Costs of Some New Long-Term Care Insurance Policies Going Down in 2018

While long-term care insurance costs are up in general, some policies are going down in 2018, according to the 2018 Long Term Care Insurance Price Index, an annual report from the American Association for Long-Term Care Insurance (AALTCI), an industry group.

A married couple who are both 60 years old would pay an average of $3,490 a year combined for a total of $333,000 of long-term care insurance coverage when they reach age 85. This is down from 2017, when the association reported that a couple could expect to pay $3,790 for the same level of coverage. Jesse Slome, the AALTCI’s director, cites two reasons for the change: “There are fewer insurers offering traditional long-term care insurance policies currently and some of the higher priced insurers sell so few policies that we excluded them from this year’s study as they really were not representative of the market conditions.”

Rates for single men and women have gone up in 2018, however. A single 55-year-old man can expect to pay an average of $1,870 a year for $164,000 worth of coverage, up from $1,665 in 2017. The same policy for a single woman averages $2,965 a year, up from $2,600 in 2017. Overall, women still pay more than men.

One thing that remains the same year to year is the importance of shopping around. The survey shows that costs for virtually identical policy coverage vary significantly from one insurer to the next.

This year’s index compares policies sold in Illinois and was conducted in January 2018.

For the association's 2018 index showing average prices for common scenarios, go here:


Planning for a Child with Special Needs

Americans are living longer than they did in years past, including those with disabilities. According to one count, 730,000 people with developmental disabilities living with caregivers who are 60 or older. This figure does not include adult children with other forms of disability nor those who live separately, but still depend on their families for vital support.

When these caregivers can no longer care for their children due to their own disability or death, the responsibility often falls on siblings, other family members, and the community. In many cases, expenses increase dramatically when care and guidance provided by parents must instead be provided by a professional for a fee.

Planning by parents can make all the difference in the life of the child with a disability, as well as that of his or her siblings who may be left with the responsibility for caretaking (on top of their own careers and caring for their own families and, possibly, ailing parents). Any plan should include the following components:

  • A plan of care that carefully establishes where the child with special needs will live, who will be responsible for assisting the person with special needs with decision making and who will monitor the person with special needs’ care.  It will help everyone involved if the parents create a written statement of their wishes for their child’s care. They know him better than anyone else. They can explain what helps, what hurts, what scares their child (who, of course, is an adult), and what reassures him. When the parents are gone, their knowledge will go with them unless they pass it on.
  • At least one type of special needs trust.  In almost all cases where a parent will leave funds at death to a disabled child, this should be done in the form of a trust. Trusts set up for the care of a disabled child generally are called “supplemental” or “special” needs trusts.  Trusts designed to aid a person with special needs are commonly known as “special needs trusts”.  There are three main types of special needs trusts: the first-party trust, the third-party trust, and the pooled trust. All three name the person with special needs as the beneficiary, but they differ in several significant ways, and each type of trust can be useful in its own way.  Choosing a trustee is also an important issue in supplemental needs trusts. Most people do not have the expertise to manage a trust, even if they are family members, and so a professional trustee may be a wise choice. For those who may be uncomfortable with the idea of an outsider managing a loved one’s affairs, it is possible to simultaneously appoint a trust “protector,” who has the power to review accounts and to hire and fire trustees, and a trust “advisor,” who instructs the trustee on the beneficiary’s needs. 
  • Life insurance.  A parent with a child with special needs should consider buying life insurance to fund the supplemental needs trust set up for the child’s support. What may look like a substantial sum to leave in trust today may run out after several years of paying for care that the parent had previously provided. The more resources available, the better the support that can be provided the child. And if both parents are alive, the cost of “second-to-die” insurance–payable only when the second of the two parents passes away–can be surprisingly low.

For more on special needs trusts and special needs planning, visit our SpecialNeedsAnswers Web site at While some ElderLawAnswers attorneys practice in this area of the law, all attorneys listed on SpecialNeedsAnswers devote a significant part of their practices to working with individuals with special needs and with their families to plan for the future.

Three Reasons Why Giving Your House to Your Children Isn't the Best Way to Protect It From Medicaid

You may be afraid of losing your home if you have to enter a nursing home and apply for Medicaid. While this fear is well-founded, transferring the home to your children is usually not the best way to protect it.

Although you generally do not have to sell your home in order to qualify for Medicaid coverage of nursing home care, the state could file a claim against the house after you die. If you get help from Medicaid to pay for the nursing home, the state must attempt to recoup from your estate whatever benefits it paid for your care. This is called “estate recovery.” If you want to protect your home from this recovery, you may be tempted to give it to your children. Here are three reasons not to:

1. Medicaid ineligibility. Transferring your house to your children (or someone else) may make you ineligible for Medicaid for a period of time. The state Medicaid agency looks at any transfers made within five years of the Medicaid application. If you made a transfer for less than market value within that time period, the state will impose a penalty period during which you will not be eligible for benefits. Depending on the house’s value, the period of Medicaid ineligibility could stretch on for years, and it would not start until the Medicaid applicant is almost completely out of money.

There are circumstances under which you can transfer a home without penalty, however, so consult a qualified elder law attorney before making any transfers. You may freely transfer your home to the following individuals without incurring a transfer penalty:

  • Your spouse
  • A child who is under age 21 or who is blind or disabled
  • Into a trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medicaid applicant, under certain circumstances)
  • A sibling who has lived in the home during the year preceding the applicant's institutionalization and who already holds an equity interest in the home
  • A “caretaker child,” who is defined as a child of the applicant who lived in the house for at least two years prior to the applicant's institutionalization and who during that period provided care that allowed the applicant to avoid a nursing home stay.

2. Loss of control. By transferring your house to your children, you will no longer own the house, which means you will not have control of it. Your children can do what they want with it. In addition, if your children are sued or get divorced, the house will be vulnerable to their creditors.

3. Adverse tax consequences. Inherited property receives a “step up” in basis when you die, which means the basis is the current value of the property. However, when you give property to a child, the tax basis for the property is the same price that you purchased the property for. If your child sells the house after you die, he or she would have to pay capital gains taxes on the difference between the tax basis and the selling price. The only way to avoid some or all of the tax is for the child to live in the house for at least two years before selling it. In that case, the child can exclude up to $250,000 ($500,000 for a couple) of capital gains from taxes.

There are other ways to protect a house from Medicaid estate recovery, including putting the home in a trust. To find out the best option in your circumstances, consult with your elder law attorney. 

GOP Tax Plan Could Deal Blow to Seniors Paying for Long-Term Care

The tax plan put forward by the Republican-led House of Representatives would eliminate many current deductions, and getting rid of one of them in particular could deal a serious financial blow to seniors and individuals with disabilities. The plan proposes eliminating the medical expense deduction, a change that will especially affect those needing long-term care.

Currently, taxpayers can deduct certain medical expenses from their income taxes if the expenses add up to more than 10 percent of adjusted gross income. These expenses can include health insurance premiums, deductibles, nursing home fees, home health care costs and even assisted living fees, if a doctor certifies that the individual must live in the facility due to health care or cognitive needs.

While most taxpayers don't have health care expenditures exceeding 10 percent of their income, many seniors and others with disabilities do. According to the IRS, 8.8 million households — almost 6 percent of tax filers — claimed medical deductions in 2015. The AARP estimates that 74 percent of those who take the deduction are age 50 or over and half have incomes of $50,000 or less. 

“It tends to be mostly … older people who do not have long-term care insurance, and end up in a nursing home,” Richard Kaplan, a professor who specializes in tax policy and elder law at the University of Illinois College of Law, told CNBC. “For people who are receiving long-term care and are paying for it themselves, this is going to be a huge deal.”

For them, having the deduction can mean that they do not run out of funds and have to rely on Medicaid, or are at least able to postpone applying for Medicaid. Eliminating the medical expense deduction will likely mean that more people will spend down their assets more quickly, requiring them to apply for Medicaid. In addition, adult children who pay for their parents' care can sometimes use the deduction. For more information about how ending the medical deduction might affect you, click here.

In addition to eliminating the medical expense deduction, the tax bill cuts corporate tax rates. The bill’s proponents argue that the tax changes will unleash huge economic growth that will result in higher tax revenue. However, if the bill’s supporters are wrong and the growth in tax revenues is not as large as hoped, the reduction in tax revenues will likely cause sharp cuts in government spending or an increase in budget deficits, or both. A reduction in spending could affect seniors and individuals with disabilities through cuts to Medicaid, Medicare, Section 8, Meals on Wheels, and food stamps.

The tax proposal would benefit a small number of wealthy seniors by eliminating the estate tax. Under the proposal, the estate tax exemption will be increased from $5.45 million to $10 million for individuals dying in 2018 through 2023. After 2023, the estate tax will be eliminated completely. The Tax Policy Center estimates that only about 0.2 percent of estates pay any federal tax under current rules.

The House’s tax plan is not final, and the Senate plan preserves the medical expense deduction.  The two bills, if passed, must be reconciled.

For an AARP fact sheet on Medicare beneficiaries who spend at least 10 percent of their income on out-of-pocket medical expenses, click here.

Social Security Beneficiaries Will Receive a 2 Percent Increase in 2018

In 2018, Social Security recipients will get their largest cost of living increase in benefits since 2012, but the additional income will likely be largely eaten up by higher Medicare Part B premiums.

Cost of living increases are tied to the consumer price index, and an upturn in inflation rates and gas prices means recipients get a small boost in 2018, amounting to $27 a month for the typical retiree. The 2 percent increase is higher than last year’s .3 percent rise and the lack of any increase at all in 2016. The cost of living change also affects the maximum amount of earnings subject to the Social Security tax, which will grow from $127,200 to $128,700.

The increase in benefits will likely be consumed by higher Medicare premiums, however. Most elderly and disabled people have their Medicare Part B premiums deducted from their monthly Social Security checks. For these individuals, if Social Security benefits don't rise, Medicare premiums can't either. This “hold harmless” provision does not apply to about 30 percent of Medicare beneficiaries: those enrolled in Medicare but who are not yet receiving Social Security, new Medicare beneficiaries, seniors earning more than $85,000 a year, and “dual eligibles” who get both Medicare and Medicaid benefits. In the past few years, Medicare beneficiaries not subject to the hold harmless provision have been paying higher Medicare premiums while Medicare premiums for those in the hold harmless group remained more or less the same. Now that seniors will be getting an increase in Social Security payments, Medicare will likely hike premiums for the seniors in the hold harmless group. And that increase may eat up the entire raise, at least for some beneficiaries.

For 2018, the monthly federal Supplemental Security Income (SSI) payment standard will be $750 for an individual and $1,125 for a couple.

For more on the 2018 Social Security benefit levels, click here.

Using a Prepaid Funeral Contract to Spend Down Assets for Medicaid

No one wants to think about his or her death, but a little preparation in the form of a prepaid funeral contract can be useful. In addition to helping your family after your death, a prepaid funeral contract can be a good way to spend down assets in order to qualify for Medicaid.

A prepaid or pre-need funeral contract allows you to purchase funeral goods and services before you die. The contract can be entered into with a funeral home or cemetery. Prepaid funeral contracts can include payments for: embalming and restoration, room for the funeral service, casket, vault or grave liner, cremation, transportation, permits, headstones, death certificates, and obituaries, among other things.

One benefit of a prepaid funeral contract is that you are paying now for a service that may increase in price—possibly saving your family money. You are also saving your family from having to make arrangements after you die, which can be difficult and time-consuming. And, if you are planning on applying for Medicaid, a prepaid funeral contract can be a way to spend down your assets.

Medicaid applicants must spend down their available assets until they reach the qualifying level ($2,000 in Ohio). By purchasing a prepaid funeral contract, you can turn available assets into an exempt asset that won’t affect your eligibility. In order for a prepaid funeral contract to be exempt from Medicaid asset rules, the contract must be irrevocable. That means you can’t change it or cancel it once it is signed.

Before purchasing a contract, you should shop around and compare prices to make sure it is the right contract for you. Buyers need to be careful that they are buying from a reputable company and need to ask for a price list to make sure they are not overpaying.

For information on planning a funeral, see my checklist on my website


Last August 1, 2016, The Ohio Medicaid program had major changes to all eligibility rules. We have had one year of experience with these changes. This presentation will review all the new rules, problems that have arisen and experience our office has had with their interpretation and implementation. There will also be a complete review of all topics listed below as well as other new developments this last year.

Wednesday, August 30, 2017 @ 8:45 AM – 12:00 PM

This seminar will focus on Medicaid eligibility from the point of view of the nursing facility. It will not focus on planning techniques to preserve assets and achieve Medicaid eligibility. The objective is to provide information, tips and relate the experience of Michael J. Millonig to assist nursing homes in avoiding problems with Medicaid applications.

Medicaid Eligibility For Nursing Home Residents

▸ Review of all new changes resulting from Ohio’s conversion to an SSI/1634 State
▸ Review all new resource eligibility rules
▸ Miller Trusts (aka Qualified Income Trusts)
▸ Retroactivity problems related to Miller Trusts
▸ Possible loss of eligibility for Medicaid recipients in Medicaid spend down group
▸ Miller Trusts for AL Waiver residents
▸ Changes to rules with Revocable Living Trusts
▸ Review of basic Medicaid Eligibility rules for nursing home vendor payments
▸ Common Problems causing ineligibility & how to avoid them
▸ Medicaid Transfer rule
▸ Explaining the Transfer rule to residents to avoid creating problems
▸ Undue hardship rule & provision for nursing homes to apply for resident
▸ Rule governing nursing home contract entrance fees
▸ Other important Medicaid rules: annuities, home equity, life estates
▸ Community Spouse Resource Allowance provisions and spend down rules
▸ Assisted Living rules for Medicaid
▸ Problems with income eligibility for AL Waiver residents; and solutions
▸ Retroactive eligibility
▸ Practical tips on processing applications and dealing with caseworkers
▸ Avoiding problems in the spend down process

This seminar has been approved for CE credit by:
1) the State of Ohio Counselor and Social Worker Board.
2) the Ohio Board of Nursing also recognizes Social Worker CEU’s if relevant to area of practice

Reservations must be made in advance with payment. Please contact Julie for more information:


Washington-Centerville Public Library
Saturday, May 13, 2017
10:30 a.m. to 12:00 p.m.


The Ohio Medicaid program has just enacted major changes; the most dramatic since its inception in 1972. Ohio has terminated its 209(b) status under federal law and has converted to an SSI/1634 State. This means that all eligibility rules will be different along with the Medicaid application process. The effective date of this change was August 1, 2016.
A seminar presentation by Michael J. Millonig, Attorney At Law. Michael J. Millonig practices law at 7929 Washington Woods Dr. in the Washington Township/Centerville area and is :
▸ Certified as an Elder Law Attorney by the National Elder Law Foundation since 1998
▸ Ohio State Bar Association Board Certified Estate Planning, Trust and Probate Specialist
▸ CPA inactive status

Topics Covered

▸ Review of all new changes resulting from Ohio’s conversion to an SSI/1634 State
▸ New Medicaid income eligibility rule
▸ Possible loss of eligibility for persons currently on Medicaid
▸ Effect of these changes on estate plans & trusts
▸ Medicaid eligibility
▸ Asset preservation strategies
▸ Use of Trusts to protect estates
▸ Medicaid Annuities
▸ Risks of gifting to children
▸ Understanding Medicaid’s Gift Transfer rule
▸ Insurance for nursing home care

The Washington-Centerville Public Library is located at 111 West Spring Valley Road, Centerville, Ohio 45458. Please call for reservations: (937) 433-8091.

A Caregiver's Holiday Survival Guide

A Holiday Survival Guide for Caregivers

For most of us, while we love the holiday season, there’s also a crazy amount of stress — stress related to managing the household, the family and all the related activities, getting everything “done”, getting work ready for next year, closing out this year, and on and on. But to some, this stress has an extra dimension — the need to care for a loved one in addition to all of the other stuff. It’s not easy to manage, which is why caregivers often tend to give up their own enjoyment for the sake of their loved one’s safety and company, and the end result can be that it’s more about holiday survival than actually enjoying the holidays. But isn’t that what they’ve been doing all year long? Right, it is. However, it doesn’t have to be that way.

Learn to prioritize, care for yourself, and reach out for help, and make this holiday count.


Becoming overwhelmed with work that needs to be done and endless lists of tasks is one of the biggest causes of stress. And what’s the best way to avoid drowning in work? The answer is: learn to prioritize.

There are so many things that seemingly need to be done during the holidays, and there’s seemingly nobody else to take care of them. Please note the word ‘seemingly’. There are many things that can be left out during the holidays, and you’d be surprised how even the smallest change to your schedule can make a great difference in maintaining your psychological peace and comfort during the holidays.

Start off by making a list of all the things that come to your mind — everything that you feel like you have to take care of. Decorating, budgeting, organizing parties, attending parties and other events, buying gifts, cleaning up, etc…. Once you have the list, try to think outside the box for once and ask yourself the following questions:

  • Does it have an immediate effect on your or someone else’s enjoyment of the holidays?
  • What’s the real reason you’re doing it? Habit? Choice? Obligation?
  • Are you really the only person who can do it? Why?
  • Do you enjoy doing it, or would you rather do something else / do it differently?

You may end up being surprised by some of your own answers. Sometimes all it takes is taking a moment to think about what you want, and how you want it. Change is often the tool for reaching peace. Try it for yourself.

Care for yourself as well.

There are two important things that a caregiver needs to keep in mind 24/7:

1) You as a caregiver are a full, worthy person.
2) Your loved one is a full, worthy person

The first point means you should beware cutting yourself off from your friends, hobbies and activities that make you feel happy and energized. Schedule coffee dates with your friends, call that cousin you haven’t talked to in a while, rent a movie you wanted to see, buy a new album by your favorite artist, just treat yourself. If you never get to do it, it’s the perfect time of the year, after all.

The second point means that whenever you start slipping into seeing your loved one as a patient rather than a person, you should get back in touch with their own personal life, involve them in yours, and most importantly: talk. Talk about your feelings, your fears, your joys and thoughts and new experiences.

Reach out.

This is the natural next step from the first point of prioritizing. Getting your family and your close ones involved in holiday planning, cooking, cleaning, decorating and shopping is the best way for you to keep your sanity. And if for any reason they can’t help you, consider hiring some help – be it a decorator, a cleaning service or a caterer. If you take some of the weight off your shoulders, you’ll see that not only will you enjoy the holidays more than ever, but also your loved ones — including the one you’re caring for — will be happy to see you shine.

Remember: it’s hard to make other people feel happy and appreciated if you don’t feel that way yourself.

winter holiday activities

Winter Holiday Activities for Seniors

As important as it is to keep our elderly loved ones safe, it is equally important to keep them entertained. Wintertime may be a difficult time for many, with the shorter and darker days, the nostalgic holiday time and the stress pushing on us from all sides. That’s why in the winter it’s more important than ever to keep the fun and activities coming.

And since you, my readers, seemed to enjoy my fall’s guide for senior activities, I’ve decided to give you a few tips for the wintertime as well.

Indoor Activities

Sometimes, the wind and snowstorms just make us feel like we want to stay at home for the weekend. And that’s perfectly fine! There are many great things to do at home with an elderly loved one and the whole family.

Cooking and Baking

Whether you decide to bake your favorite holiday treats, try out foreign recipes, make a batch of chilli for everyone to enjoy during a family party or make a homemade egg nog, the kitchen is the perfect place to spend some quality time with your senior loved one. You can learn their favorite recipe, and aside from having fun you’ll also end up with a bunch of – very likely excellent – food.

Holiday crafts

Making a festive centerpiece, a wreath, scene display or arrangement, crocheting, drawing holiday-themed window murals or crafting gifts – those are just a few examples of things that are fun to do not only for seniors, but for the whole family while being warm and cozy at home during the long winter nights. It’s a great way to keep everyone busy and it serves as pleasant mental training, too.

Indoor gardening

Gardening in general is proven to be one of the most relaxing and stimulating activities out there. But there’s no reason to lay down the rake during the winter months – there are ways to enjoy the benefits of gardening during winter, such as planting your favorite flowers or herbs indoors. Indoor gardening is a safe hobby with little risk and a great outcome.

Game nights

Who doesn’t love a good game of bingo, solitaire, Monopoly or chess! Board and social games are perfect for spending a lot of time with friends and family while also providing unmatched brain stimulation, all that while having a great deal of fun.

Outdoor Activities

Staying inside is great, but every now and then it’s good to get out there and enjoy the holiday spirit.

Parades and tree lightings

One of the most beautiful things about the winter is that it is filled with various holiday-themed and family friendly events outdoors, such as tree lightings or holiday parades. Engaging in the local community while enjoying the start of the holiday season together can become a beautiful family tradition that everyone is looking forward to.

Holiday themed culture events

Find out about the concerts, movies and theater performances, art exhibitions and other interesting and educational events in your area. If you are a fan of art, the holidays are a great time to enjoy some of it with the elderly members of your family. Dressing up and going out for some culture can be as enjoyable for the kids as for the grandparents.


If the grandparents are healthy and feeling up to it, why not take them snow walking or ice skating? It’s the season after all, plus a healthy amount of outdoor exercise will do everyone good. Just make sure everyone stays warm, and that safety doesn’t get left behind in the whirlwind of fun. Or if sports are too demanding an activity for your senior loved one, how about engaging them in a snow fort construction or snowman building with the kids?

Catching up with friends

During the holidays we all tend to feel a little more nostalgic and a little more connected to all the people who are important to us. Offer your elderly relative a drive to see their friends or offer to help organize a game night or a tea party. Socialization is known to make people feel more engaged and happy, and that’s extremely important during all times of the year, but during the holidays especially.