The Common Question
“What? Nursing care is expensive, especially for long-term illness. I have retirement savings, assets, and a wife with dementia. I have no long-term care insurance; it was too expensive years ago. What are you talking about—Medicaid? I’m not rich, but I’m not poor.”
That reaction is common. When care is needed, many couples discover that Medicaid can help almost any married couple pay for long-term care—whether at home or in a nursing facility.
Note: Rules differ greatly between married and single individuals.
Case 1: The Unmarried Individual
Meet Jack—recently diagnosed with Parkinson’s. His doctors say his health will decline over the coming years. Jack has built savings and wants his children to inherit the fruits of his life’s work.
His choice is simple:
- Pay out of pocket for care until his assets are depleted, then apply for Medicaid.
- Or, with the help of a qualified attorney, plan-ahead.
If Jack starts planning five years before care is needed, much of his estate can be preserved for his heirs.
If care is needed sooner—say, in four years—he may have to pay, out of pocket, for one year.
Lesson: Seek a qualified elder law attorney who is experienced in pre-Medicaid planning. The process is complex, but the right guidance can protect most—or even all—of your family’s legacy. (#MedicaidNursingCarePlanning)
Case 2: The Married Couple
Now we meet Jim and Lois, ages 75 and 73. Jim has dementia. Lois has cared for him lovingly for years but now faces her own health limits. Jim weighs 180 lbs.; Lois is only 100lbs. Bathing, lifting, and daily care have become impossible.
Their part-time caregiver costs keep climbing, and Lois worries about what comes next.
At a meeting with her attorney, Ward Beeker, she learns about Medicaid Nursing Care Planning.
Here’s the key:
Under federal Medicaid law, each state allows a Medicaid Qualified Annuity (MQA).
All cash and liquid assets can be transferred into a specially structured immediate annuity payable to the healthy spouse (Lois). This converts countable assets into a protected income stream.
Once in place, Medicaid covers Jim’s nursing care costs—while Lois keeps the income from the annuity to support her living expenses.
In short: The assets stay with the healthy spouse. The state pays the care bill.
The Bigger Picture
Long-term care costs in the U.S. exceed $1.5 trillion annually, with Medicaid covering roughly $74 billion of nursing care expenses each year—representing tens of billions in family wealth preserved instead of spent down.
Every state has its own rules, which change frequently. If your future includes possible health decline—or even the risk of it—it is important NOW, to create a plan to safeguard your assets and your loved ones’ future.
Essential Documents
In addition to a Medicaid plan, legal counsel will ensure the following key legal documents are current and accessible:
- Last Will and Testament
- Durable Power of Attorney
- Healthcare Power of Attorney / Advance Directive
- Living Will
- (Possibly) a Trust
Also organize:
- Property deeds
- Business and tax documents
- Life insurance, CDs, and investment accounts
- Marriage, birth, and military records
- Vehicle titles and insurance
- Appraisals and provenance for antiques or art
- Household budgets and expense records
- Family heirlooms and keepsakes
Final Thoughts
Planning ahead preserves your dignity, your spouse’s financial security, and your family’s legacy.
I can refer you to qualified Medicaid planning attorneys in any state. My guidance is offered at no cost, based on over 25 years of experience in Medicaid Qualified Annuity planning and collaboration with elder law attorneys nationwide.
