" (see explanation below) long-term care policies are treated as an unreimbursed medical expense. These premiums – what the policyholder pays the insurance company to keep the policy in force – are deductible to the extent that they, along with other unreimbursed medical expenses (including "Medigap" insurance premiums), exceed 7.5 percent of the insured's adjusted gross income. Long-term care insurance premiums are deductible for the taxpayer, his or her spouse and other dependents. If you are self-employed, the rules are a little different. You can take the amount of the premium as a deduction as long as you made a net profit – your medical expenses do not have to exceed 7.5 percent of your income.

However, there is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for 2007. Any premium amounts above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year Maximum deduction
40 or less $290
More than 40 but not more than 50 $550
More than 50 but not more than 60 $1,110
More than 60 but not more than 70 $2,950
More than 70 $3,680


What Is a "Qualified" Policy?

To be "qualified," policies issued on or after January 1, 1997, must adhere to regulations established by the National Association of Insurance Commissioners. Among the requirements are that the policy must offer the consumer the options of "inflation" and "nonforfeiture" protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as "qualified" as long as they have been approved by the insurance commissioner of the state in which they are sold.

The Taxation of Benefits

Benefits from reimbursement policies, which pay for the actual services a beneficiary receives, are not included in income. Benefits from per diem or indemnity policies, which pay a predetermined amount each day, are not included in income except amounts that exceed the beneficiary's total qualified long-term care expenses or $260 per day (for 2007), whichever is greater.

For details on these and other tax law changes of interest for 2007 (PDF format), click here.

The Georgetown University Long-Term Care Financing Project has a two-page fact sheet, "Tax Code Treatment of Long-Term Care and Long-Term Care Insurance." To download it in PDF format, go to: http://ltc.georgetown.edu/pdfs/taxcode.pdf

(If you do not have the free PDF reader installed on your computer, download it here.)


Elder Law Associates PA is a boutique elder law firm that practices exclusively in Medicaid and long term care planning; home and community-based waiver services; Medicaid applications; nursing home residents’ rights litigation; asset preservation planning with a special focus on planning in light of the Deficit Reduction Act of 2005, including promissory notes and personal care agreements; disability planning, including special needs trusts and guardianship; estate planning, including wills and trusts; long term care insurance; advanced directives; and probate, which encompasses estate and trust administration. We assist clients in planning for the possibility of disability, incapacity, home health care, assisted living and/or nursing home placement. Our firm enables clients to avoid impoverishment caused by the escalating cost of long term care, to maintain their right to make health care decisions and to avoid unnecessary medical treatment.

We hope you have enjoyed The Elder Law Report. If you have questions about something you read, elder law matters or
issues concerning persons with disabilities, we would be delighted to hear from you. We serve as an elder law resource to many professionals and organizations and want to become your elder law resource as well. You can reach us at
Info@ElderLawAssociates.com.

Feel free to share The Elder Law Report with others who will benefit from our insights - just click on the blue "Forward email" link at the very bottom of the page.

Warm regards,

EM & HSK

Ellen S. Morris, Esq. & Howard S. Krooks, Esq.

phone: (561) 750-3850 / (800) 353-3752
fax: (561) 750-4069
 
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This publication is intended for general information purposes only. It is not intended to constitute individual legal advice to any specific client.

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