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Can Long-term Care Insurance Coverage Be Denied?

in Articles by Greg McIntyre Leave a comment

Long-term care insurance can be a valuable tool. However, to get the most out of what you’re paying for, it is important to understand how your policy works. Each policy is different but most have similar components. Below, we look at some of the typical issues faced by long-term care insurance policy holders and what can be done if you’re denied coverage. 


Elimination Period


The “elimination period” on a long-term care insurance (LTC insurance) policy refers to the period between when the policyholder goes into long-term care and when the benefits begin to pay out. The length of this period can be 90 days or more. Ostensibly, the reasoning behind the elimination period is to ensure that the policy begins to pay when the policy owner is unquestionably in need of long-term care. The rationale is that the insurance company doesn’t want to pay if you go into a facility for a month and return home. Whatever the reasoning, many LTC insurance owners must pay a substantial amount of money for the first few months of care. This can come as a surprise for many policy owners and lead to financial hardship. 


Unintentional Policy Cancellation

What if the policy owner cancels or stops payment due to diminished capacity? Perhaps they are suffering from dementia and can no longer manage their affairs. Many policies include an exception to the cancellation that allow you to “reinstate” the policy if it was cancelled due to the diminished capacity of one or more of the policy owners. 
Typically, once the payments begin, the premiums for the policy are waived, meaning you do not need to pay premiums during the time in which a policy is paying out. However, the pay out can stop for many reasons. Perhaps the policy owner did not meet the policy’s definition of in need of coverage (more on this below) during recertification. Perhaps the insurance company wasn’t given the invoices for the care that they are paying for. Regardless, if the payments stop, the premiums once again become due. If the premiums aren’t paid, then the policy will be cancelled.


Prerequisites for Coverage


All LTC insurance policies have a prerequisite that must be met before they pay for care. Each policy defines this differently; however, it typically involves the policy owner needing substantial assistants with multiple activities of daily living (ADLs). 
Some of these definitions can be tricky and the insurance company will require proof that their definition is met before payment occurs. As such, there can be instances where someone is in need of care but can’t get the insurance company to pay because their medical record lacks a small ultimately insignificant detail. Because of the red tape and difficulty dealing with these insurance companies, it can be hard to determine what is missing.

What Can Be Done if Denied


All LTC policies have an avenue to appeal a denial of coverage. An appeal can be a difficult and lengthy process. The help of an attorney is crucial to navigate the appeal process. An attorney can assist with making the appeal, nailing down deadlines, and pinpointing what items of information are missing. An attorney can also help set the foundation for if the insurance company continues to deny coverage and the matter must be taken to court. 
If you have questions about how to handle Long-term Care Insurance Appeals, give the experienced attorneys at McIntyre Elder Law a call at 888.999.6600. 

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Brenton S. Begley, Elder Law Attorney

Regards,

Brenton S. Begley

Elder Law Attorney

McIntyre Elder Law

“We help seniors maintain their lifestyle and preserve their legacies.”


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“The Talk” – Planning for and with our loved ones as they age

in Articles by Greg McIntyre Leave a comment

Having the talk is hard. I’m referring to the talk that is inevitably held between adult children and their parents to include any other close relatives. The talk is frequently centered around a sensitive subject that will affect the entire family.

Perhaps people have noticed early signs of memory loss or confusion in a loved one. There could be a recent diagnosis affecting competency or cognition. Big words like Alzheimer’s disease, Dementia, or Long-term care begin to have real meaning and stir up feelings of uncertainty, anxiety, and helplessness. The family dynamic is known to shift, and family members can diverge in thought and action.

Even in light of the above, the talk is necessary. A family’s strength comes, in part, from the selflessness of its members. That same selflessness requires that we set aside our reactive, ego-centric nature.

Anyone can initiate or host the talk. However, it is best practice to refrain from imposing your own personal desires. Coming from a place of awareness, understanding, and support will set the stage to ensure you and your loved ones are equipped to make informed decisions. The best interest of our loved ones is the overriding theme.

But, how do we define “best interest?” Reasonable people can disagree on what that means. Maybe everyone disagrees. The talk is important just the same because decision making requires information and information is obtained through communication.

In having the talk, consider several important questions:

What estate planning documents are in place, if any?

Is our loved one competent? What does that mean exactly? Is guardianship necessary?

What will I leave behind and where will it go?

Who are the appointed decision makers while I’m alive? Are those decision makers ready and able?

What legal options are available to protect assets?

What happens if long-term care is needed? How will we pay for it?

What legal impact might this have on a retirement or savings?

What happens to me if something happens to my spouse?

What happens next?

The answers to many of these questions begin to materialize with the benefit of legal counsel.

The Attorneys at McIntyre Elder Law can serve as your guide through the legal maze and address issues head on. We aim to inform and empower clients to make informed decisions. In turn, that makes having “the talk” a little easier. Reach out today at 888-999-6600 or visit us a our website at mcelderlaw.com to schedule your free consultation today.

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Therron Causey

Estate Planning & Elder Law Attorney

704-749-9244

therron@mcelderlaw.com

mcelderlaw.com


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How to protect your hard earned money and property.

in Articles by Greg McIntyre Leave a comment

From the Charlotte Uptown Desk of Attorney Therron Causey: How to protect your hard earned money and property.

Call for Free Consult:

– Charlotte: 704-749-9244

– Shelby: 704-259-7040

– Hendersonville: 828-233-5991

Online at: mcelderlaw.com.


If you or your loved one has questions we would be glad to extend a FREE CONSULT to answer those estate planning and elder law questions and get your affairs in order. Let the experienced attorneys at McIntyre Elder Law help. Call (704) 259-7040.

Schedule Free Consult

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How to Protect Your Home!!!

in Articles by Greg McIntyre Leave a comment

How to Protect Your Home!!! First you have to know the several risks… Watch this short, informative video from Attorney Brenton Begley.

Schedule your FREE CONSULT today!

Call for Free Consult:

– Charlotte: 704-749-9244

– Shelby: 704-259-7040

– Hendersonville: 828-233-5991

Online at: mcelderlaw.com.

Schedule Free Consult

Book Your FREE CONSULT Today!

IN PERSON . VIDEO CONSULT . PHONE CONSULT


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Adult Guardianships Explained!

in Articles by Greg McIntyre Leave a comment

Charlotte Uptown Attorney, Therron Causey, works on lots of Adult Guardianship cases for our firm. He was kind enough to record a 3 minute video on Guardianships for us. Enjoy!

Schedule your FREE CONSULT today!

Call for Free Consult:

– Charlotte: 704-749-9244

– Shelby: 704-259-7040

– Hendersonville: 828-233-5991

Online at: mcelderlaw.com.

Schedule Free Consult

Book Your FREE CONSULT Today!

IN PERSON . VIDEO CONSULT . PHONE CONSULT


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🤺 How to Challenge a Will

in Articles by Greg McIntyre Leave a comment

            You’ve heard the story before. Someone dies and they leave behind a will, which surprises at least one of their loved ones. This person feels slighted, cheated, abandoned, or indignant. Maybe, they think, the will was influenced by the shady tactics of others. Maybe the person who made the will had no idea what they were doing. Either way, the will should be challenged. The question then becomes: how does one go about challenging a will?

In NC, a challenge to a will is called a “caveat.” There are only a few bases upon which one may bring a caveat. Perhaps the will is invalid because it was procured by undue influence or duress. Perhaps the person making the will (the “Testator”) lack the requisite mental capacity to execute the will at the time it was signed. Or, perhaps the will was not validly executed as required by NC law.

Undue influence means that the Testator was influenced to make the will and that the person doing the influence either had them over a barrel or used isolation and deceit to convince them to execute the will. Duress means that the person doing the influencing use overtly threatening behavior to influence the Testator to sign the will. In either case, the rationale is that the Testator would not have executed the will in question had the influencer not used threats or deceit. Thus, the will should not stand.

To make a will in NC, the Testator must understand what they’re doing. This means that they must have a clear idea of their assets and their heirs, and also understand the effect of the will that they are executing at the time they sign it. Just because someone has “diminished capacity” doesn’t mean that they lack testamentary capacity. As long as they understand what’s going on and the effect of the will’s execution at the time of signing, the will is valid. That being said, it is best to proceed with an abundance of caution if the Testator is known to have di minished capacity.

Lastly, a will in NC must be signed by the Testator in the presence of two attesting witnesses (the Testator and witnesses must be over 18). If there is a failure in the signing of the will, it is considered invalid.

Now that you know the basis upon which a will can be challenged, you can effectuate your challenge by filing a caveat in the county where the estate process (probate) has commenced. The caveat will freeze the probate process until a superior court can determine the validity of the will.

Proceed with Caution

            Before you challenge a will, it is important to understand the effect of the will’s invalidation. For example, let’s say Bob wants to challenge his father’s will made in 2020 because it left him out. Bob goes through the caveat process and is successful in getting the will thrown out. However, there was a prior will made by his father in 2000 that also disinherited Bob.  Bob has just gone through a whole trial just to achieve the same result.

            If you have questions about challenging a will, give the experienced attorneys at McIntyre Elder Law a call or schedule your FREE CONSULT online at: mcelderlaw.com.


If we can help you preserve assets before major changes in the law we would be glad to do so and would offer a FREE consult to sit down and discuss asset protection. Give s a call to schedule your free consult today or schedule online at: mcelderlaw.com. For a list of local numbers to our offices see below:

  • Charlotte: 704-749-9244
  • Shelby: 704-259-7040
  • Hendersonville: 828-233-5991

Schedule Free Consult

Book Your FREE CONSULT Today!

IN PERSON . VIDEO CONSULT . PHONE CONSULT

Brenton S. Begley, Elder Law Attorney

Regards,

Brenton S. Begley

Elder Law Attorney

McIntyre Elder Law

“We help seniors maintain their lifestyle and preserve their legacies.”

www.mcelderlaw.com


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🏠 The Many Ways You Own Real Estate . Elder Law Report .

in Articles by Greg McIntyre Leave a comment

How can the way you own real estate help or hurt you as you age? Find out in this week’s episode.


If you or your loved one has questions we would be glad to extend a FREE CONSULT to answer those estate planning and elder law questions and get your affairs in order. Let the experienced attorneys at McIntyre Elder Law help. Call (828) 233-5991.

Schedule Free Consult

IN PERSON . VIDEO CONSULT . PHONE CONSULT

Book Your FREE CONSULT Today!

Sippin’ Tea ☕ with T!

in Articles by Greg McIntyre Leave a comment

Our Probate Case Manager, Tiffany Blackburn, breaks down the “Publication Period” that takes place during a Probate process.

#theelderlawguy #lawyergreg #estateplanning #savingthefarm #hometownheroes #vetbens #medicaidcrisisplanning


If you or your loved one has questions we would be glad to extend a FREE CONSULT to answer those estate planning and elder law questions and get your affairs in order. Let the experienced attorneys at McIntyre Elder Law help. Call (828) 233-5991.

Schedule Free Consult

IN PERSON . VIDEO CONSULT . PHONE CONSULT

Book Your FREE CONSULT Today!

Elder Law Policy Watch: American Jobs Plan

in Articles, Attorney Advisor Series by Greg McIntyre Leave a comment

Now that the American Rescue Plan has been passed by Congress, which was directed at addressing the Biden administration’s goals around providing relief related to Covid-19, the focus has shifted to the next major proposal from the White House.  This new legislative proposal is known as the American Jobs Plan.  In the spirit of keeping you up to date on any changes that could occur relating to long-term care, we want to place a spotlight on a few areas of this legislation.

Relevant proposals from the American Jobs Plan:

  • Expand access to long-term care services under Medicaid
  • Increase support and wages for home health workers
  • Upgrade VA hospitals and federal buildings

The proposed expansion of access to long-term care services under Medicaid would be achieved by an increase to the program for home and community-based services (HCBS) and to the program known as Money Follows the Person, which has the goal of transferring nursing home residents back to the community. 

The specifics of Biden’s legislation sets out $400 billion that would be earmarked for this discussed increase in access to home and community based care.  To put that number into context, the $400 billion would be achieved by an annual increase in spending of $50 billion annually over the course of 8 years.  That number represents a 40% increase in the reported spending by Medicaid on long-term care in 2018 and a 70% increase for the same year’s budget on home and community-based services.  Additionally, that first $50 billion would be on top of the one-year increase that was passed earlier this year in the American Rescue Plan which saw a $12 billion dollar contribution to the home and community-based services budget.

The American Jobs Plan calls for increasing support for home health workers based on data that shows one in six of workers in this line of work live in poverty. In support of these policy measures, the administration points to a study from the Washington Center for Equitable Growth to demonstrate that increasing the pay for direct care workers led to a reduction in the number of health violations and number of deaths while also lowering the cost of preventative care.

Another study from researchers at UMass Boston argues that the quality of care patients receive and the productivity of direct care workers increases as the pay of those workers is raised.   Their research showed that an increase in pay as proposed under this legislation would lead to fewer staffing shortages, lower turnover, and higher productivity in direct care workers. 

The American Jobs Plan also looks for $18 billion to be spent on modernizing hospitals and clinics under the direction of Veterans Affairs.  The administration’s proposal points out that the median age of U.S. private sector hospitals is approximately 11 years, while the median age for the network of VA hospitals is 58 years.  This section of the proposal aims to bring those VA hospitals up to a standard that contributes to a quality of care our nation’s veterans deserve.

The full array of proposals in the American Jobs Plan covers much more than the scope of this update.  And of course, there can be a big difference between what form legislation takes as it is first proposed and what it looks like when it is passed by Congress. However, any mention of changes in the world of long-term care means we want to be alert as a firm to any impacts that could be on the horizon for our clients. You can expect more details from us as we track the passage of any of these proposals into law.


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If you or your loved one has questions we would be glad to extend a FREE CONSULT to answer those estate planning and elder law questions and get your affairs in order. Let the experienced attorneys at McIntyre Elder Law help. Call (828) 233-5991.

Schedule Free Consult

IN PERSON . VIDEO CONSULT . PHONE CONSULT

Book Your FREE CONSULT Today!

Jake Edwards, Attorney

Jake Edwards

Estate Planning & Elder Law Attorney

mcelderlaw.com

Hendersonville Office

136 S. King St. Hendersonville, NC 28792

828-233-5991

❌ Elimination of Step-Up-In-Basis?

in Articles by Greg McIntyre Leave a comment

❌ Elimination of Step-Up-In-Basis? High taxation and what that might mean for you and more in this Elder Law Report. Stay tuned!!!

If we can help you preserve assets before major changes in the law we would be glad to do so and would offer a FREE consult to sit down and discuss asset protection. Give s a call to schedule your free consult today or schedule online at: mcelderlaw.com. For a list of local numbers to our offices see below:

  • Charlotte: 704-749-9244
  • Shelby: 704-259-7040
  • Hendersonville: 828-233-5991

Please don’t wait ‘til it’s too late. Call McIntyre Elder Law today.

Schedule Free Consult

IN PERSON . VIDEO CONSULT . PHONE CONSULT

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