strategies no no no no no don't change the channel just because you might not be in that position right now somebody in your family is that's why the information is very good so stay tuned and you know what we do on the dr joy show before we get started right we take the read deep breaths are you ready inhale exhale attorney focused on elder care strategies that's what we're here to talk about but tell tell me a little bit about you your background i know i know you from before but i don't want to give give it away to my viewers so tell me a little bit about you sure dr joy i was a high school teacher and football coach hillsborough hundred central an immaculate high school and i went to law school at night i got my law degree at night while i was teaching by day ok so you see my face right ok so you you you averaged about four hours of sleep ok all right i only interrupt anyone go ahead when there was a possibility that the governor was going to cut back state aid to one of the schools i was working at i decided i better have another iron in the fire just in case my job was limited so i did go to law school at night and i got my law degree from signal oh great and how we know each other is from another encounter years later to talk about wills a state if they planning and so i've known him for a long long time but now i have the question you gone from real estate a to elder care law what gave you the impetus to do that to make that switch dr joy real estate closings in new jersey particularly central and north jersey are very contentious i felt as if i were a referee in a national hockey league game so where elder law is more of a pastoral field of law i feel as if i could be a teacher again and actually do some good to see it because now i'll pay you later because one of my questions was how did you being a teacher and a football coach at those three institutions while you were going to law school help you in your current capacity and you just said that so the you want to teach people about elder law strategies so my question to you is i'm confused medicare medicaid colossal confusion with myself and i know colossal confusi with a lot of my viewers let's discuss that what are the major differences surely that's a common point of confusion i might add medicare and medicaid came to us during the kennedy johnson era ok medicare a rule of thumb is for people who are sixty five and older ok and it is a state similar to a national health insurance program although we don't have a bona fide national health insurance program as do other countries this is as close as will get for people who are sixty five and older it pays for hospital bills doctor's bills prescription drugs ok and a limited amount of stay in a rehab facility where as medicaid is something different medicaid originally was established to help indigent people pay for their doctor bills and hospital bills that's how it started in the mid sixty's but something happened that congress did not foresee at that time and society didn't either and what was that huge amount of the population was going to have their bodies outlive their minds so medicaid became transformed from just a program to help indigent people pay their doctor hospital and medical bills to a program that also subsidizes long term care facilities ok so the life expectancy so are there any specific conditions that are not covered under medicaid or medicare or medicare if you have medicare part a  the prescription drug plan and medigap for people who are sixty five and older it pretty much will cover all doctor bills or hospital bills all diagnostic tests all prescription drugs and  pick up any co pays or deductibles that are not usually paid for by the traditional programs ok so medicare that the bottom line is that you have to be sixty five to get it that's pretty much say north carolina versus new jersey no it does not medicare is a national program and it's it's the same in every state ok all right so now you said part a p b and some other gap thing that you said so when a person turns sixty five because i'm trying to break this down you know a football coach are you going to work with me to try to break this down to suck the joy so part a part b and the prescription plan and some other guess there were four pieces one hundred sixty five you get all four of those or do you pick and choose those pieces ok that's a good question when one is sixty five they can automatically get medicare part a which is the hospital a little state that's good you can then elect to get part b which covers the doctor bills and certain diagnostic procedures ok if you have to elect to that up you also have to elect to pick up medicare part d which is the drug prescription program and these are all additional charges i was going to ask that question is is that going to cost the person that's actually doing the election is any part of it  part of it free only medicare part a the hospital that's ok so if they check the box for prescription it's an added fee that a great check the box for what would be again there's there's b which is the doctor died inaudible tests ok so there is there is an extra there's an extra charge how are those charges the finder determined for that sixty five year old person ok medicare part b has certain guidelines a change every so often and it is income based so a person who has a lot of then come may pay a higher premium for part b prescription drug plan there are a number of plans on the market that one can elect to choose and it's very some cost and also what we call the medigap or medicare supplement plan there are a number of plans out there and a person picks and choose what style what type of coverage they want and the coverage is more expensive for a comprehensive plan as opposed to a bare bones plan so it all depends but it's all laid out it's all laid out very well it's all laid out very well for you you know but the average person might not know and that's where your service comes in correct that's right up there now you mentioned income at sixty five most people a lot of people maybe were still working but they're not making as much money as they say were in their forty's or early fifty's so how far back of their income is is attached to this calculation medicare looks at the current income and roughly medicare part b will cost someone one hundred five dollars a month but it's subtracted from your social security check ok so you don't even see it now you don't really see you don't see it so you're not going to give  security check and then you're asked me to write you a check one hundred five dollars that's correct ok all right so so that's ok so now what happens if there are a lot of assets involved how does one protect their assets so that they could still get the medical care portion but not you know not have to pay so high i assets can include it in the income or is it just ok well i made one hundred fifty thousand dollars this year it's just going to be based on that not my home and everything else that's correct dr joy the premium that one pays for medicare part b is just based on the end come level ok ok so now what if you can't afford medicare if one can't afford medicare there are programs through the state the various states that will help supplement the premiums so they go automatically lead to medicaid then is that is that the other option well initially if they need assistance paying their medicare part b bills they contact the state in new jersey and the state of new jersey actually through the social security office i should say the social security office it will guide them to the right direction as to how to get a to pay those medicare premiums that they might not be able to afford i'm glad you clarified it says so sixth falso security office instead of just new just state in new jersey because i have viewers all over and so security office will exist in every state that's correct care nursing home care and very for home care regular home care like someone can care for you in your own home how is that covered ok under the medicare program as opposed to medicaid it has to be skilled care that's needed something where one needs a medical skill or background training to administer the type of care that that individual is getting ok so consequently a mere caregiver that babysits and supervises doesn't qualify physical therapy would be would say things like that ok and what if the person had a stroke and they were incapacitated and they needed assistance from the bed they need assistance twenty four twenty four seven jim like they can't do anything for themselves they they cannot communicate and if they didn't have medic if they didn't have medicare would they automatically get medicaid medicaid would pick up part b where actually medicaid picks up where medicare leaves off ok now for at home care right and care when a skilled  that's more or less covered under the jurisdiction of medicaid because medicare does not pay much for care in a skilled nursing facility or even at home care the period is limited for example if someone is in the hospital by the medicare program why did they need the twenty days if however a day fifteen they're deemed healed that it stops now after twenty days dr joye if they still need rehab twenty one to one hundred there's a co pay it's approximately one hundred sixty dollars a day for the patient and the other hundred sixty dollars comes in from medicare that's if they need we had still need rehab twenty one to one hundred however if after day fifty they're deemed he old as best as they're going to get it stops after one hundred days it's all private pay at that point oh no private pay a hundred days their three month three month plus ten days i'm doing the calculation ninety plus ten so they are there's some coverage there for the first hundred days but now tell me what happens in day out one hundred one or first of all during that hundred day period if someone takes a medicare supplement parent plan we also call medigap that one hundred sixty dollars co pay is covered now after one hundred days it's totally private paid ok and what are the private pay rates well it depends on if someone isn't an assisted living as opposed to a nursing home right nursing homes in new jersey can run as high as twelve thirteen thousand dollars in the central and northern part of the state living with the very basic level one care in the neighborhood of five thousand dollars a month but that becomes all private after day one hundred so five thousand dollars a month now i want to do one hundred days plus now five thousand dollars a month on the low for assisted living violets if they're living up to thirteen thousand dollars a month that's correct we're these people getting this money where does the money come from if you don't jim help help me sure help me with this because if a person has a house now let's talk about the assets we're there they're one hundred at one hundred and one day hundred in one now they got to pay this five thousand dollars a month where they come from that is the dilemma that society is facing now an option is long term care insurance if one qualify spurred ok but long term care insurance premiums can be rather expensive ok when do you start to pay for those  point and well the younger person is when they sign up for long term care insurance the less of the premium ok that's true however in a lot of policies the premiums will increase with inflation and it gets to the point where certain people will say jim i can't afford this anymore right i can't afford this premium and at that point we suggest maybe their children can contribute and if their children can't then they have to drop the policy and then pay from their private assets ok let's talk about private as that how does one pay from their private acid ok a lot depends on if a person is married with it at home healthy spouse ok or if a person is single now a married couple of the house can be conveyed to the healthy spouse and fact all assets can be conveyed to the healthy spouse however the healthy spouse is only allowed to keep half the value of the liquid assets not to exceed approximately one hundred and twenty thousand dollars are you kidding me no no doctor anything over and above that has to be spent down on the loved one's care before they are eligible for medicaid for a skilled facility come on jim there's got to be does gotta be a trick to something like this whole spend down thing because i know some elderly people i mean seventy's eighty's ninety's and they say oh no i have to buy this they i have to i have to spend my money when should people start spending down like to avoid so they can get the help that they need that the government can give them right without somebody saying you we're going to we're going to take your house now that that's a scheme it's scary for a lot of people say what's counted what's a countable asset is it like not so healthy spouse spends down at that point medicaid picks up their bill for the skilled nursing facility or for the assisted living ok now see the average person i don't think know that that that's where you would come in all right so who've what's what how do you deem an asset how do you what's what dean not you but what is deemed by as an asset by the government if they can they can come after we call those available assets a marital home that's conveyed to a healthy spouse at home spouse is an exempt asset half the value of the liquid assets not to exceed one hundred twenty thousand dollars is also deemed protected so that's everything inside the house the car while the car is allowed jewelry is allowed a wedding ring and a gauge might ring new jersey really doesn't harass people on furniture ok and side there are used to be some concerns about the amount of furniture and personal property you can have new jersey really doesn't look into that investment property is deemed protected to a point now in other states dr joy a person's retirement plan for a one k or ira is protected even if or propels them above that hundred twenty thousand dollar figure ok new jersey is not one of those states so that means get scuse me get the hell out of new jersey is that what you're saying while there are definitely friendlier states than new jersey for medicaid in fact dr joye new jersey is referred to by other elder law attorneys as north korea would twenty five or a and they never touched it and now all of a thetan is sixty five seventy and they're in this state in this state where they had it their health is declining and they're going to need some assistance what happens while the healthy spouse dr joye if they have a hefty annuity for a one k or retirement plan they're limited in the amount they could keep anything over above the one twenty thousand is going to have to be spent down on the ill spouse's care but in states like pennsylvania for example that doesn't happen cross the bridge then just cross the bridge in other words sell you have get out of the thing in new jersey or those unfriendly states because i'm sure there's other unfriend there are aides right get out of those and move but do you know how hard it is for someone that you know at that point in their life to just uproot and move to another state oh absolutely so what's the answer this is going to be a problem that's going to become more pronounced in the future as the baby boomers age see there was a boom in population after world war two during the korean war years and the baby boomers of which i'm one just now starting to reach the age where they may be entering skilled nursing facilities and quite frankly our system is not set up for that the baby boomers will take this system down unless some drastic revisions are made and quite frankly none of the presidential candidates are even talking about that you don't hear that mention you know we don't eat only the thigh though and that's meant to thighs it's going to be a huge crisis so how does one protect themselves is that where the care planning comes in well what we have five people to do is to number one get in the ready ready mode which means have all the proper estate planning documents in place that give somebody the power in your family usually the healthy spouse and for single people a reliable child or sibling that allows that person to press the buttons that are known as the exceptions to the medicaid five year lookback rule ok so what happens is assets are transferred which are exceptions to the medicaid five year lookback rules and once the person becomes eligible for medicaid if that program is not enough to meet that person's emotional physical spiritual and mental leads the assets that were conveyed to the children or to somebody else can be used to enhance that level of care ok ok so whoa so you have a protection of assets issue you have one hundred twenty thousand dollars that the healthy spouse king can keep right and then what about everything else what are those what are those documents that you're that you mentioned sure we advise people to consider what's called a comprehensive the stay plan when i was a football coach we had a game plan that's right and the game plan was very because we never knew what the opposing team was going to throw at us right or how they were going to defend the so we had a variety of plays and long term care planning there's a variety of instruments to stop one legal document that's the magic bullet a will or living trust because nobody gets out of this world live dr joy that's x imperative right and a will a living trust should have a state tax planning provisions for states like new jersey that have a death tax there should also be a power of attorney the not your conventional power of attorney that you might use for real estate closing or you might use for rob you might download from the internet but one that specifically details every single solitary power one could have right because of all the documents we prepare in our office dr joy the power of attorney is the one we're on the phone with at least twice a month  with banks and financial institutions that are afraid of these powers of attorney than they're afraid that the agent is going to rob from the loved one or they're afraid that the agent is going to take the asset out of their bank and put it into a competitor across the street right and medicaid will argue that your love that your agent never had the authority to press the buttons for the five year lookback rule i'll probably turn it is thirty pages long because it addresses every conceivable thing that could possibly be thrown at our clients so a power of attorney is very very crucial and the no one paid thing absolutely not ok the other document we feel is crucial is a living will but separate from a health care power of attorney ok see that every lawyer does it differently our living will has a forty eight item checklist we give people for medical situations a b c and d each medical situation is a little different but we asked the same twelve questions under each ok why are we so detailed to say and what why and where right number one it sets the record straight so the family knows what the loved one wants and doesn't want that's good number two if the hospital is trying to push a procedure on the person that that individual told his family never let them do this to me the end of then right the agent could say i'm fighting you right my loved one does not want that procedure right and if they report that individual to adult protective services then the person could say to adult protective services please don't yell at me i'm just my husband's messenger right this is his forty eight item checklist and go wake them up out of this coma and yell at him the messenger oh you can't shoot the messenger also if insurance or medicare doesn't want to cover a procedure based on a person's age or advanced condition on the grounds that that individual would have never wanted that the healthy spouse at the age of the family could say oh yes they did oh no they didn't you don't have your parent husband's best interests right yes i do here's their forty eight item chaplets wake them up out of their coma and yell at them right now that is separate d joy from what's called the health care power of attorney ok a health care probably turn to give somebody the power to bring that checklist forward at the appropriate time plus make other decisions should it be robert wood in new brunswick right what in hamilton this they had to fly into another if they exactly how k the other thing is we advise when someone is admitting themselves to the hospital right and they ask for a living will we prefer that they not show the living will and forty eight item checklist because it throws a person's cards on the table yes example if they checked off no when a lot of areas right they're going to say that the nurses on that patients floor hay and when this guy presses the call button take your time take your time or ignore him right keep going keep going so now this living will and i got to interject and then we got to get to the top three tips in the living will there's numbers around that whole living will thing if the ago because i know for us we came into your office t j and i we came in and we said jim we want to do a living will and you put a number on the boarding you gave us some instructions and we didn't qualify that so the number is or you're talking about a living trust trust the minority a will with this with planning provisions in there the right in new jersey is six hundred and seventy five thousand dollars yes that's right if someone exceeds six hundred seventy five thousand dollars in our opinion you need more than just a simple will the if you're concerned about the right right ok so that that's good now cool quickly share your top three top three planning tip top three only three jim and then i want to wrap it up and you tell everybody where people can find you because this is great information thank you dr joy top three tips number one preparation get your estate plan and the ready ready mode number two anticipation know when it's time to address a long term care issue that is surfacing in the family and it does not necessarily diagnose by the medical profession and number three execution pressing the right buttons to implement all the government allows us to do for the exceptions to the medicaid five year lookback rule i want to thank you for being a guest on a dr joy show and helping myself and my viewers we