Presentation on theme: "Life Insurance in the Estate Plan and Incapacity Planning"— Presentation transcript:
1 Life Insurance in the Estate Plan and Incapacity Planning Session 9DePaul University CFP® Program
2 Life Insurance and Estate Planning Objectives Financial protection for survivors by replacing the insured’s lost income.Frank bought life insurance to help ensure that his survivors wouldn't suffer financially when he died. When Frank died and his paycheck stopped, his family had enough money to maintain their lifestyle and live comfortably for years.Replace wealth that is lost due to estate settlement expenses and taxes.Frank bought enough life insurance to cover the potential costs of settling his estate, including taxes, fees, and other debts.Charitable giving - estate enjoys tax deductionUsing life insurance, Frank was able to leave a substantial and fully deductible gift to his favorite charity at death or before.DePaul University All rights reserved.
3 Estate Planning and Risk Management A complete financial/estate plan must consider:income protection during the client’s earning yearsfuture needs – income replacement, andprotection of estate.Life insuranceDisability insuranceLong-term care insuranceDePaul University All rights reserved.
4 Life Insurance in the Estate Plan If, at death or within 3-years of death, an individual holds incidents of ownership in a life insurance policy under which s/he is the insured, the entire face value of the policy is included in the insured’s gross estate.Incidents of ownership include:The right to name/change beneficiariesThe right to assign ownership of the policyThe right to policy loans from cash valueThe right to surrender the coverageDePaul University All rights reserved.
5 DePaul University All rights reserved. Question 9-1All of the following represent “incidents of ownership” in a life insurance policy except:A. The right to change the beneficiary from your spouse to your child.B. The right to assign ownership of your policy to an irrevocable life insurance trust (ILIT).C. The right to borrow from the policy’s cash savings account.D. The right to pay the premium.The correct answer is D. Paying the premium on a life insurance policy does not make the payor an “owner” for tax purposes. The other items do.DePaul University All rights reserved.
6 DePaul University All rights reserved. Term Life InsuranceTerm insurance pays policy’s face amount if insured dies during coverage period.Temporary protectionTypically lowest cost when insured is youngPremiums generally rise as insured agesDePaul University All rights reserved.
7 Convertible Term Life Insurance Convertible term life insurance allows changing a term policy to a permanent policy (such as whole-life or universal life) without penalties.Most term policies issued today are renewable and convertible, allowing the insured to adjust coverage needs to changing circumstances.Many young, healthy policyholders choose a convertible term insurance policy initially because of the low cost premiums and basic coverage.In the future, may policyholders may decide that a cash value policy is better suited to their financial plan.Conversion typically accomplished at attained ageIn some policies, owner may pay a lump sum to maintain the original issue age premium going forward.DePaul University All rights reserved.
8 First-to-Die (Joint Life) Insurance First-to-die (joint life) covers >2 insureds, paying benefits at the first death.Benefits may be used for:Survivor incomeSurvivor spouseSurviving business owners/partnersMortgage protectionFunding business buy/sell agreementsCovering consumer and other debtDePaul University All rights reserved.
9 Second-to-Die (Survivorship Life) Insurance Second-to-die (survivorship) life insurance covers two lives, paying benefits at the second deathTypically used to provide funds to pay federal estate tax on death of second spouseMay be term policy or permanent coverageCost:Greater than on a single life, butLower than with two individual policiesUnderwritingTypically less stringent than with individual policiesMay present insurance opportunity for insured in questionable healthDePaul University All rights reserved.
10 DePaul University All rights reserved. Question 9-2Which of the following statements about second-to die life insurance is true?A. For a couple, it is typically used to pay federal estate taxes on the estate of the first spouse to die.B. It is seldom held in trust.C. An individual who would be denied coverage under an individual life insurance policy may be covered under a second-to-die policy.D. A second-to-die policy is typically more expensive than two policies on two spouses.The best answer is C. An individual who would be denied coverage under an individual life insurance policy may be covered under a second-to-die policy. For a couple, it is typically used to pay federal estate taxes on the estate of the SECOND spouse to die. It is usually owned by an irrevocable life insurance trust. A second-to-die policy is typically A second-to-die policy is typically more expensive than two policies on two spouses. LESS expensive than two policies on two spouses.DePaul University All rights reserved.
11 DePaul University All rights reserved. Whole Life InsuranceWhole life insurance provides protection at a level premium for the entire life of the insured. Policy typically endows (pays face value) at age 100TypesStraight whole life (ordinary life, continuous premium life)Premiums paid throughout insured’s lifeLimited-pay whole lifePremiums limited to specific number of yearsExamples20-pay lifePaid-up at age 65Higher premiums than ordinary life because later (riskier) years must be “prepaid”DePaul University All rights reserved.
12 Universal Life Insurance Similar to whole life insurance but cost of insurance inside the UL policy is based on annually renewable term life insurance.Advantages include:premium flexibilityadjustable death benefits.at the policy owner's request, subject to insurability.DePaul University All rights reserved.
13 Two Universal Life Insurance Policy Designs Most universal life insurance offered today reflects one of the two benefit designs below:Level death benefit (aka Option A)Death benefit constant unless cash value exceeds certain amountsOver certain cash value amounts, death benefit increasedIncreasing death benefit (aka Option B)Death benefit increases to correspond with increasing cash valueDePaul University All rights reserved.
14 Increasing Death Benefit Universal Life Insurance Example Mike is covered for $200,000 under an increasing death benefit (Option B) universal life insurance policy. Its cash value has grown to $50,000.Death benefit grows by $50,000 to $250,000 totalThus, $250,000 will be included in Mike’s gross estate if he holds incidents of ownership in the policy within 3 years of his death.DePaul University All rights reserved.
15 DePaul University All rights reserved. Suicide ClauseIf the insured commits suicide within the suicide period, only the aggregate premiums are paid to beneficiaryIf insured holds incidents of ownership, only the premium refund amount (not the death benefit) is included in the gross estateSuicide period typically 2 yearsFollowing suicide period, the death benefit is payable even if insured commits suicideDePaul University All rights reserved.
16 DePaul University All rights reserved. Question 9-3Due to the recession, Bruno committed suicide 18 months after his $1MM life insurance policy was issued. He had paid $30,000 in premiums. Approximately what amount will be included in Bruno’s gross estate?$1,000,000$970,000$30,000$-0-The best answer is C. If the insured commits suicide within the suicide period, only the aggregate premiums are paid to the beneficiary and includable in the gross estate for FET purposes.DePaul University All rights reserved.
17 Accidental Death Benefit (Double Indemnity) The accidental death benefit rider pays double (if double indemnity) or triple, (if triple indemnity) if the insured’s death accidentalAssuming the insured holds incedents of ownership, the rider will double (or triple) the amount to be included in the gross estateDePaul University All rights reserved.
18 DePaul University All rights reserved. Simultaneous DeathThe Uniform Simultaneous Death Act specifies that, if two or more people die within 120 hours of one another, and no will or other document provides for this situation explicitly, each is considered to have predeceased the other.The USDA, as adopted by various States, varies from jurisdiction to jurisdictionThe statute creates a rebuttable presumptionDePaul University All rights reserved.
19 Simultaneous Death (continued) Linda is insured under a life insurance policy. Her husband, Alex, is its beneficiary. They are both killed in a plane crash, dying at or near the same time. If the policyholder named a secondary beneficiary in the policy, that person will receive the life insurance benefit. If no secondary beneficiary has been named, then it is assumed that she outlived Alex, and the benefit is inherited through Linda’s estate.DePaul University All rights reserved.
20 General Rules for Life Insurance Inclusion in Gross Estate Life insurance will be included in an individual’s gross estate for federal estate tax purposes if:The decedent held incidents of ownership at death, orThe insured transferred ownership of the policy within the three year period preceding deathThe policy’s death benefit is payable to the insured’s estateOr the primary beneficiary predeceases the insured and no contingent beneficiary exists, making the estate the default beneficiaryDePaul University All rights reserved.
21 Policy Ownership by the Insured If it is reasonably certain that the insured’s estate will not be taxable, the client owning the policy on his/her own life is not problematic.However, if federal estate tax is likely the client should consider alternative owners including:The spousePolicy’s interpolated terminal reserve is included in the spouse’s estate if he/she predeceases the insuredAnother family memberTypically adult childrenIrrevocable Life Insurance Trust (ILIT)Generally the most appropriate choiceDePaul University All rights reserved.
22 Estate Taxation of Life Insurance on Another’s Life For federal estate tax, the interpolated terminal reserve (approximate replacement value) is includible in the estate of an individual owning a life insurance policy under which another individual is insured.DePaul University All rights reserved.
23 Owning a Policy on an Insured Spouse If one spouse dies owning a life insurance policy on the other, the amount included in the gross estate of the decedent/owner (NOT the insured) will be:For a term life policy, the unused premiumFor a cash value policy, the interpolated terminal reserve and the unused premiumSimilar to replacement valueInsurance company provides figuresDePaul University All rights reserved.
24 DePaul University All rights reserved. Question 9-5Laura dies owning a $1 million (face value) whole life policy on her husband, Scott. It has an interpolated terminal reserve of $160,000 and an unused premium of $11,000. Approximately what amount, if any, is included in Laura’s gross estate? A. $-0- because the insured is still living. B. $1million C. $171,000 D. $160,000The correct answer is C representing both the interpolated terminal reserve and the unused premium.DePaul University All rights reserved.
25 Income Taxation of Death Benefits Under general rule, insurance death benefits are received income tax free by the beneficiaryException for life insurance “transferred for value”Death benefit less premiums paid (basis) is taxable to the beneficiaryException for corporate-owned life insuranceGain from death benefit may be subject to alternative minimum tax (AMT)DePaul University All rights reserved.
26 Exceptions to Transfer for Value Rule Even where the policy is acquired for consideration, the death benefit remains income tax free under these exceptions to the rule:Policy is transferred to the insuredPolicy is transferred to a partner of the insuredMay occur with buy/sell agreementsPolicy is transferred to corporation in which insured is shareholder or officerDePaul University All rights reserved.
27 The Irrevocable Life Insurance Trust (ILIT) Estate taxes on insurance proceeds may be avoided by creating a properly executed irrevocable life insurance trust ILIT.May include policies on one life or second-to die policiesWith a married couple, the second-to-die policy is popular due to the marital deductiontaxes only due at the second deathless costly than two separate policies.DePaul University All rights reserved.
28 ILIT May Be Funded or Unfunded An ILIT may be fundedOther income producing assets are transferred to the trust to generate money for the premiumIncome is taxed under grantor trust rulesTransfer of assets triggers gift tax consequencesOr, an ILIT may be unfundedThe grantor makes gifts so trustee can pay the premiumsAnnual gift tax exposureUsually avoided using Crummey powersDePaul University All rights reserved.
29 DePaul University All rights reserved. Paying the PremiumsAlthough though the ILIT owns the policy, the grantor can still (and typically must) pay the premiums.The grantor can annual make gifts of cash to the trust, and the trustee can use this money to pay policy premiums.Even with Crummey powers, gifts in excess of $13,000/beneficiary power holder are taxable gifts.DePaul University All rights reserved.
30 DePaul University All rights reserved. Giving Up ControlIf your trust purchases and owns the policy(s), the grantor typically has no right to change the beneficiary or borrow from/against the policy.The grantor names the beneficiaries of the trust and the trust/policy owner is the beneficiary of the proceeds.Because the ILIT is irrevocable, the grantor would typically not serve as trustee, eliminating any potential incedents of ownership.DePaul University All rights reserved.
31 Transferring Current Policies A grantor can transfer ownership of a policy he owns to an ILIT in order to shield the proceeds from estate taxes.This is a taxable transfer.Grantor’s death within three years of transfer forces gross estate inclusion of proceeds.If the proceeds increase the value of the estate to more than $5.12 million tax will be due.DePaul University All rights reserved.
32 Beneficiaries Can Still Enjoy Proceeds When the ILIT receives the death benefits from its policy(s) at the insured grantor’s death, thay are income and estate tax free. The trustee may:Distribute funds beneficiariesUse funds to provide estate liquidityPurchase assets from estateUsually no gain due to basis step-upOften trustee of ILIT is also executor of estateDePaul University All rights reserved.
33 DePaul University All rights reserved. ILIT ExampleRobert and his wife Sally accumulated a small real estate empire throughout California, including a Lake Forest home ($4,000,000), a vacation home in Lake Tahoe ($2,120,000) and three rental properties in Hawaii (together worth $5,500,000). Robert’s liquid assets were mostly spent by the end of his life, amounting to $150,000. Sally has died and Robert has not remarried. $6 million of the estate will be subject to the federal estate tax at a rate of 35% and Robert’s and Sally’s children, Peter and Ruth, will not have sufficient cash to cover the bill unless they sell off some of the properties.DePaul University All rights reserved.
34 ILIT Example (continued) Robert establishes a qualifying ILIT, funding it with an insurance policy, and naming his children, Peter and Ruth, as remainder beneficiaries of the trust. Robert makes gifts to the trust covered by his $13,000 annual gift tax exclusion times the two beneficiaries, who each hold a Crummey power. The gifts are used to pay the policy premiums. When Robert dies, the proceeds of the life insurance policy are received by the trustee estate tax-free. The trustee then purchases one or more parcels from the estate. There is no (or little gain), the estate has cash and the children are beneficiaries of the trust which hold the transferred property.DePaul University All rights reserved.
35 DePaul University All rights reserved. Question 9-6Most irrevocable life insurance trusts: A. Name the grantor as trustee B. Are designed to keep life insurance proceeds out of the insured owner’s gross estate. C. Testamentary D. Asset free until death.The best answer is B. Most irrevocable life insurance trusts are designed to keep life insurance proceeds out of the insured owner’s gross estate. They should NOT name the grantor as trustee. The ILIT is typically an intervivos trust. It holds assets life insurance policies at minimum and perhaps other types income producing assets as well.DePaul University All rights reserved.
36 DePaul University All rights reserved. Gifting One’s PolicyUnder the three rule, even gifts of life insurance to a spouse must be included in the donor’s gross estate if they are made within 3 years of death.Example: Sharon dies within two years of transferring ownership of a life insurance policy (under which she is the insured) to her husband, Jerry.The FACE VALUE of the policy must be included in Sharon’s gross estate.Offset by marital deduction if Jerry is the beneficiarySame result where policy is gifted but insurance company was not notified of the change in ownership.DePaul University All rights reserved.
37 Business Buy-Sell Agreements Death or disability of a business owner or partner may jeopardize continuation of that business. Often the optimal plan is for the surviving partner(s) or shareholder(s) to buy the business interest of a deceased or disabled partner.Contractual agreement sets terms for both buyer(s) and seller(s)Purchase can be funded byLife insurance (common)Other assetsDePaul University All rights reserved.
38 Two Types of Buy-Sell Agreements Buy-sell agreements are typically designed as either:Cross purchase arrangementsIndividual owners purchase life insurance on one anotherCumbersome with many owners/partnersEntity (stock redemption) arrangementsEntity owns life insurance on major shareholders (or partners)Typically, closely held corporationOne policy per insured shareholder/partnerDePaul University All rights reserved.
39 Advantages to Buy-Sell Agreements Properly designed buy-sell agreements typically provide the following advantages:Higher probability that business will continueReady market for business interestsLiquidity forDisabled owner’s expensesDeceased owner’s estate tax and expensesEstablishes value for decedent’s estateIf reasonableDePaul University All rights reserved.
40 Cross Purchase Buy-Sell Example Hugh, Sue, and Stu own Taco Swell, a chain of fast food restaurants recently appraised to be worth $3,000,000. Under a cross purchase arrangement, they would own life insurance as follows:Owner Insured InsuredHugh $500K on Sue $500K on StuSue $500K on Hugh $500K on StuStu $500K on Hugh $500K on SueDePaul University All rights reserved.
41 Stock Redemption (Entity Purchase) Buy-Sell Agreements Under a stock redemption (entity purchase) agreement, the business (typically a corporation) agrees to purchase a deceased (or disabled) owners’ interest(s) in the business.The business owns and is beneficiary of the life insurance policies funding the agreementMay be best arrangement when > 3 ownersDePaul University All rights reserved.
42 DePaul University All rights reserved. Tax and Other Implications to Stock Redemption (Entity Purchase) Buy-Sell AgreementsPremiums are not deductible to businessDeath benefits not taxable to business as beneficiaryHowever, benefits may be exposed to corporate alternative minimum tax (AMT)Remaining owners receive increased business valueNo step up in basis to remaining ownersLife insurance can be attached by business creditorsTransfer for value exposure if policies sold to parties other than the insuredDePaul University All rights reserved.
43 Death-Activated Buy-Sell Agreement Example Red signed a buy-sell agreement before his death. His interest in the business was appraised at $1,000,000. His basis in the business is $100,000.When Red dies (assuming agreement remains in force), business (or partners) buy Red’s interest from his estate for $1,000,000Red’s estate enjoys full step up in basisAvoids $900,000 capital gain$1,000,000 in Red’s gross estatePossible estate tax exposureDePaul University All rights reserved.
44 Transfer for Value Exposures with Buy-Sell Agreements If the business closes, eliminating the need for insurance policies on others, individuals can purchase the life insurance policies.If owners purchase (or exchange) policies, thus owning insurance on lives of others, transfer for value occursDeath benefits then taxable at ordinary ratesIf owners purchase policies on their own lives exception from transfer for value rules appliesDeath benefits remain nontaxable (income tax)DePaul University All rights reserved.
45 DePaul University All rights reserved. Question 9-7Jack and Mack, both married, own Jack and Mack’s Landscaping. They enter into a cross purchase buy/sell agreement funded with life insurance. How should their policies be owned?A. Jack owns on Mack’s life and vice versa.B. Jack and Mack’s Landscaping owns the policies on its two owners.C. Jack and Mack’s spouses own the policies respectively.D. The policies are not considered “owned” for purposes of the buy/sell agreement.The best answer is A. Given the cross purchase buy/sell agreement funded with life insurance, their policies be owned each owner on the life of the other. B describes an entity agreement. Life insurance is a financial asset; thus, regardless of its use, it is “owned.”DePaul University All rights reserved.
46 Key Person (Key Employee) Life Insurance A business may own life insurance on the life of one or more key employeesBusiness has insurable interest due to:Possible lost income on key person’s deathPossible increased expenses due to key person’s deathDePaul University All rights reserved.
47 Estate Tax Implications of Key Person Life Insurance In a key person life insurance arrangement, the owner of the policy is the employer, who names itself beneficiary of the policy’s proceeds.Thus no amounts attributable to the policy covering the insured employee is includible in that employee’s gross estate.Proceeds will increase stockvalue.DePaul University All rights reserved.
48 DePaul University All rights reserved. IncapacityIncapacity describes the inability to engage in legal matters (contracts, generally) due to lack of intellectual or physical ability.An incapacitated person may be legally incompetent.Minors lack capacity to contractThis means that a contract is voidable by the minor – not by the other partyDePaul University All rights reserved.
49 DePaul University All rights reserved. Powers of AttorneyIncapacity planning may be addressed through powers of attorney for property or for health care.A power of attorney is a written document under which an individual, known as the principal, empowers another adult, known as attorney-in-fact, holder of the power, or agent, to act on that principal’s behalf.DePaul University All rights reserved.
50 Durable versus Nondurable Powers of Attorney A nondurable power of attorney becomes invalid upon the incapacity of the principal.Thus ineffective for incapacity planningA durable power of attorney survives the principal’s incapacityPrincipal must be competent when DPOA is executedPower holder called “attorney-in-fact” or “agent”DePaul University All rights reserved.
51 Powers Terminate on Death Whether durable or nondurable, powers of attorney become invalid upon the death of the principal.At this point the executor (if one is named) takes overOften the same individual is named to both fiduciary offices.DePaul University All rights reserved.
52 DePaul University All rights reserved. Question 9-8The intent of making a power of attorney “durable” is to: A. Make it last beyond the death of the principal. B. Name successor attorneys-in-fact. C. Make it valid through the principal’s incapacity. D. Make it limited to financial matters only.The correct answer is C. The intent of making a power of attorney “durable” is to make it valid through the principal’s incapacity. Powers of attorney, durable or not, expire upon the principal’s death.DePaul University All rights reserved.
53 Durable Power of Attorney for Health Care (DPOAHC) A durable power of attorney for health care (DPOAHC) empowers an attorney-in-fact to make a variety of health care decisions for a principal unable to make such decisions for him/herself.DPOAHC may be immediately effective but will only be honored if principal is unable to communicate his or her wishesDPOAHC generally a document separate from property/financial-related powers of attorneyDePaul University All rights reserved.
54 Durable Power of Attorney for Property The durable power of attorney for property can be designed to empower the attorney-in-fact immediately or only upon the incapacity of the principal (a springing power).Such powers typically enable the attorney-in-fact to:Buy, sell or lease the principal’s assetsCollect debts on the principal’s behalfSue on the principal’s behalfOperate the principal’s businessDePaul University All rights reserved.
55 Powers of Attorney Transfer and Tax Functions Under a power of attorney, the attorney-in-fact may:Make gifts to members of the principal’s family to accomplishEstate equalization with spouseMaximization of annual gift tax exclusion(s)Create living trusts to benefit principal and principal’s familyTransfer principal’s property to a previously established living trustSign joint tax returns (with spouse) on principal’s behalfExercise special powers if appointmentDePaul University All rights reserved.
56 General versus Limited Powers of Attorney General powers of attorney (durable or nondurable) authorize the attorney-in-fact to act on the principal’s behalf in all legal and financial mattersLimited powers of attorney authorize the attorney-in-fact to perform only certain acts or control specified propertyExample: Trading authorization for a brokerage account is a limited power of attorney addressing that account onlyDePaul University All rights reserved.
57 Springing Power of Attorney A springing power of attorney authorizes the agent to act on the principal’s behalf only if the principal becomes incompetent/ incapacitated.Possibly appropriate in circumstances the where principal wishes to maintain control as long as s/he is ableCan be problematic if principal fails to communicate intent to agent or POA fails to identify what constitutes incapacityDePaul University All rights reserved.
58 DePaul University All rights reserved. Question 9-9What is the most likely reason why Elizabeth made her power of attorney a “springing” power?A. She wants to control her own affairs presuming she is able to do so.B. She wants the power of attorney only to activate upon her death.C. She wants her power of attorney to be revocable.D. All the above.The best answer is A. The most likely reason why a principal would make her power of attorney a “springing” power would be the wish to control her own affairs presuming she is able to do so. Powers of attorney are revocable whether they spring or not and expire on death.DePaul University All rights reserved.
59 Advance Medical Directives Living wills and durable powers of attorney for health care direct physicians and hospitals as to the medical choices of the principal and should be part of a clients’ estate plan.Living will addresses life-ending decisions onlyExample: Unplug the respiratorDurable powers of attorney for health care grant broader powersExample: Surgical authorization for patient unable to communicate by speech or writingDePaul University All rights reserved.
60 Guardianships/Conservatorships Guardians and conservators are persons appointed by the Court for a ward when the Court determines that one of the following circumstances exists:The ward is a minor (less than 18 years old)The ward is mentally ill, as evidenced by the opinion of a qualified physicianThe ward is mentally retarded, as certified by a qualified physicianThe ward, because of excessive drinking, gambling and the like, wastes or lessens his estate, commonly called a "spendthrift."DePaul University All rights reserved.
61 Guardian/Conservator of the Person A second individual may be appointed to represent an incompetent (the ward). The guardian of the person is responsible for the ward’s daily well being and addresses such matters as the ward’s:Living situationMedical careFood and clothingEtc.DePaul University All rights reserved.
62 Guardian/Conservator of the Estate The guardian of the estate is responsible for the ward’s financial well being and addresses such matters including:Pay the ward's debtsRepresent the ward in all lawsuitsControl and manage the ward's propertyInvest the ward's fundsCollect funds due the wardSupport the ward and his family from the ward's fundsSell, lease or mortgage the ward's property, given Probate Court approvalDePaul University All rights reserved.
63 DePaul University All rights reserved. Question 9-10The ultimate supervisory responsibility in conjunction with a guardianship/conservatorship rests with:The guardianThe family of the wardThe courtThe trusteeThe best answer is C. The ultimate supervisory responsibility in conjunction with a guardianship/conservatorship rests with the court.DePaul University All rights reserved.
64 Revocable Trusts for Incapacity Planning While most transferors select themselves as trustees of their own revocable living trusts, a successor trustee should be named to succeed the grantor as trustee in the event of incapacityThe trust should set forth the criteria for determining incapacityNamed successor should have a copy of the trust documentAlso, ideally, a current statement of accountsDePaul University All rights reserved.
65 Revocable Trusts versus Powers of Attorney For incapacity planning, the living revocable trust has two advantages over the power of attorney:The trust continues beyond deathFacilitates orderly post mortem transferProbate avoided for property actually titled in the name of the trustTrusts are universally honoredAcceptance of power of attorney documents may vary from State to StateDePaul University All rights reserved.
66 DePaul University All rights reserved. MedicaidMedicaid is a federally-funded, state-run program that provides medical assistance to individuals and families with limited assets and resources. Each state sets its own guidelines regarding eligibility and services.In most states Medicaid is not available to individuals owning >$2,000 in assets.Medicaid pays for:Health care costs, including doctor's visitsLong-term care, including custodial careDePaul University All rights reserved.
67 Lookback Rules Impact Eligibility The Deficit Reduction Act of 2005 increased the Medicaid look-back period to 5-years. Thus, asset transfers for less than FMV within the 5-year period before an individual applies to Medicaid for long-term care assistance will reduce benefits. Example:Within the previous 5-years, Grandpa gifted $40,000 to various family members. If the average nursing home cost in Grandpa’s state is $4,000 per month, Grandpa is denied 10 months of Medicaid nursing home assistance.Had Grandpa gifted $400,000, he would be denied 100 months of Medicaid long-term care assistance.DePaul University All rights reserved.
68 Medicaid Home Equity Eligibility Rules Any individual with home equity above $500,000 is now ineligible for MedicaidException where applicant’s spouse resides in the home or the home is occupied by a child under age 21, blind or disabledStates may raise the threshold to up to $750,000.DePaul University All rights reserved.
69 Medicaid Eligibility and Annuities If a Medicaid applicant has any interest in an annuity, the purchase of the annuity will be treated as an uncompensated transfer subject to a penalty period unless the state is named as the primary remainder beneficiary for at least the total amount of medical assistance paid for on behalf of the Medicaid applicantOr the state is named as the contingent remainder beneficiary after the community spouse or minor or disabled child.DePaul University All rights reserved.
70 Medicaid and the Community Spouse Federal law does not require that a married couple impoverish themselves before one spouse may gain eligibility for Medicaid. Instead, the spouse of a Medicaid enrollee, called a “community spouse,” is entitled to a specific portion of the combined income and assets owned by the couple.Generally, a community spouse is entitled to half of the couple’s combined resources (up to a maximum), and at least a minimum amount of the combined monthly income.DePaul University All rights reserved.
71 DePaul University All rights reserved. Question 9-11Medicaid rules would be least likely to require that:The community spouse hold assets of no more than $2,000.The recipient’s assets and income fall below stated thresholds.Assets given away within five years of applying for Medicaid benefits may jeopardize such benefits.The recipient must be unable to complete certain ADLs in order to receive long-term care benefits.DePaul University All rights reserved.
72 The Special Needs Trust A special needs trust (SNT) is a means to leave money to a disabled family member, without interfering with public benefits such as Medicaid or Social Security Disability benefits.The most common special needs trust is a family-type trust, set up by the parents. The parents fund the money for the trust, often by will, and sometimes using life insurance payable to the trust.In most cases, the disabled child/beneficiary has a discretionary life interest. After the beneficiary’s death the remainder passes to other family members.DePaul University All rights reserved.
73 Maintaining Benefit Eligibility The key to a family-type special needs trust is that the money CANNOT be used for housing, food, or clothing. Those are considered "basic needs" under SSI and Medicaid laws.If the disabled person is receiving free housing, food or clothing from a family member or a trust, government benefits will be reduced or eliminated.DePaul University All rights reserved.
74 Appropriate Special Needs Trust Design The trust can be used to purchase a home, and perhaps rent it to the disabled person.The trust can pay for repairs, utilities and taxes for a home; it can purchase furnishings for the home.The SNT can pay for vacations, summer camp, or trips. It can buy bowling shoes or other sporting equipment.The SNT can pay medical costs not otherwise covered by Medicaid, such as vitamins.It can pay for funeral and burial costs. DePaul University All rights reserved.
75 DePaul University All rights reserved. The Payback TrustA court-ordered trust, also called a “Type A” or “Payback” special needs trust, is appropriate where the disabled person has inherited money, or received a personal injury settlement.Because the disabled person “owns” the money, the trust is a grantor trust.The disabled person must be under 65 years old and meet the medical standards of Social Security disability.The trust must require that, at the disabled person’s death, remaining assets will first reimburse the State for assistance it provided to the disabled beneficiaryDePaul University All rights reserved.