It’s Open Enrollment Season for Obamacare

If you have an inadequate health insurance plan or you have changed your situation and need new insurance, now’s the time to go out on the exchange and look around. Open enrollment is from November 1st to December 15th. Today’s NY Times has an in-depth discussion of what’s out there. Take a look also at this very recent NY Daily News article.

The American health insurance system is a frustrating  tangle which is hard to navigate and requires a lot of time to deal with, from selecting policies to figuring out how to afford insurance to changing prescription plans based on their formularies to coping with absurd denials of coverage for drugs or treatment that the patient’s doctor recommends. Unbelievable amounts of hours are spent by patients and their advocates every year, often during their workday when those hours might be better spent getting the work done. Before the affordable care act, our small-company plan’s premiums were rising by double digits every year. The ACA was designed to greatly broaden the pool of healthy, premium-paying plan participants as a way to bring those premiums down. With the rollbacks of certain protections that were built into the Affordable Care Act (“Obamacare”), in the free-market economy, that critical aspect of the program has been removed, and companies are allowed to offer policies that provide minimal coverage and are still costly to pay for. People are spending as much on their insurance as they are on housing. It’s absurd.

I’d like to see a system where coverage isn’t linked to employment and instead is just based on something simple, like geography … for example, everyone who resides in a county which has population in excess of X people enrolls in that county’s plan, and very small counties just combine into a regional plan of an adequate and defined size. You’d only have to change plans if you moved out of county. No more worries that your smaller employer won’t have an insurance plan.  Let the insurance companies compete behind the scenes to be the plan administrator. Have all practitioners in a given county accept that insurance plan as well as others. Let the plans negotiate drug prices or treatment prices like the Veterans Administration does (for drugs) or Medicare (treatment). Control the price of premiums and subsidize premiums through tax returns (as is done under the ACA) so that no participant has to pay more than a certain nation-wide percentage of their modified adjusted gross income. It’s absurd that an employee in a company which has a health plan should have to pay $12,000 a year for their share of the premium to have coverage for their family. The cost of insurance may not make too big of a dent in the budget of someone earning $180,000 a year, but the premium cost is the same for the person earning $60,000 a year.

By the way, if you are at that age to enroll in Medicare (65), keep an eye on your deadlines as well, and be sure to be mindful of the potential lifetime penalties for failure to enroll in Part B when you sign up, even if you are still employed.

For advice and representation on senior care legal planning, call us at 732-382-6070


More formality may be better with intergenerational households

As elder law attorneys, our clients have presented us with many difficult situations involving adult children or grandchildren who live in their houses. Sometimes a child has run into some hard times and sees the parent’s home as an economical option; the child may move into his parent’s house along with his spouse and children. Sometimes the child just never became self-sufficient and never made any plan to move out. The adult child may or may not be disabled. Sometimes the expenses are being shared to a degree, but often the parent pays for most of the expenses. The parent may be wrestling with a feeling of obligation, and the child may have a feeling of entitlement. The child may feel that they are “taking care of the parent,” yet the actual need for care or the work being done may be imprecise and doubted by others in the family.

The longer the arrangement lasts, the more difficult it can be for the parent to move on. The dynamic can really change when there are other children who are upset at the arrangement. The parent’s financial security may get on edge. Things can particularly blow up when the parent has to hire a caregiver or wants to sell the house in order to downsize or move to assisted living or nursing home.  How can all of these competing interests be managed? How will the house be sold, and where will the child go?

Aging parents who are still supporting their adult children may want to do some careful planning. They need to consider what will happen to them if they need their funds for care but their child is counting on all of that ongoing financial support. There are many issues to consider. Should they charge actual rent? Should there be a written lease that specifies that occupancy only continues of the occupancy fees are paid? Should they put restrictions on the child’s behavior so that the parent’s peaceful residence isn’t disturbed? A parent may want to put a provision in his or her Will that allocates some extra amount for the dependent child so that at the parent’s death, there are extra funds for relocation. By putting protective provisions into the estate plan, the parent may be able to provide better protections than counting on other family members to honor the parent’s verbal “wishes.” It may not work well to just assume that the whole family will be able to work out an agreement to support the dependent one after mom or dad passes on.

At some point, should the parent insist that the child move out, but agree to pay for the alternate housing for some period of time? What if the house is going to be sold. Does the parent want to give the child written, enforceable rights to remain in the house for a certain amount of time under certain terms & conditions if the parent dies or moves out? How will that impact the parent’s well-being, or the ability of their Executor to wrap up the estate after death? Will the child need a new guardian or life care planner?

Call us for legal advice on developing a family well being plan … 732-382-6070

Ideas for transition plan for orphaned adult children with intellectual disabilities

There was a time when people who had developmental intellectual disabilities such as Down Syndrome rarely lived past their 20’s. With medical progress, many of these individuals will be blessed with a reasonably normal full life span. This presents major challenges for their parents or guardians, for the child could outlive the parent and lose that critical source of familiar lifestyle support.

For parents,the idea that their disabled child would survive them may be a new idea — they may never have expected this to occur.Also,  it can be very difficult to ponder the idea that someone else would be taking care of their dependent adult child who has intellectual disabilities. Who would know her as well? Who would be so attentive to every nuance of the child’s daily routine and mood? Who would fully understand the child’s special needs and preferences? Some parents avoid dealing with these issues because they are so, so difficult to think about. There is a better way, because as I have always said since I first began elder law and special needs planning 20 years ago, “careful planning can prevent a crisis.”

Sudden removal of the child from the home where they have lived for decades can add substantially to the trauma of losing the parent. His bedroom is his safe and familiar place. He knows the layout of the rooms and yard and can safely navigate in that protected environment. Think about the trauma if  the parent died and the house were suddenly sold and he were moved elsewhere.

I have developed testamentary plans for some clients in which the house is left to a Trust for benefit of the disabled child, along with sufficient cash to support the house and pay for the necessary live-in caregivers to enable the child to remain in the home for some transitional period of time. The house expenses are likely to be at least $1,500 a month, maybe $1,800 — taxes, insurance, maintenance, repair, heat and air conditioning. The time period depends on the needs and goals. In some cases it’s a year, in other cases longer. Each case is unique. This arrangement not only provides continuity, it can protect the individual while awaiting a residential placement through the Division of Developmental Disabilities (NJ-DDD), for instance. The Will can mandate the protective terms and the trust can be funded with life insurance or liquid assets. The child’s successor guardian or conservator would need to work well with the Trustee. The Will can direct that once the property is sold, a certain percentage of the assets remain in trust for the disabled child’s special needs while the rest is distributed to the other heirs. There is no end to the creative ways you can structure things.

“Leaving it all up to the other children” is also a plan, but one which has no specific financial or housing protections, and can create unnecessary burdens that could impair the relationship among your children. Instead, you can design a detailed care plan for your child which will survive your loving care, and give everyone involved the necessary peace of mind.

Call us about your estate planning and  life care planning for your child with special needs ……… 732-382-6070