Will Making a Gift Conflict with Medicaid?

People usually make gifts for three reasons—because they want to provide for the recipient, because they want to protect assets, or minimize tax liability. However, gifting in one’s elder years can have expensive and unintended consequences, as reported in the article “IRS standards for gifting differ from Medicaid” from The News-Enterprise, especially with Medicaid.

As a quick aside, if you’ve read any of my articles on gifting, you know I preach caution.  Way too many people make gifts because of a perceived benefit, and don’t consult a professional to determine whether there is a benefit.  That said, for the purposes of this article, I’m going to focus on Medicaid gift tax consequences as opposed to all of the other pros and cons in making gifts.

A primary reason for most people to make gifts is tax planning.  The IRS gift tax becomes expensive, if gifts are large. However, each individual has a lifetime gift exemption and, as of this writing, it is $12.06 million, which is historically high. A married couple may make a gift of $24.12 million. Most people don’t get anywhere near these levels. Those who do are advised to do estate and tax planning to protect their assets.

The IRS also allows an annual exemption. For 2022, the annual exemption is $16,000 per person. Anyone can gift up to $16,000 per person and to multiple people, without reducing their lifetime exemption.

However, the more real danger is the effect of a gift on Medicaid or long-term care benefits.  People, and frequently financial advisors and non-attorney professionals, often confuse the IRS annual exclusion with Medicaid requirements for eligibility. IRS gift tax rules are totally different from Medicaid rules.

Medicaid does not offer an annual gift exclusion. Medicaid penalizes any gift made within 60 months before applying to Medicaid, unless there has been a specific exception.  The Veterans Administration may also penalize gifts made within 36 months before applying for certain VA programs based on eligibility.

For Medicaid purposes, gifts include outright gifts to individuals, selling property for less than fair market value, transferring assets to an irrevocable trust, or giving away partial interests.  Some gifts are expressly permitted, such as gifts between spouses.  Also, most states have some species of an exception for very small gifts, but that definition varies widely.

For example, in Texas there is no exception for small gifts.  However, Medicaid staff is instructed not to inquire into potential gift transactions for less than $200 total in a month.  That doesn’t create a strategy of gifting typically, but it avoids Medicaid penalties when Grandma gives $50 to a grandchild for their birthday.

The penalty for gifting in Medicaid is a penalty period.  In short, Medicaid looks at your eligibility, and once otherwise eligible will calculate a penalty period by dividing the value of your gifts by a penalty rate based upon the daily average cost of a nursing home in the year of the gift.  So, if you gave away $50,000 and the penalty rate is $250 per day, you are ineligible for 200 days.  During this time you’ll have to find a way to pay yourself before Medicaid will.

So, gifting where Medicaid may be an issue in the future often has very real and dangerous consequences.  That doesn’t mean gifting can’t be useful in Medicaid, as sometimes gifting is an express strategy for eligibility, but anyone making gifts should do so at the advice of an attorney.

Reference: The News-Enterprise (Aug. 6, 2022) “IRS standards for gifting differ from Medicaid”

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How to Claim and Use Life Insurance

Many people have life insurance, and they have it for a multitude of reasons.  These include funeral costs, liquidity in an estate, help paying off taxes and so on.  Whatever your reason for having it, I wanted to talk about how to make a claim on it, and separately, what to do with it once you have.  You can see more at Kiplinger’s recent article entitled “What Is the Best Way for a Widow to Use Life Insurance Proceeds?”

When making a claim, you’ll need a couple of things.  First and foremost, perhaps blindly obvious, is that your beneficiaries need to know you have it.  If an insurance company becomes aware of a death they might reach out to named beneficiaries, but that is a big assumption.  So, your life insurance beneficiaries or whoever may claim the insurance needs to know it exists.

Holding that aside, the person entitled to the money will start by contacting the insurance company.  The company will send or direct that person on where to download a form to claim the insurance.  Beneficiaries typically need to provide proof of who they are, a death certificate for the insured (which in most places is issued within a few weeks of death) and other information about how to pay the insurance.  For example, some companies ask if you want to turn it into an investment fund at their financial institution, others arrange how to cut the check and so on.

It is worth noting that your executor or trustee won’t have the right to do this unless the estate or the trust is the beneficiary of the life insurance.  All told, the process typically takes something like 30 days.

Now, what to do with the insurance proceeds varies based upon the purpose and need of the life insurance.  I’m also going to assume for now that the insurance isn’t being paid to a trust which is designed to hold assets long term such as a descendant’s trusts.  That might have different concerns.

So, with that said, here are some ideas on how to use the life insurance.

Funeral Costs. Use life insurance money to cover these costs to decrease your financial strain.  Most funeral companies actually have you purchase a small insurance policy in order to prepay a funeral.

Ongoing Expenses. This is especially true when one spouse dies, but living expenses do not stop. Your income is frequently reduced. In fact, after the death of a spouse, household income generally declines by about 40% due to changes in Social Security benefits, spouse’s retirement income and earnings. The death benefit from a life insurance policy can help provide the funds you need to help cover your mortgage, car payment, utilities, food, clothing and health care premiums.

Debts. You are generally not personally responsible for paying off the debts of the decedent. However, when an estate does not have enough funds to pay all the debts, any gifts that were supposed to be paid out to beneficiaries will most likely be reduced. Note that you may be responsible for certain types of debt, such as debt that is jointly owned or a loan that you have co-signed. Talk to an experienced estate attorney to understand the laws of your state, so that you know where you stand concerning all debts.  By way of example, you have very few responsibilities to pay a decedent’s debts in Texas.

Taxes.  As a tie-in to debts, some people use life insurance to give an influx of liquidity to pay estate taxes.  This often helps when an estate is large due to real estate or businesses or other illiquid assets.  The IRS of course wants the tax paid in cash, so life insurance gives you the cash to do so without liquidating other assets.

Create an Emergency Fund. Life insurance can help build a liquid emergency fund, which should cover three to six months of expenses.

Supplement Your Retirement. When one spouse passes, the survivor becomes much more economically vulnerable. To retire, a person typically needs 80% of their preretirement income to live comfortably.  So, insurance provides and extra supplement to cover that need.

Reference: Kiplinger (Dec. 17, 2021) “What Is the Best Way for a Widow to Use Life Insurance Proceeds?”

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Health Mistakes to Avoid after 50

Everyone can improve their health as they age by avoiding key health mistakes people make after age 50.

Many of our clients are concerned with their health as they age.  All of us can improve the odds of a longer, more healthful life simply by avoiding the health mistakes that people tend to make after age 50, published in Money Talks News’ recent article entitled “7 Deadly Health Mistakes People Make After Age 50.”

  1. Loss of Social Connection. COVID-19 taught us many things, among them, people shouldn’t be alone. A 2018 study found that isolation may double a person’s risk of dying of cardiovascular disease. What’s more, social isolation is linked to increased risk of depression, cognitive decline, obesity and a weakened immune system. Men are at greater risk of suffering from social isolation, as a recent survey found just 48% of retired men living alone were very satisfied with the number of friends they had. However, about 71% of retired women living alone were very satisfied with their number of social connections.
  2. High-sodium foods. A very common health mistake is eating too many high-sodium foods.  About 90% of the sodium that we consume comes from salt. 90% of Americans over age two also consume too much sodium, so reduce your sodium intake. Do that and your blood pressure should fall within a couple of weeks, helping to lower your risk of deadly heart disease and stroke, the CDC says.  Several online sources list common high-sodium foods in our diets.
  3. Postponing colorectal cancer screening. Medical experts say that all adults 50 to 75 should have colorectal cancer screening. This test can find precancerous polyps, which are the main source of colorectal cancer, which is treatable when found in its early stages. With the Affordable Care Act of 2010, colorectal screening is among a list of preventive services that generally are free for people who have health insurance and are between the ages of 50 and 75.
  4. Not taking a daily aspirin. Not everyone over 50 should take an aspirin every day, but it can be good for those with certain potentially life-threatening health conditions. The Mayo Clinic says, “The U.S. Preventive Services Task Force recommends daily aspirin therapy if you’re age 50 to 59, you’re not at increased bleeding risk and you have an increased risk of heart attack or stroke of 10 percent or greater over the next 10 years.”

Taking aspirin makes blood platelets less “sticky,” helping to prevent the clots that lead to heart attacks and strokes, explains Harvard Medical School. Talk to your doctor before starting a daily aspirin regimen.

  1. Failing to lift weights. As we get older, the risk of the bone disease osteoporosis increases. About 10 million people have osteoporosis, and 44 million more have low bone density, which puts them at risk for the disease, according to the National Osteoporosis Foundation. Women are especially at risk for osteoporosis, since one in two women will break a bone due to osteoporosis. This happens more often in women than a heart attack, stroke and breast cancer combined. Getting sufficient calcium and vitamin D is critical to preventing osteoporosis. Weight-bearing exercise is also a great way to strengthen bones.
  2. Not drinking enough water. Anytime my kids tell me they have an upset stomach, don’t feel well or have a headache,  I respond the same way.  Drink some water.  Hydration is key for health, and the Mayo Clinic says that older adults carry a lower volume of water in their bodies. In addition, they are more likely to take medications that boost the risk of dehydration. Their sense of thirst is less acute, making it easy for them to forget the need to drink. Severe dehydration can lead to:
  • Seizures
  • Life-threatening heatstroke
  • Urinary and kidney issues; and
  • Hypovolemic shock (low blood volume shock).

As a general rule, men should drink 15.5 cups (3.7 liters) of fluids and 11.5 cups (2.7 liters) of fluids a day for women. 20% of daily fluid intake also typically comes from food.

  1. Continuing to smoke. Quitting smoker is easier said then done, but kicking the nicotine habit pays dividends at any age. The improvements accumulate over the next nine months, and by one year after quitting, your heart attack risk drops dramatically. However, improvements can be fast. For example:
  • Your heart rate and blood pressure drop 20 minutes after quitting:
  • The carbon monoxide level in your blood drops to normal a few days after quitting; and
  • Circulation improves and your lung function increases two weeks to three months after quitting.

Reference: Money Talks News (May 24, 2021) “7 Deadly Health Mistakes People Make After Age 50”

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