Wisconsin Elder Law and Long Term Care Planning


Elder law is another aspect of estate planning, focusing primarily on the needs of families and individuals as they age. Issues of aging include senior housing and home care, long-term (or nursing home) care, guardianships and health care documents, Medicare and Medicaid.

The Long Term Care Dilemma

As our population ages, more and more of us confront elder law-related issues, whether for ourselves or our parents. One of the most pressing issues is long-term nursing home care, which usually is not covered by traditional health insurance. Depending on where you live and the level of care needed, nursing home care can cost from $35,000 to $150,000 a year. The average stay is slightly more than three years. Most people end up paying for nursing home care until their personal (or family) assets are depleted, then they may qualify for Medicaid to pick up the cost.

Careful planning, however, can help protect your assets, whether for you, your spouse, or for your children. The belt-and-suspenders approach is to purchase long-term care insurance while you are healthy enough to qualify, and to make sure you receive the benefits to which you are entitled under Medicare and Medicaid.

Medicare

Clients are frequently confused over the differences between Medicare and Medicaid. Though their names are very similar, the programs are quite different. Medicare is an entitlement program, a federal health insurance program in which most people enroll when they turn 65 years old. There are no financial qualification rules. Medicare has two primary parts: Part A and Part B.

Medicare Part A covers in-hospital care, extended care after a hospital stay, some home health care services, and hospice services. The rules for nursing home coverage are very strict and, in fact, Medicare pays for less than 9 percent of nursing home care in this country.

Medicare Resources

Wisconsin Medicaid

Medicaid, is a joint federal-state program, subject to certain federal requirements, each state implements its own regulations on how the program is managed. Medicaid is not an entitlement program like Medicare, but rather a form of welfare. Medicaid eligibility is determined after the proper application is submitted to the commonwealth. There are many Medicaid insurance programs available in Wisconsin, from basic medical coverage to nursing home programs. Information about Medicaid for long-term care in a nursing home or community setting can be found on the Wisconsin Department of Health Services website.

The Aging and Disability Resources section also provides a wealth of information for seniors and care givers.

We assist seniors and their families in making the tough decisions regarding long-term care planning, including whether Medicaid eligibility may be an option. Navigating the Medicaid rules on your own can be a nightmare at best, and subject you to penalties at worst. We work closely with clients to assist with understanding the challenging Medicaid rules, and provide sound legal advice regarding plans for securing eligibility for Medicaid.

Long Term Care Insurance

You may want to consider insuring your financial security through proper Long Term Care Insurance (LTCI). However, don’t wait too late to apply, because your health actually purchases the LTCI, your money simply pays the premium. No one relishes the notion of paying insurance premiums of any kind. After all, you can pay and pay and never collect on a claim. The purpose of insurance is to transfer a risk that you can afford (i.e., the payment of a premium with no guarantee of its return) to cover a risk you cannot afford. For example, what homeowner does not insure their personal residence from damage due to a fire? For most people, the premium is paid without a second thought. So why would any responsible, mature American not insure against the financial risk of requiring long-term care at some point?

An appropriate LTCI policy can be designed to fit almost any budget. Most LTCI policies share some common features you should know which include the following:

  • Benefit Amount: How much and how long will the policy pay?
  • Benefit Triggers: When will the policy pay benefits?
  • Inflation Protection: Will the purchasing power of the benefit amount increase over time?
  • Level of Care: Are home, custodial and intermediate care costs covered along with skilled nursing care?

We can provide advice and counsel regarding your long term care options, including evaluation of any LTCI policy before you sign.

Senior Housing Options

Helping a parent move to senior housing can seem more intimidating than orchestrating a rocket launch. The death of a spouse, declining health or safety concerns can trigger the need to move. The first phase comes with the realization that what has been home is no longer suitable. Emotional ties to a place are hard to overcome. Finding a new home that is appealing and appropriate is no easy task, and neither is culling through a lifetime’s accumulation of “stuff.”

Here are some tips to help make the transition easier:

  • Plan ahead. Don’t wait for a health crisis to start the process. The smoothest transitions occur when the person moving is in the driver’s seat.
  • Get a full assessment of the current situation. Physical care needs and financial resources are where to start. Consider the costs of staying in place, including renovation and ongoing maintenance. Add the cost of rising utility bills and taxes, and don’t forget transportation and food. Make a list and decide whether it’s cheaper to stay or move to a community designed for seniors.
  • Take a multi-phase approach. Seniors often take longer than a year to actually make the move.
  • Fully explore new housing options. Senior living offers a broader range of options than ever before.

Navigating the Medicaid rules on your own can be a nightmare at best, and subject you to penalties at worst. We work closely with clients to assist with understanding the challenging Medicaid rules, and provide sound legal advice regarding plans for securing eligibility for Medicaid.


Best of DeForest Windsor

Wisconsin Attorney Marsha Tesar, with Tesar Law Group, S.C. assists clients in DeForest, Madison, Sun Prairie, Waunakee and the surrounding area with Estate Planning, Elder Law, Medicaid, Wills, Trusts, Revocable Living Trusts, Special Needs Planning, Business Organization and Contracts, Asset Protection, Real Estate Law, Estate Tax, Wisconsin Probate and Estate Administration. Our firm strives to provide quality, cost effective legal representation to families and businesses throughout Dane County, Columbia County and the State of Wisconsin.

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