deceptively similar, but Medicare – not Medicaid – is the program that covers skilled care. Seniors who have entered retirement and who are not covered by a group health care plan to supplement Medicare, and who are otherwise able to sustain themselves in the community, should evaluate a Medicare supplement to cover those skilled care costs not entirely covered by Medicare. Are there any other comments that you would like to make regarding Medicaid planning? The statistics are staggering in terms of the likelihood that one will require the type of care a person receives in a nursing home. Planning for this cost, including evaluating a long-term care insurance product and legal plans, should be part of everyone’s planning process. There can be income tax advantages as well, as there are ways to design the trust to avoid the higher trust income tax rates and to obtain a cost basis adjustment for the assets at the death of the person who created and funded the trust. This will lower capital gains tax when assets are sold after death. Although gifting to a trust is generally preferable, whether gifting to an individual or a trust, a great deal of care should be taken in deciding to gift assets, as once they are gifted the elder will not have the right to get the assets back. In what ways does Medicaid planning interact with other aspects of estate planning, such as the use of wills, trusts and powers of attorney? For all clients in their 60s and beyond, 32 LAWYER MONTHLY OCTOBER 2023 an estate planning consultation should include a review of Medicaid planning techniques. Often just ensuring that a well-drafted power of attorney is in place that allows for Medicaid planning is an important step so that planning can be done in the future if an unexpected health event occurs, such as a stroke or brain injury. What aspects of healthcare are not covered by Medicaid, and how can seniors plan for those potential gaps in coverage? It should be understood that Medicaid is not intended to provide skilled care of the type received in a hospital. Medicaid was intended to provide for custodial care or care for individuals who are not able to perform activities of daily living, such as feeding, bathing, dressing, ambulating and transitioning. The terms are
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