One concern I frequently hear is a worry that the government will take assets from a loved one or take assets from an estate instead of family members inheriting it. These are valid concerns because there are specific instances where this can happen, but as a general rule, the government DOES NOT take assets unless they have a legal reason for doing so.
The State of Tennessee will not take your assets
There are a few instances where the government will take your assets if you die without a will. For example, if someone received Medicaid (TennCare) to pay for long-term care, if they owed back taxes, or if no family members can be located. But, as a general rule, the State of Tennessee is not going to take your assets.
Tennessee will find your closest heirs
The State of Tennessee has a statute that lays out how your assets will pass if you die without a will. Your assets will pass to what we call your heirs at law. Those are really the people that you probably think of as your closest relatives: your spouse, your children, your grandchildren, your parents, your siblings, your nieces and nephews, your cousins, and farther out. But it’s the close relatives that the state will seek out.
Generally, the government is going to look for anyone related to you before they get any money. I hope that sharing this information with you has given you a sense of relief if you were told inaccurate information elsewhere.
If you have other questions about your estate or that of a loved one, click here to schedule a call with us.
Last week we defined TennCare and how it applies to our clients. This week I want to go more in-depth with how TennCare serves Tennesseans with long-term care.
Many people believe that Medicare benefits will cover nursing home care once an individual is 65 or older, but this simply isn’t true. While Medicare covers the first 100 days, it doesn’t cover long-term assisted living. Read more about Medicare here.
“ Choices” is Tennessee’s Medicaid program for long-term care services and support
Back to TennCare/Medicaid…
My Mom doesn’t have long-term healthcare insurance. What are my options?
Payout of pocket until you run out of cash – This is an unrealistic option for most families. Nursing home care is expensive. Not a lot of people have an extra $7,000-$11,000 a month in their bank accounts.
Do a reverse mortgage on her home.
Qualify for the TennCare / Medicaid program called “CHOICES”.
As you can see, options 1 and 2 are very unpleasant and leave nothing left for a loved one’s legacy. However, option 3, CHOICES, is definitely something worth looking into.
What is CHOICES?
CHOICES is the category of TennCare that provides Long-Term Services and Supports (LTSS) such as nursing home care.
What is the process for getting qualified for CHOICES?
In order to be eligible to receive benefits from TennCare/Medicaid your loved one must first qualify within these three categories:
Medical eligibility
Income threshold
Asset threshold
Being medically and financially eligible is necessary for TennCare approval
How does someone become medically eligible for TennCare CHOICES?
The state of Tennessee will determine who is medically eligible to receive TennCare Long-Term Services and Support (LTSS) by using a pre-admission evaluation (PAE). This PAE is used to determine if the applicant can do basic life skills on their own without help. The PAE will also determine if the applicant is safe in their current environment.
The PAE is a strict evaluation and it is performed on a case-by-case basis. An applicant must receive a score of 9 or higher on a 26 point scale in order to be considered medically eligible for TennCare Long-Term Support Services.
For example, a caregiver or healthcare provider may be asked about a patient’s level of ability to do things and how much assistance is needed.
The following Activities of Daily Living (ADLs) are covered in the PAE evaluation:
Transfering
Mobility
Communication
Medication
Orientation
Eating
Behavior
If you or your loved one is unlikely to get to a nine or higher on the PAE, it is always appropriate to ask for a “safety determination” evaluation as an alternative route of becoming medically eligible for Choices.
How can someone become financially eligible to receive CHOICES?
You must be able to prove that the applicant has a low income and little assets. As of January 2022, an individual applying for TennCare CHOICES cannot have an income exceeding $2,523.00 per month. Additionally, the applicant cannot have more than $2,000 in assets. This includes any money in the bank and investment accounts but also requires consideration of retirement accounts, life insurance policies, real estate, artwork, jewelry, and any other valuables. When we talk about the assets for a couple of things get a little more complex. The most important thing is that both the applicant and their family are taken care of, both medically and financially.
My Mom is over the limits for income and assets? What do we do?
If the applicant is in excess of the amounts we can plan for that! We have a tool to help people who have excess income and assets yet need to qualify for TennCare/Medicaid called the “Care and Savings Assessment”. With this Care and Savings Assessment, we work to determine the best way to structure you or your loved one’s finances, either now or in the future. We plan so that our clients have the peace of mind knowing they can qualify for TennCare if and when they need it!
In conclusion
It is often helpful to have an attorney assess your financial situation and offer recommendations on how those finances may be restructured to qualify for TennCare Long-Term Services and Support (LTSS). As an experienced TennCare planning attorney, I can help you evaluate your risk and create a plan that takes care of everyone in the family.
Are you ready for help with TennCare planning? Contact us and we can discuss your plan. Next week we will go over some examples of how we restructure an individual’s finances to meet their needs for long-term care.
So you’ve been to your primary care provider and they’ve told you it’s time to see a specialist. Or maybe they’re changing practices or retiring! Or maybe you’re looking at our list of recommended doctors appointments and realizing you need to make some new appointments as you get older. Whatever the case, now you’re tasked with finding a new doctor – and it might feel daunting. We’ve got some tried and true recommendations to make this task just a little easier for you.
Don’t be afraid to ask for a recommendation!
Start with the doctor you trust – who do they recommend you visit? Maybe that’s a specialist within a greater healthcare system (Vanderbilt, St. Thomas, etc.) or maybe it’s someone who has expertise in your specific diagnosis. But don’t stop there! Next, if you’re comfortable, reach out to your family and friends to see if they have a provider whom they really like. Why do they like their doctor? If you trust their opinions, this might be a good resource for you.
If you’re able, consider the possibility of driving to get a good doctor. Sure, they’re on the other side of town, but if they come highly recommended and you’re only going 1-2 times a year, it might be worth the traffic!
Lastly, be sure to consider any deal breakers. This looks different for everyone, but it could include transportation factors, a specific focus in their practice, or you’re looking for a doctor of a specific gender (like a female OB/GYN). Take my example – my husband and I are child-free, so I was very pleased to find a gynecologist who doesn’t also help with childbirth. It means she is able to focus on what matters to me and isn’t away delivering a baby when my appointment time comes around.
Check out their internet presence.
Most offices these days have a website, listing their hours, providers, and even patient ratings of the physicians. Do you like what you read there? Or is there something that makes you think twice? If there are comments, take the time to read those, as they may give you a deeper understanding of the provider’s demeanor and care (rather than just a 5 star rating).
Additionally, use this website to confirm the doctor’s licensure. You can also view any disciplinary matters on your particular doctor in their Practitioner Profile on this website.
Contact the provider’s office.
The last thing you want is to show up and find they only accept a certain type of insurance coverage! Call the office and ask if they take your insurance; you can find your information on your insurance card. Keep in mind that the staff may need to look up the information, but “I don’t know” is not an acceptable answer here. If the person who answers isn’t sure, ask to speak to someone in the billing department to verify your coverage.
Don’t forget to also ask if you will need a referral to their office from your primary care provider. Some specialists will accept self-referrals, but your insurance company might think otherwise!
What about a copay?
Oftentimes, your insurance card will list a copay amount for various types of providers. If not, be sure to log in to your insurance company’s website and verify the copay, or call the number on your card to speak with a representative. Specialist visits typically have a higher copay amount than a regular PCP appointment; you will want to be prepared.
Remember: just because you see a doctor once doesn’t mean you have to continue seeing them. Just like any professional, you should find someone that you are comfortable with – which isn’t a reflection on the doctor or their skills, sometimes it’s something that you just have a gut feeling about and want to find a better fit. Feel free to tell the doctor this. If you can articulate what you want, tell them and ask if they have a recommendation. They probably know other doctors in their area!
You and your provider are a team, and by working together, you should be able to ensure you are taken care of for years to come! You have the ability to direct your healthcare and make decisions for your future; hooray for being proactive!
As a child, our parents are responsible for making sure we get our regular check ups and vaccinations, but as an adult- throw in figuring out health insurance- things get so much more complicated!
Scheduling doctor appointments is a necessary task that can come with a lot of headache and uncertainty. How often should we go? Where do you find a primary care physician????
Just like you get your car a check up before you go on a long trip, it’s important to regularly check in with appropriate medical professionals in order to prevent a bigger health crisis down the road. Which screenings do we need throughout our life and at what intervals? Let us help you relieve some of that stress by following these scheduling and screening tips!
Read on for a list of appointments you should make this year, and remember to ask if your insurance is in-network when you schedule! We’ve got a handy tool at the end of this article to help you keep track of your appointments.
Appointments for All Adults 18+
Primary care physician (PCP)
When: Annually
Who: Everyone. Seeing a PCP on a regular basis is the best way to monitor your wellness. Your PCP will be able to help you make an informed decision on what appointments you should add to your annual list.
Dentist
When: Every 6 months
Who: Everyone
Gynecologist
When: Annually or if pregnant/trying to conceive
Who: People with female reproductive systems. It is recommended that you begin annual gynecologist visits as a teenager or after you become sexually active. Regardless of sexual activity, it is recommended that your first visit be by age 21 at the latest. If you have a new sexual partner, an STI test is recommended. If you regularly have more than one sexual partner, it might be wise to have a STI and Pap test every 6 months.
Eye doctor
When: If you have healthy vision, schedule a visit once in your 20s, twice in your 30s, and once at age 40. Those with existing vision needs should follow their eye doctor’s recommendations on frequency of visits. If you develop any vision difficulty or eye problems, a check up is recommended.
Who: Everyone
Dermatologist
When: Annually
Who: Everyone, especially if you spend a lot of time in the sun, are fair-skinned, or have family history of skin cancer.
Vaccinations
When: As recommended. Your PCP should be able to help you decide when to get vaccinations or boosters. Vaccine recommendations frequently include:
Annual flu vaccine comes out around September
HPV vaccine and meningitis for young adults
Shingles
Covid 19 vaccine and appropriate boosters
Who: Everyone
It’s important to get regular appointments with your doctors so they will have a baseline for your health conditions in case things change.
Appointments for Adults ages 40 +
Gynecologist – Mammogram
When: Annually
Who: People with breasts
PCP – Rectal Exam/PSA blood test
When: Annually
Who: People with prostates
Gastroenterologist – Colonoscopy
When: Regular screenings are recommended for those between the ages of 45 and 75. If your colonoscopy shows no signs of cancer, you can typically wait 10 years before scheduling another one.
Who: Everyone
If you’re 50+, add this l screening to your list:
Lung Screening
When: Annually
Who: Adults who have smoked 1 pack of cigarettes per day for 20 years or 2 packs per day for 10 years and currently smoke, or adults who have quit smoking within the last 15 years.
If you’re 60+, add this screening to your list:
Osteoporosis Screening
When: Age 65 and up
Who: Cisgender women and People assigned female at birth
If you have a family history or risk factors of any particular diseases, talk with your PCP to decide if you need earlier, more regular, or other specific screenings. Remember, prevention is better (and cheaper) than the cure!
Extra tips:
Need a New Year’s Resolution? Schedule all of your doctor appointments before the end of January so that you can cross that task off your to-do list and feel good about prioritizing your wellness
The ACA covers 100% of preventative health care. Visit Healthcare.gov for more information.
Add travel time to your appointments in your calendar
Remember to wear short sleeves to doctors appointments so they can easily take your blood pressure
We know keeping up with all of these appointments and screenings can be overwhelming. If you’re a visual organizer like us, please use our fillable guide to make sure all of your appointments are scheduled. Hang the guide on your fridge or in your office so that you’ll never miss an appointment!
Cheers to taking care of ourselves and advocating for our health in 2023!
Trusts are a legal tool that can be used for many purposes including estate planning, asset protection, and income tax minimization. Trusts are a way of managing property with the intention of protecting it so that it can be passed on via inheritance to future generations.
Trusts establish a fiduciary relationship that allows a third party to hold a person’s assets on behalf of that person’s beneficiary or beneficiaries. The person establishing the trust and designating the beneficiaries is known as the “settlor” or “trustor,” and the third party who holds the assets on behalf of the beneficiaries is the “trustee.”
Why do people create trusts?
Why do people create trusts in the first place? How do you know if you need a trust? First, people create trusts to control and protect their assets, especially for after they pass away. Trusts provide legal protection for the trustor’s real and personal property, and can also provide protection from creditors. Second, people create trusts because they are concerned about their money being spent on someone other than who it was intended for. Trusts are established to make sure that the trustor’s assets are distributed according to their wishes. If you have significant assets, especially a significant amount of real estate assets, or you have very specific wishes about how and when you want your assets distributed after you pass away, a trust might be for you. The best thing to do is talk to your attorney, who will help you determine whether a trust is the best way to protect your assets.
A beneficiary cannot just “take” an inheritance out of a trust
Since the purpose of a trust is to protect your assets, beneficiaries cannot just take their inheritance out of the trust as they please. The trustee must follow the terms of the trust established by the trustor.
Minors & age clauses within trusts
People under the age of 18 legally cannot control their own money. A trust may be established for a minor beneficiary in order for them to have financial resources during their minority, but these resources are managed by the trustee according to the terms established by the trustor. For example, a trustor may include that their beneficiary receives a regular allowance from the trust.
However, turning 18 does not necessarily mean that the beneficiary will automatically have unlimited access to the trust. Many trustors include payout clauses that extend the trust for a certain amount of time after the beneficiary turns 18. The policy behind this is that, while an 18-year-old may legally be able to control money and property and enter into contracts, the late teenage and early adult years are still a very developmental stage of life. An 18-year-old very well may not have the maturity and money management skills required to handle a significant amount of assets. Age clauses allow for the beneficiary to continue receiving periodic funds from the trust, but provide another level of protection of the trustor’s assets until the beneficiary reaches an age of presumed maturity, usually when the beneficiary reaches their mid-20s.
Trusts for beneficiaries with special needs
These types of trusts are intended to provide for individuals with special needs while also allowing them to retain government benefits like social security or Medicaid. The Trustee will distribute funds from the trust as needed, or on a regular schedule, to take care of the special needs beneficiary’s living expenses and health care needs.
Do you have assets that need to be directed to a beneficiary in a specific manner?
The terms for receiving an inheritance are set when the trust is created
Overall, money moves from a trust only according to the terms set forth at the creation of the trust. This may mean a periodic payment to the beneficiary distributed by the trustee, lump-sum payment to the beneficiary at a certain age, or both. Assets cannot be removed from the trust unless the terms provide for it. To obtain assets from the trust that are not provided for within the terms of the trust, you likely will have to go to court.
In conclusion
When it comes to estate planning, there are many ways that you can distribute your assets according to your wishes. One of the most popular ways is to create a trust.
There are many types of trusts out there. A trust can be either revocable or irrevocable and it can have unique clauses for receiving an inheritance. Trusts are in many ways the opposite of a will. A will is used to distribute property after someone dies, while a trust is set up while someone is alive and involves giving up control over the assets.
Not sure if a trust is right for you? Discuss your financial and family situation with a qualified attorney first.
