The Internal Revenue Service (IRS) has announced the amounts taxpayers of different ages can deduct from their 2022 income as a result of buying long-term care insurance, and the figures are almost the same as in 2021.

Many types of medical expenses are deductible from your taxes. To claim the deduction, your total unreimbursed medical expenses (which can include premiums for “qualified” long-term care insurance policies), have to be more than 7.5 percent of your adjusted gross income in 2022.

As long as the long-term care insurance policy is “qualified” (see below), these premiums -- what the policyholder pays the insurance company to keep the policy in force -- are deductible for the taxpayer, his or her spouse, and other dependents. If you are self-employed, the tax-deductibility rules are a little different: You can take the amount of the premium as a deduction as long as you made a net profit; your medical expenses do not have to exceed a certain percentage of your income. The tax deduction is generally not available with so-called hybrid policies, such as life insurance and annuity policies with a long-term care benefit. 

There is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for tax year 2022. They are the same as in 2021, with the exception that for those in the age 60 to 70 age range the IRS reduced the limit by $10, from $1,420 to $1,410.  Any premium amounts for the year above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year
Maximum deduction for year

40 or less       $450

More than 40 but not more than 50       $850

More than 50 but not more than 60    $1,690

More than 60 but not more than 70        $4,510

More than 70                 $5,640

Another change announced by the IRS involves benefits from per diem or indemnity policies, which pay a predetermined amount each day. These benefits are not included in income except amounts that exceed the beneficiary's total qualified long-term care expenses or $390 per day, whichever is greater.
For these and other inflation adjustments from the IRS, click here.  

What Is a "Qualified" Policy?
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To be "qualified," policies issued on or after January 1, 1997, must adhere to certain requirements, among them that the policy must offer the consumer the options of "inflation" and "nonforfeiture" protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as "qualified" as long as they have been approved by the insurance commissioner of the state in which they are sold. 

​Every year Medicare gives beneficiaries a window of opportunity to shop around and determine if their current Medicare plan is still the best one for them. During Medicare's Open Enrollment Period, which runs from October 15 to December 7, beneficiaries can freely enroll in or switch plans. 
During this period, you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. 

Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

According to the New York Times, few Medicare beneficiaries take advantage of Open Enrollment, but of those who do, nearly half cut their premiums by at least 5 percent. Even beneficiaries who have been satisfied with their plans in 2021 should review their choices for 2022, as both premiums and plan coverage can fluctuate from year to year. For example: 

• Are the doctors you use still part of your Medicare Advantage plan’s provider network? 
• Have any of the prescriptions you take been dropped from your prescription plan’s list of covered drugs (the “formulary”)? 
• What are your total out-of-pocket costs? 
• Could you save money with the same coverage by switching to a different plan?

For answers to questions like these, carefully look over the plan's "Annual Notice of Change" letter to you. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks.   
Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals' personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited. If you think you've been a victim of fraud or identity theft, contact Medicare. 
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Here are more resources for navigating the Open Enrollment Period:

• Medicare Plan Finder, which helps you find a plan to match your needs: www.medicare.gov/find-a-plan 
• Medicare coverage options: www.medicare.gov/medicarecoverageoptions/
• The 2022 Medicare & You handbook, which all Medicare beneficiaries should have received. The handbook can also be downloaded online at:  medicare.gov/forms-help-resources/medicare-you-handbook/download-medicare-you-in-different-formats
• The Medicare Rights Center: www.medicareinteractive.org
• Your State Health Insurance Assistance Program, which offers independent counseling: www.shiptacenter.org

The year was 1983: The U.S. invaded Granada. A gallon of gas cost 96 cents. Michael Jackson’s ‘Thriller’ video premiered. That year was also the last time that Social Security recipients saw a cost-of-living increase steeper than the one just announced for 2022. This year, Social Security benefits will rise 5.9 percent, the sharpest upsurge since 1983’s 7.4 percent jump. 

Cost-of-living increases are tied to the consumer price index, and rising inflation rates and gas prices caused by the ongoing coronavirus pandemic mean Social Security recipients will get a large boost in 2022. The 5.9 percent increase dwarfs last year’s 1.3 percent rise, and over the past decade hikes have averaged just 1.65 percent. The average monthly benefit of $1,565 in 2021 will go up by $92 a month to $1,657 a month for an individual beneficiary, or $19,884 yearly. 
The cost-of-living change also affects the maximum amount of earnings subject to the Social Security tax, which will grow from $142,800 to $147,000.

For 2022, the monthly federal Supplemental Security Income (SSI) payment standard will be $841 for an individual and $1,261 for a couple.

Part of the increase will be eaten up by higher Medicare Part B premiums, however. The standard monthly premium for Medicare Part B enrollees has not been announced yet, but it is projected to rise $10 a month to $158.30. 

Most beneficiaries will be able to find out their specific cost-of-living adjustment online by logging on to my Social Security in December 2021. While you can still receive your increase notice by mail, you have the option to get the notice online instead.
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For more on the 2022 Social Security benefit levels, click here.

Britney Spears’s legal fight to wrest back control over her personal and financial affairs has flooded the issue of guardianship in Klieg lights. While a full guardianship may be necessary for many individuals who are incapable of managing their own affairs due to dementia or intellectual, developmental or mental health disabilities, the Spears case underlines the option of more limited alternatives.

Every adult is assumed to be capable of making his or her own decisions unless a court determines otherwise. If an adult becomes incapable of making responsible decisions, the court will appoint a substitute decision maker, usually called a "guardian" or a "conservator," depending on the state.

Guardianship is a legal relationship between a competent adult (the "guardian") and a person who because of incapacity is no longer able to take care of his or her own affairs (the "ward"). The guardian can be authorized to make legal, financial, and health care decisions for the ward. The National Center for State Courts says that about 1.3 million adults are living under guardianships or conservatorships with some $50 billion in assets.

The standard under which a person is deemed to require a guardian differs from state to state, and because guardianships are subject to state law, data on them is hard to collect and protections against abuse vary widely.  Netflix’s popular movie, I Care a Lot, spotlighted some weaknesses in the guardianship system that make it possible for an unscrupulous guardian to take control of an elderly person’s life and bleed their resources dry. 

The Spears Case: An Unusual Situation

Britney Spears has been under a court-ordered conservatorship that has controlled her career and finances since 2008. Her father, Jamie Spears, was appointed her temporary conservator when the pop singer was allegedly struggling with mental health issues and had been hospitalized, and a Los Angeles court later made the conservatorship permanent.

On July 14, a Los Angeles judge approved the resignation of Spears’s court-appointed lawyer and granted her request to hire her own lawyer. The 39-year-old singer told the judge that she wants to end the long-running conservatorship that put her father in charge of her estimated $60 million fortune and business affairs, and others in control of such personal decisions as whether she can marry and have a baby. "I'm here to get rid of my dad and charge him with conservatorship abuse," she said.

Whatever the merits of this controversial case, what makes Spears's situation so unusual is the fact that she does not appear to be incompetent, at least when it comes to her professional accomplishments. In the 13 years since the conservatorship was put in place, she has continued her career as a pop star, earning millions from a four-year concert residency act in Las Vegas and serving as a judge on the television reality show “The X Factor.”

Another anomaly is the fact that until now Spears was represented by a court-appointed attorney who, she argued, did not represent her wishes or interests. However, while the media has given wide coverage to Spears’s side of the dispute, we have heard almost nothing from the professionals handling her affairs, who are constrained from publicly disclosing confidential information.

It’s easy to see why conservatorship, which takes away a person’s right to make decisions about significant aspects of his own life, is considered among the most restrictive legal remedies in the American judicial system. For this reason, courts are legally required to seek alternatives that will safeguard the ward’s finances and wellbeing but with the fewest restrictions, in an effort to protect that person’s rights.

Protections Without Total Loss of Control

In the case of an elderly person who may no longer be able to handle some or all of her own affairs, there are various approaches that provide protection without stripping that person of control over all decisions, as in Spears’s case.

Many people in need of help can make responsible decisions in some areas of their lives but not others (such as making major financial decisions). Families might consider setting up what’s called a “limited guardianship.” Most states allow judges to appoint guardians with limited powers that are specifically tailored to the alleged incapacitated person's needs. For example, a court can appoint a guardian to oversee a person's housing and health care, but not to manage the person's bathing, eating, and socialization. Conservators can be appointed to handle the financial affairs of someone who is not good with money, without having any power to manage health care decision making—the options are almost infinite.

Alternatives to Guardianship

Sometimes, guardianship isn't the answer at all. If a person can execute estate planning documents, she can also sign a durable power of attorney and a health care proxy, which allows someone to assist her with decisions without court involvement. "Supported decision making" is a growing alternative to guardianship in which trusted advisors like family, friends or professionals assist in making decisions, although the individual retains the ultimate right to make their own decisions.

Trying an alternative to guardianship can be important for several reasons. First, it prevents a court from ruling that someone is "incapacitated," which carries with it a stigma and can be hard to undo, as Britney Spears is finding. Second, it puts the person in the driver's seat. Third, it is much less expensive and time-consuming.

Another option is a revocable or "living" trust that can be set up to hold an older person's assets, with a relative, friend or financial institution serving as trustee. Alternatively, the older person can be a co-trustee of the trust with another individual who will take over the duties of trustee should the older person become incapacitated.

Experts say that Britney Spears faces a long, difficult path if she seeks to terminate her conservatorship. She would need to file a formal petition, which would require presenting evidence in hearings and depositions. She could face objections at every stage from attorneys representing her father and others involved in her care. (Spears has indicated her unwillingness to submit to a mental evaluation or test in her effort to end the conservatorship.)

If you have questions about what type of guardianship may be right for your family member, or if you are currently under guardianship and are looking to gain control of your affairs, talk to your elder law attorney today.

For an article on what may lie ahead in the Britney Spears case, click here.
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For an article by University of Virginia Family Law Professor Naomi Cahn on how guardianships can lead to abuse, click here.

The Senate Democrats' proposal for a $3.5 trillion spending plan includes expanding Medicare to provide dental, vision, and hearing benefits. The proposal is now being negotiated in Congress. 

Currently Medicare does not offer much in the way of dental, vision, and hearing benefits. Medicare Part A will cover certain emergency or necessary procedures that are received in the hospital. For example, if you are hospitalized after an accident and require jaw reconstruction, Medicare Part A will pay for the dental work required as part of that procedure. 

Medicare Part B offers very limited coverage of some vision and hearing services. For example, while Medicare Part B won’t cover routine eye exams, it does cover yearly glaucoma screenings for people at high risk and cataract surgery, among a few other limited exceptions. Part B will also cover some diagnostic hearing and balance exams if they are ordered by a doctor, but it will not cover routine hearing exams or hearing aids. There is no coverage at all for routine dental work.

Many people choose Medicare Advantage plans, which are run by private insurers, instead of traditional Medicare because it is possible to get some dental, vision, and hearing benefits in most plans. According to the Kaiser Family Foundation, 79 percent of people in Medicare Advantage plans have vision coverage, 74 percent have dental coverage, and 72 percent have hearing aid coverage. 
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Under the Democrats’ proposal, Medicare beneficiaries would be able to receive dental, vision, and health benefits through traditional Medicare, making it more competitive with Medicare Advantage. The exact details of the proposal are unknown, but in a 2019 bill that passed the House, Medicare beneficiaries would have paid 20 percent of the cost for basic dental coverage and routine eye and hearing exams. Democrats want to pass the spending bill through the reconciliation process, which requires all 50 Democrats to agree to the plan. Negotiations are currently underway to craft a bill that has the support of all the Democratic senators.

Is your family of the “Leave It to Beaver” variety -- opposite-gender parents, the first marriage for each, one or more kids, all healthy and thriving? If so, your estate plan will probably be pretty straightforward. But if not, it's not as simple and you have a lot of company.

The percentage of married households in the United States fell from 75 percent in 1960 to 49 percent in 2020. About 40 percent of all marriages end in divorce. Nearly 80 percent of people who divorce remarry -- accounting for a pretty large proportion of the 49 percent of American households that are married.

About 1.5 million babies a year are born to unmarried women, more than a third of all births. This can complicate matters, especially when the father is not identified or, in the case of donated sperm, does not exist. It also can mean a greater need for planning when there is no obvious back-up parent if something happens to the mother.

If you are in a relationship, but not married, been married more than once, have children by more than one partner, or have beneficiaries who cannot manage funds for one reason or another, then it's more important that you do estate planning and your planning cannot be plain vanilla. Here are a few tips to consider:

1. Give Your Partner Rights. There are laws in place empowering spouses and governing the distribution of property in the event of death. The so-called "rules of intestacy" provide that property will pass to spouses and children, or to parents if someone dies without a spouse or children. But no laws protect unmarried partners or unadopted children. There have been many cases of parents pushing aside the same-sex partners of their children upon death or incapacity. We can all use wills, trusts, durable powers of attorney and health care proxies to choose who should step in for us when needed and who should receive our property.
2. But Don't Give the New Spouse Too Many Rights. All too often, despite the best of intentions and good will, when parents remarry the new family doesn't bond. The children from prior marriages or relationships don't become friends with one another or with the new spouse of their father or mother. Frequently, the death of one spouse means that all of the assets of both families end up with the surviving spouse and ultimately pass to his or her children and grandchildren. Frank discussions about what the new couple wants and planning to make sure it plays out as planned can prevent a lot of misunderstanding and resentment. Again, wills, trusts, durable powers of attorney and health care proxies can permit the new couple to choose the outcome they prefer, rather than just let life (and death) happen and the chips fall where they may
3. Don't Be Afraid to Talk Pre-Nup. While most people entering a first marriage have no children and few assets, this is not the case with a second or third marriage. Before getting married again, the couple needs to talk about what they have in mind in terms of mutual financial support of one another and of their children from prior marriages and relationships. Then they need to put their understanding in writing so that down the road there are no misunderstandings or different memories of what they agreed. If memorialized in a prenuptial agreement, it will also be legally enforceable. If circumstances change, the couple can always modify their agreement.
4. Use Trusts. Wills are generally straight forward and blunt instruments. When you pass away, your property passes to the people you name. Wills do not easily permit more flexible planning. For instance, you may want to permit your new spouse to live in your home for as long as he wants, but for it to ultimately pass to your children and grandchildren. A trust permits you to plan for this scenario, giving your spouse rights, but someone else -- the trustee -- the power to manage the property and protect it for the next generation. Or a couple could pool all of their resources in a single joint trust for their benefit during their lives, with the funds remaining after they have both passed away to be distributed equally to the children they each bring to the new relationship or marriage.
5. Goals First, Planning Second.  No planning can take place in a vacuum or based on assumptions without asking questions. Anyone considering planning for themselves and for loved ones, whether in a traditional or non-traditional relationship, needs to start by listing her goals. Is her primary concern providing for herself? Leaving an inheritance to children? Protecting a spouse or partner? Or a pet? Making sure children are independent, but have a safety net if necessary? Of course, most of us don't have just one goal, but we should start by writing them all down. Then we can see if it's possible to achieve all of them, or if we need to prioritize. Ultimately, the estate plan should reflect these goals and priorities. While this is true of anyone doing estate planning, it is more important the more family and non-family bonds one has because the plan will have to balance and prioritize more interests.

The bottom line is that our laws for distribution of property and rights in the event of incapacity are based on a vision of a marriage between one woman and one man with one or more children. However standard this ever was in reality, it is much less the norm today, almost certainly applying to fewer than half of American adults. For those who don't fit the one nuclear family mold, planning is both more important and more interesting. Don't put it off.

It is a very good idea to create advance directives in order to plan for the possibility that you may one day be unable to make your own medical decisions. In doing so, there can be confusion about the difference between a living will and a "do-not-resuscitate" order (DNR). While both these documents are advance medical directives, they serve different purposes.
A living will is a document that you can use to give instructions regarding treatment if you become terminally ill or are in a persistent vegetative state and unable to communicate your instructions. In Massachusetts we do not have a living will statute so you will often see these planning measures with different labels such as "Expression of Intentions regarding Health Care."  The living will states under what conditions life-sustaining treatment should be terminated. If you would like to avoid life-sustaining treatment when it would be hopeless, you need a living will. A living will takes effect only when you are incapacitated and is not set in stone -- you can always revoke it at a later date if you wish to do so.
When drawing up a living will, you need to consider the various care options and what you would like done. You need to think about whether you want care to extend your life no matter what or only in certain circumstances. A living will can dictate when you want a ventilator, dialysis, tube feeding, blood transfusions, and other life- saving or life-prolonging options. 
A DNR is a different document. A DNR says that if your heart stops or you stop breathing, medical professionals should not attempt to revive you. This is very different from a living will, which only goes into effect if you are unable to communicate your wishes for care. Everyone can benefit from a living will, while DNRs are only for very elderly and/or frail patients for whom it wouldn't make sense to administer CPR.

Long-term care involves not only a loss of personal autonomy; it also comes at a tremendous financial price. Proper planning can help your family prepare for the financial toll and protect assets for future generations. 
Long-term care can be very expensive, especially around-the-clock nursing home care. Most people end up paying for nursing home care out of their savings until they run out, at which point they can qualify for MassHealth to pick up the cost. 
MassHealth rules require that recipients have no more than $2,000 in "countable" assets (the figure may be somewhat higher in some states) and limited income. Any excess assets need to be spent down before you can qualify for MassHealth. In addition, in order to be eligible for MassHealth, you cannot have recently transferred assets. If you transfer assets within five years of applying for MassHealth, you may be subject to a penalty period during which you cannot receive benefits. After you die, MassHealth also has the right to recover from your estate, which in the case of a MassHealth recipient usually means only the house.
Careful planning in advance can help protect your estate for your spouse or children. If you make a plan before you need long-term care, you may have the luxury of distributing or protecting your assets in advance. This way, when you do need long-term care, you will quickly qualify for MassHealth benefits. The following are some tools that can be used in an estate plan to prepare for MassHealth: 

• Trusts. One of most important estate planning tools you can use is an "irrevocable" trust -- a trust that cannot be changed after it has been created. In most cases, this type of trust is drafted so that the income is payable to you (the person establishing the trust, called the "grantor") for life, and the principal cannot be applied to benefit you or your spouse. At your death the principal is paid to your heirs. This way, the funds in the trust are protected and you can use the income for your living expenses. For MassHealth purposes, the principal in such trusts is not counted as a resource, provided the trustee cannot pay it to you or your spouse for either of your benefits. However, if you do move to a nursing home, the trust income will have to go to the nursing home. And to avoid MassHealth’s “look-back period,” the trust must be funded at least five years before applying for benefits.   
• Annuities. Annuities are another tool married couples can use when a MassHealth application is imminent. An immediate annuity, in its simplest form, is a contract with an insurance company under which the policyholder pays a certain lump sum of money to the insurer and the insurer sends the policyholder a monthly check for the rest of his or her life. In most states the purchase of an annuity is not considered to be a transfer for purposes of eligibility for MassHealth, but is instead the purchase of an investment. It transforms otherwise countable assets into a non-countable income stream. As long as the income is in the name of the spouse who is not in the nursing home, it's considered non-countable.  
• Protecting your home. After a MassHealth recipient dies, the state must attempt to recoup from his or her estate whatever benefits it paid for the recipient's care. This is called "estate recovery." For most MassHealth recipients, their house is the only asset available, but there are steps you can take to protect your home. Putting your house in a trust can be a good option, but once a house is placed in an irrevocable trust, you cannot remove it. .

Talk to your attorney about whether your estate plan should include preparation for possible MassHealth eligibility. 

The IRS has announced that the tax deduction for medical expenses includes amounts spent on face masks, sanitizer and other products purchased to prevent the spread of the coronavirus. 
If you have significant medical expenses, you may be able to deduct them from your taxes. Many types of medical expenses are deductible, from long-term care to hospital stays to hearing aids. This year, the IRS has made clear that “medical expenses” also includes amounts paid for personal protective equipment, such as masks, hand sanitizer, and sanitizing wipes, as long as they were used for the primary purpose of preventing the spread of COVID-19. 
However, this deduction will be irrelevant to most taxpayers. To claim the deduction, your medical expenses have to be more than 7.5 percent of your adjusted gross income and your other deductions have to be sufficient to justify itemizing rather than taking the standard deduction. This may be the case if you have large home care, nursing home or assisted living expenses (the latter only deductible if you’re there for medical reasons), in which case the cost of your face masks, etc., is going to be a drop in the bucket. In addition, you can only deduct medical expenses you paid during the year, regardless of when the services were provided, and medical expenses are not deductible if they are reimbursable by insurance.

For the IRS’s press release on deducting personal protective equipment, click here.  
For more information on what you can and cannot deduct, see Publication 502 on the IRS Web site.

In a profanity-laced episode of his HBO show that is by turns hilarious and deeply disturbing, comedian John Oliver delivers one of his trademark rants, this one exposing the “abuse and neglect” that he says are all-too-prevalent in our system of long-term care. 
On the show Last Week Tonight, Oliver begins the 22-minute segment by recounting lurid media coverage of conditions in nursing homes, often caused by facility staff who are overworked and underpaid. One nursing assistant explains in an interview that each staff member at her nursing home has 22 residents to take care of every day, making it impossible to address all of their needs. Oliver contrasts the cost of nursing home care with the pay for the staff, pointing out that most nursing homes are for-profit institutions that charge thousands of dollars a month for care. Unfortunately, as Oliver explains, safeguards are no better in assisted living facilities, which are even more lightly regulated than nursing homes. 
Oliver also examines the difference in care provided based on who is paying for it. Medicare offers limited nursing home coverage, but it reimburses nursing homes for the full cost of care. As a result, if Medicare is paying for a resident’s care, then the resident may get more services than are necessary so the facility can reap more reimbursements. By contrast, Medicaid pays nursing homes much less, so Medicaid recipients may receive inferior care and may sometimes even be illegally dumped into the community. 
Understaffing and inadequate training of nursing home staff have consequences. Oliver gives examples of residents who met tragic fates due to staff neglect, including one resident who slipped into a pond and was eaten by an alligator and another who froze to death on Christmas. He also relates the story of a woman who tried for hours to summon help from staff at her nursing home before finally calling the local police for assistance.  
Oliver suggests that one remedy is increasing access to home-based care. President Biden has proposed $400 billion to improve home and community-based services. Whatever the solution, Oliver emphasizes that we need to show that we care deeply about “what happens to the elderly and people with disabilities in this country, because right now evidence points to the fact that we absolutely don’t.”
Click here to view the segment.  WARNING: As we note at the outset, Oliver’s diatribe is filled with expletives and may not be appropriate for all viewers. 
For Slate's take on Oliver's deep dive into the long-term care system, click here.