Looking for Long-Term Care?

Takeaways

• Choosing a nursing home can be daunting, but rating systems like the U.S. News & World Report’s Best Nursing Homes of 2026 can serve as a starting point.

• A thorough search requires looking beyond rankings to assess quality of care, staff consistency, and facility transparency.

Realizing that you or a loved one needs to move into a nursing home can be stressful. Just the process of looking for the right facility can seem daunting. You want to make sure the facility you choose is a good place and will offer the necessary care, safety, and comfort.

Many factors come into play when searching for the right nursing home, such as staffing, quality of care, cost, and location. With all the factors to consider and all the options, it can be hard to choose. However, there are resources available, one of which is U.S. News & World Report’s annual nursing home ratings report.

Last month, U.S. News & World Report unveiled its Best Nursing Homes of 2026 ratings report, which analyzed data for nearly 15,000 nursing homes. For these rankings, U.S. News & World Report made their study more comprehensive by expanding their quality metrics from nine to 19 for short-term rehabilitation facilities and from eight to 17 for long-term care facilities.

Key Findings of the 2026 Report

Some of the key findings from the report include:

• Fewer than 19 percent of the nearly 15,000 facilities reviewed earned a “Best Nursing Home” designation in the categories of short-term rehabilitation, long-term care, or both.

• On average, the top-rated nursing homes (those designated “Best”):

  • provide 20 percent more total staffing per resident per day than the national average

  • offer 80 percent more physical therapy per resident per day in their rehab units than the national average

  • achieve a 15 percent lower rate of hospitalizations among long-term residents compared with national norms

  • have a 33 percent lower rate of emergency room visits for rehab patients at the highest-performing skilled nursing facilities

Beyond the Rankings: Key Considerations When Looking for a Nursing Home

When looking for the nursing home that is the right fit for your loved one, consider rankings together with the following:

Resident-Centered Care and Quality of Life

Look beyond clinical metrics to assess the emotional and social environment of the facility. A top-tier nursing home prioritizes the residents’ individuality and dignity.

• Engagement and activity. Are there varied daily activities that cater to different interests? Is there evidence of genuine resident participation and enjoyment?

• Personalized schedules. Do residents have a choice in their daily routine, such as when they wake up, eat, or bathe, or is everything strictly scheduled by the facility?

• Integration with the community. Does the home foster connections with the local community, such as through volunteer programs, outings, or intergenerational visits?

Staff-Resident Interaction and Retention

The relationship between residents and staff is paramount. High staff retention often correlates with better quality of care.

• Observation of interaction. During a visit, observe how staff members speak to and interact with residents. Is the tone they use respectful, warm, and patient?

• Staff consistency. Ask about the facility’s staff turnover rates. A stable, familiar team of caregivers is crucial for building trust and ensuring consistent, quality care.

• Response time. Note how quickly and attentively staff respond to resident requests or calls for assistance.

Transparency and Communication

An excellent facility maintains open and proactive communication with residents and their families.

• Family involvement. Is the facility welcoming to family visits and participation in care planning?

• Grievance process. Is there a clear, accessible, and well-publicized process for residents or families to voice concerns without fear of retaliation?

• Financial clarity. Ensure that the billing and service agreements are transparent and easy to understand, outlining all potential costs and what is included in the daily rate.

Structuring Your Search for the Ideal Nursing Home

Phase 1: Prescreening and Vetting

Start by narrowing your list based on essential criteria before conducting any in-person visits.

• Define your loved one’s needs. Determine the level of care required and the necessary financial structure (Medicare, Medicaid, private pay).

• Filter your list according to ratings. Use the U.S. News and Medicare’s Nursing Home Compare rankings to eliminate any facilities with consistently low ratings or serious, recent violations.

• Review each facility’s deficiencies. Thoroughly read the state’s inspection reports. Note the frequency and severity of deficiencies, paying special attention to those related to harm or abuse.

Phase 2: In-Person Visit and Observation

Once you have a shortlist of potential facilities, schedule an in-person visit. Ideally, make one planned visit and one unannounced visit.

• Observe mealtime at the facility. This is a crucial time to assess the quality of food, the level of assistance residents receive, and the overall social environment.

• Tour resident rooms if possible. Check for cleanliness, personalization, and a comfortable temperature. Note if call lights are answered promptly.

• Interview key staff at the facility. Speak with the director of nursing, the administrator, and a few certified nursing assistants if you can. Ask specific questions about emergency protocols and staff-to-resident ratios on different shifts.

Phase 3: Final Decision and Contract Review

Before signing, ensure all logistical and legal elements are clear.

• Review the admission contract. Carefully read the small print, especially regarding involuntary discharge policies, payment expectations, and any arbitration agreements. Consider having an elder law attorney review this document.

• Conduct a trial stay (if applicable). If the resident is moving from a hospital or rehab, a short-term stay can serve as a trial run before committing to long-term residency.

• Establish a communication plan. Before moving in, formalize a schedule for care conferences and set clear expectations for how and when the family will receive updates on your loved one’s health and well-being.

Resources to Use When Choosing a Nursing Home

Several nursing homes options may be available in your area, so choosing the right one may feel overwhelming. However, in addition to U.S. News & World Report’s annual nursing home ratings report, consider other rating systems to help you make a more informed decision.

• Medicare’s Your Guide to Choosing a Nursing Home. This is a helpful booklet published by Medicare that explains what to ask, how to compare facilities, and where to find data.

• State health departments. Many states maintain databases of nursing home inspection reports and licensing status.

• Ombudsman programs. Long-term care ombudsmen advocate for residents’ rights and can suggest local nursing homes or help with complaints.

• Local aging services agencies. Nonprofits, Area Agencies on Aging, or senior resource centers can guide families in touring and evaluating options.

Choosing a nursing home is an important personal choice, and what’s best depends on each individual’s needs, goals, and financial situation. After doing your research, start visiting your top choices. If you are looking for a nursing home or assisted living facility for yourself, bring a trusted friend or family member with you to provide an objective view of the facility.

Additional Reading

For additional reading on topics related to nursing homes and long-term care, check out the following articles:

• What Are Nursing Home Residents’ Rights?

• Which Should I Choose? Nursing Home Care vs. Hospice Care

• Discussing Long-Term Care With Older Adults in Your Life

• Activities of Daily Living and the Need for Long-Term Care

• What a Good Long-Term Care Insurance Policy Should Include

• Older Adults Lack Information in Search for Long-Term Care Services

Giving to Grandkids? Consider Gift Tax, 529 Plans, and More

Takeaways

• Grandparents should clarify whether financial assistance for their grandkids is a gift or a loan.

• Consider 529 plans for education funding to ensure fairness and tax benefits.

• Grandparents should also ensure their own financial security, especially regarding potential long-term care costs.

Grandparents often are particularly generous to grandchildren as they see their family’s legacy continuing to the next generation. In many cases, grandparents feel they have ample resources while their children or grandchildren may be struggling financially.

Assistance with summer camp fees, college tuition, wedding costs, or the down payment on a first home can permit grandchildren to take advantage of opportunities that otherwise would be out of reach. Some grandparents also don’t feel it’s right that children and grandchildren should need to wait for an inheritance, when they have more than they need.

Helping out family members is to be encouraged but can raise numerous legal issues involving taxes and eligibility for public benefits, as well as questions of fairness among family members. Here are six issues grandparents should consider before making gifts to loved ones:

Is It a Gift or a Loan?

Does the grandparent expect anything in return? Do they want the funds repaid or is the money an advance on the grandchild’s eventual inheritance? Either way, this should be made clear, preferably in writing, whether in a letter that goes with the check or, in the case of a loan, a formal promissory note.

Is Everyone Being Treated Equally?

Not every grandchild has the same financial needs. At the same time, grandparents may not feel equally close to all their grandchildren. While it’s the grandparent’s money and they can do what they want with it, if they’re not treating all their grandchildren equally, they might want to consider whether unequal generosity will create resentment within the family.

Many elder law clients say that what they do with their money during their lives is their business. They may help out some children and grandchildren more than others based on need, with the expectation that this will be kept private. They may then opt to treat all their children equally in their estate plan.

Beware Taxable Gifts

Any gift to an individual in excess of $19,000 (in 2025) per year must be reported to the Internal Revenue Service (IRS) on a gift tax return via Form 709. Two grandparents together can give up to $38,000 per recipient per year (as of 2025) with no reporting requirement. Note that there’s no limit or reporting requirement for payments made directly to medical and educational institutions for health care expenses and tuition for other individuals.

529 Plans

Many grandparents want to help pay higher education tuition for their grandchildren, especially given the incredibly high cost of undergraduate and graduate school today. But perhaps not all your grandchildren are the same age, making it difficult to make sure that they all receive the same level of assistance from you. Some grandchildren may still be in diapers while others are getting their doctorates.

One potential solution is to fund 529 accounts for each grandchild. These are special accounts that grow tax deferred, with the income and growth never taxed as long as the funds are used for higher education expenses.

Don’t Be Too Generous

Grandparents need to make sure that they keep enough money to pay for their own needs. While small gifts probably won’t make any difference one way or another, too many large gifts can quickly deplete a lifetime of scrimping and saving. It won’t do the family much good if a grandparent is just scraping by because they’ve done too much to support their children or grandchildren.

Consider the Need for Long-Term Care

To be certain that they’ve kept enough of their own savings, grandparents need to consider the possibility of needing care. Whether they stay at home in their later years or move into assisted living or a nursing home, long-term care is more expensive than ever before. In fact, the annual median cost of in-home care with a home health aide in the United States was nearly $80,000 in 2024.

In addition, those seniors who can’t afford to pay for such care from their own funds need to be aware that any gift can make them ineligible for Medicaid benefits for the following five years.

What Else to Keep in Mind

Each family situation has its own unique dynamics, so there may likely be other issues to consider. For example, you might not trust your grandchildren to spend a gift wisely. Or, your gifts may undermine the parents’ plans for your grandchild.

In some instances, grandparents may want to consider “incentive” trusts, which provide that the funds will be distributed when grandchildren reach certain milestones, such as graduating from college or holding down a job. Communication with the middle generation can be key to making certain that gifts achieve the best results for all concerned.

Related Articles

• Congress Considering Full Repeal of the Estate Tax

• IRS Announces 2025 Gift and Estate Tax Exemptions

Overcoming Challenges in Guardianship Cases for Older Adults

Takeaways

• Guardianship becomes necessary when an older adult cannot make decisions and lacks a valid power of attorney.

• The guardianship process can be complicated by family disputes, difficulties in proving the adult’s incapacity, and challenges with ongoing guardian responsibilities.

• Strategies such as mediation, naming successor guardians, and meticulous record-keeping can help prevent common issues in guardianship cases.

When an older adult with dementia or another cognitive disability can no longer make important decisions for themselves, such as how to manage their money or what kind of care they need, a trusted person may have to step in and make these decisions for them.

If the incapacitated older adult has a valid health care and financial power of attorney in place, they have already nominated someone they trust. This person has the legal authority to make decisions for them.

However, sometimes there is no valid power of attorney. The older adult may not have executed one, no one can find the document, or the agent(s) they nominated are unavailable.

When there is no agent with the power to act on behalf of the older adult under a valid power of attorney, families face a significant hurdle. The older adult may no longer understand what a power of attorney is and what powers they would give their surrogate decision-maker. If that is the case, they are unable to create a valid power of attorney. In this situation, the older adult lacks someone with the legal authority to make decisions for them.

Guardianship of an Incapacitated Adult

Guardianship presents itself as a solution. In a guardianship, the court appoints someone to make decisions for the incapacitated adult.

There are different types of guardianship (some states use the term conservatorship). Total (full or plenary, in some states) guardianship gives the guardian the most control. A guardian or conservator of the estate manages finances. In a limited guardianship, the court specifies what the guardian can and cannot do. Courts generally favor limited guardianships where possible.

Petitioning the court for guardianship over the older adult is a much more involved legal process than becoming an agent under a power of attorney. Becoming a guardian requires proving that the adult is unable to make personal or financial decisions for themselves in a court of law and assuring the judge that the petitioner is a suitable guardian.

Guardianship Case Challenges

When challenges arise, filing for guardianship over an older adult can be lengthy and complex. Families may encounter several problems throughout the guardianship process. Disagreements about whether the elder needs a guardian and who should fill the role can create tension. Proving the older adult’s incapacity requires relevant and timely medical evidence and testimony, which can involve significant preparation for the guardianship hearing.

After the court has assigned a guardian, complexities can arise if family members bring accusations of improper conduct, the guardian seeks to resign, or the person under guardianship wants to replace the guardian or end the guardianship.

An elder law attorney can help family members navigate such challenges. Having an attorney with experience can be particularly helpful for those involved in complex guardianship matters.

While each case is unique, the following are challenges families may encounter in a guardianship case involving an older adult.

Disagreements About the Need for Guardianship

Full guardianship requires that the adult be incapable of making personal or financial decisions. One of the first challenges that can come up in a guardianship case is when family members disagree about whether a guardianship is even required.

To overcome this obstacle, the older adult may undergo a medical evaluation by a qualified physician. The physician may assess their condition to shed light on whether the individual has the mental capacity to make their own personal and financial decisions. Should the guardianship case go forward, the physician’s report becomes an important piece of evidence.

When the older adult can still make decisions but could benefit from some assistance from a person they trust, less restrictive alternatives to full guardianship may be more appropriate. The court may decide a limited guardianship is most suitable.

Alternatives to guardianship that preserve the older adult’s autonomy include creating power of attorney documents or setting up a supported decision-making arrangement, which is an informal relationship where an older person chooses someone to help with certain decisions.

In instances where someone needs help specifically with managing their Social Security benefits, the government may appoint a representative payee, which can be a less restrictive alternative to full guardianship or guardianship of the estate.

Difficulties Proving Incapacity

Proving incapacity is central to guardianship of an adult. Guardianship is only needed when a person has lost the capacity to make their own decisions.

Families can run into difficulties with this when they petition for guardianship without the proper medical evidence. They will need a recent medical evaluation, known as the physician’s report. If it has been some time since the proposed protected person has been to the doctor, the court may decline to order the guardianship or may order a new medical evaluation. This can lead to delays.

To avoid this complication, family members seeking guardianship over an older adult with a disability should make sure that the adult has had a recent medical evaluation and include the physician’s report with the petition.

Family Disputes About Who Should Be Guardian

Even when families agree that guardianship is the best course of action, disputes can arise about who should take on the role. Siblings may be at odds over who should take care of aging parents. Children from prior marriages and current spouses may also both want to assume the role.

When there are multiple petitions for guardianship over an adult, the court will make the final decision. People who get along and can work together may serve as co-guardians.

Families facing conflict may be able to avoid lengthy litigation and preserve relationships through alternative dispute resolution such as mediation. Generally, mediation is a voluntary process. Rather than finding a winner and loser, the process seeks to foster common ground. A neutral third party, called the mediator, listens to both sides, and facilitates communication and compromise.

Missing the Annual Report

Guardians must file an annual report with the court, which typically details the kind of care the person under guardianship has received. Not filing the annual report can spark accusations of mishandling. The court may remove the guardian and penalize them.

Guardians can avoid problems with annual reporting in several ways, including the following:

• Keeping detailed records, including an accounting of spending from the estate

• Hiring a professional, such as an accountant

• Staying organized and on top of deadlines or working with an attorney to file the report on time

Guardian Resigning

If the guardian dies, resigns, or becomes unable to serve, families may not know who should make decisions for their elderly loved one. A guardian who no longer wants to serve must get permission from the court and explain why, such as health reasons, conflict, or moving away. The court will review whether the request is in the ward’s best interests. Those with financial responsibilities still must file an annual accounting.

Nominating a successor in the initial guardianship petition can make a smoother transition if the first guardian can no longer continue. The court will appoint this person if it remains in the best interests of the older adult.

Ending a Guardianship

A guardianship is an arrangement that can limit a person’s personal agency. If the person under guardianship is unhappy and is able to tell the court, they may try to end the guardianship. If the person remains unable to make decisions for themselves but is dissatisfied with the arrangement, the court may replace the guardian with someone else who can act in their best interest.

In cases where the individual under the guardianship has regained capacity, medical evidence may show that the guardianship is no longer needed.

Strategies for Preventing Challenges

Petitioners in guardianship cases can anticipate and avoid these common challenges in several ways, including:

• Working with a mediator to resolve family disputes

• Naming a successor guardian in the guardianship petition

• Maintaining good records for the annual report

• Acting in an ethical manner and in accordance with the best interests of the older person under guardianship

Additional Reading

• How Mediation Helps Resolve Elder Care Disputes

• Wendy Williams Case Shines Light on Guardianship

• What to Do If Appointed Guardian of an Older Adult

How to Prevent Long-Term Care Insurance Claim Denials

Takeaways

• Understanding your long-term care insurance policy and its specific requirements (benefit triggers, covered services, elimination periods) is crucial to preventing claim denials.

• Common reasons for claims denials include insufficient medical documentation, preexisting condition exclusions, failure to meet elimination period requirements, and administrative errors.

• To help prevent denials, make sure you thoroughly understand your policy, confirm that your care providers meet policy requirements, maintain detailed medical and care records, and accurately track the elimination period.

• If a claim is denied, you have the right to appeal and should carefully review the denial letter, file an appeal promptly with supporting evidence, and seek help from state insurance departments or elder law attorneys if necessary.

• State-level consumer protections also offer safeguards such as limitations on preexisting conditions, written explanations for denials, and appeal rights.

Long-term care insurance can provide necessary financial support when someone needs help with daily activities such as bathing, dressing, or eating, whether they live at home, in an assisted living facility, or in a nursing home. However, when the time comes to use the benefits, some policyholders are surprised to find their claims denied. Understanding why denials happen and how to avoid them can save families significant stress and expense.

Why Long-Term Care Insurance Claims Get Denied

Long-term care insurance claims may be denied for various reasons, including those described below.

Lack of Medical Documentation

One of the most common reasons for denial is insufficient medical evidence to show that the insured meets the policy’s “benefit trigger.” Most policies require that a doctor or licensed health care professional certify that the person needs help with at least two activities of daily living (ADLs), such as eating, bathing, or dressing, or that the person has a severe cognitive impairment. If medical records don’t clearly document these limitations, insurers may reject the claim.

Preexisting Condition Exclusions

Some older long-term care policies exclude coverage for preexisting conditions for a certain period after the policy begins. If the need for care arises during that exclusion period, or if the insurer believes the condition existed before coverage began, the claim may be denied.

Not Understanding What’s Covered

Many denials occur because policyholders assume that all types of care or facilities are covered. For instance, some policies cover only licensed home health agencies, not independent caregivers or family members. Others may exclude assisted living facilities unless they meet specific licensing or staffing standards.

Failure to Meet Elimination Period Requirements

An elimination period is like a deductible measured in time rather than money; it’s the number of days the policyholder must pay for care before the insurer starts to pay. If documentation doesn’t show continuous care during that period, the insurer may delay or deny payment.

Administrative or Technical Errors

Sometimes denials stem from paperwork mistakes, missing signatures, or incomplete claim forms. Even small administrative issues can cause delays.

How to Prevent Claim Denials

Having an insurance claim denied can be a hassle and can lead to a long appeals process or unplanned care expenses. Here’s how to help prevent claims from being denied.

Understand Your Policy Before You Need It

Review your policy carefully, ideally with the help of a trusted family member, attorney, or financial advisor. Take note of the following:

• What types of care and facilities are covered

• The definition of “benefit triggers” (ADLs or cognitive impairment)

• Elimination periods and daily or lifetime benefit limits

• Exclusions or limitations for certain conditions

Keep copies of your policy, correspondence, and any amendments in one place so they’re easy to access later.

Confirm That Your Provider Meets Policy Requirements

If your policy only covers licensed providers, verify that your caregiver or long-term care facility meets those qualifications. Before beginning care, call your insurer to confirm that the provider is eligible under the policy terms.

Maintain Detailed Medical and Care Records

Ensure your doctor, home health agency, or facility keeps detailed notes about your limitations and the level of assistance you need. Ask for copies of care plans, assessments, and progress reports. They can make a difference during a claims review.

Track the Elimination Period Accurately

Keep receipts, caregiver timesheets, and invoices for all care provided during the elimination period. Gaps in documentation can delay benefit payments.

If Your Claim Is Denied

Fortunately, a denial doesn’t necessarily mean the end of the road.

Read the Denial Letter Carefully

The insurer must explain the specific reason for denial. This letter is your roadmap for next steps, whether it’s providing more documentation, clarifying a misunderstanding, or filing a formal appeal.

File an Appeal Promptly

Most insurers have internal appeal procedures with strict deadlines. Follow them closely and include supporting evidence such as updated medical records, physician statements, and care logs.

Seek Help if Needed

If the appeal fails, consider reaching out to your state’s Department of Insurance, which oversees long-term care insurance regulations. Many states have consumer protection units or ombudsman programs that can review your case and help mediate disputes.

Certified long-term care insurance specialists can provide guidance and can assist in filing claims and appeals. Elder law attorneys can also provide guidance and can represent you in appeals.

Consumer Protections

Long-term care insurance is regulated at the state level, but many states have adopted model laws based on standards set by the National Association of Insurance Commissioners (NAIC). These regulations include protections such as:

• Clear definitions of benefit triggers and covered services

• Clarifications regarding limitations on preexisting condition exclusions

• Requirements that insurers provide written explanations for claim denials

• Appeal rights for denied claims

Knowing your rights under state law can help you hold insurers accountable.

The Bottom Line

A long-term care insurance denial can feel overwhelming, especially when you or a loved one needs care right away. However, in many cases, denials can be avoided or overturned with preparation, documentation, and persistence.

By understanding your policy, keeping thorough records, and knowing your appeal rights, you can increase the chances of receiving the benefits you’ve paid for and planned on receiving.

Additional Reading

For additional reading on topics related to long-term care insurance, check out the following articles:

• What a Good Long-Term Care Insurance Policy Should Include

• When Should You Purchase Long-Term Care Insurance?

• Deducting Long-Term Care Insurance Premiums in 2025

• Questions to Ask Before Buying Long-Term Care Insurance

• Who Should Purchase Long-Term Care Insurance?

• Older Adults Lack Information in Search for Long-Term Care Services

How Medicare Changes in 2026 Will Affect Older Adults

Takeaways

• Medicare is implementing changes in 2026 to lower prescription drug costs, enhance consumer protections, and test new care management approaches.

• New negotiated prices for some prescription drugs and an annual out-of-pocket cap of $2,100 for Part D covered medications will lead to lower drug costs for many enrollees.

• A new special enrollment period will protect beneficiaries who choose a Medicare Advantage plan based on inaccurate provider directory information.

• A prior authorization pilot program will be implemented in six states for certain services and equipment in traditional Medicare.

• Beneficiaries can opt to spread their prescription drug costs evenly over 12 months.

Medicare is rolling out several important changes in 2026 that are intended to lower prescription drug costs, strengthen consumer protections, and test new ways of managing care. If you’re enrolled in Medicare, or will be soon, here’s what you need to know.

Lower Negotiated Prices for Some Prescription Drugs

Starting January 1, 2026, Medicare will begin using newly negotiated prices for a group of commonly used and expensive prescription drugs. These are the first medications selected under the Medicare Drug Price Negotiation Program.

What This Means for You

If you take one of these drugs, you may see lower costs at the pharmacy. Savings will vary depending on the medication and your Part D plan. Check with your plan or pharmacist in late 2025 to see whether any of your prescriptions are on the negotiated list.

Annual Cap on Prescription Drug Costs

In 2026, the most you will have to spend out of pocket on prescription drugs covered by Medicare Part D will be $2,100. Once you reach that amount, you won’t pay anything more for covered medications for the rest of the year.

Why This Matters

This cap on out-of-pocket costs for medications offers financial peace of mind for people with serious health conditions or expensive prescriptions. Many older adults will see significantly lower yearly drug costs compared with past years.

New Safety Net for Choosing a Medicare Advantage Plan

It’s not unusual for Medicare Advantage plan directories to list doctors or clinics incorrectly. To protect beneficiaries, Medicare is giving people who join a plan based on inaccurate provider directory information a special opportunity to switch plans.

How It Works

If you enroll in a Medicare Advantage plan and later discover that your doctor or hospital was incorrectly listed as in-network, you will have three months after your coverage begins to change plans.

Tip

When you choose a plan, take screenshots or print the provider information you relied on. That documentation may help you if you need to use the special extension period to switch plans.

Prior Authorization Pilot Program in Six States

Medicare is testing a new prior-authorization program in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. This pilot program will apply to certain services and equipment in traditional Medicare.

What This Means for You

If you live in one of the pilot states, you may need prior approval for certain procedures or medical equipment. The goal is to prevent unnecessary care, but some people worry it could lead to delays. If your doctor orders something that needs approval and it’s urgent, ask about expedited review options.

Option to Spread Drug Costs Throughout the Year

If your prescription costs usually pile up early in the year, you can ask your plan to spread your costs evenly over 12 months instead of paying large amounts at once. This, option, which has been in place as of 2025, is known as the Medicare Prescription Payment Plan. It seeks to help Medicare recipients enrolled in a prescription drug plan with budgeting and will continue in 2026.

For example, someone expecting to pay $2,400 in out-of-pocket prescription drug costs may opt into the plan and divide their total cost into payments of about $200 per month. To sign up for the payment plan, review your plan’s materials or call their customer service line to ensure this option is available and suitable for your situation. (Note that some plans will automatically reenroll you each year unless you opt out.)

What Older Adults Should Do

Here are some things older adults can do during the 2026 health care coverage enrollment period.

• Review your current list of medications and your current plan during open enrollment to make sure you’re getting the best prices.

• Ensure that your current health care provider and preferred pharmacy are still in-network, especially if you are enrolled in a Medicare Advantage plan. Keep documentation if you rely on Medicare’s plan directory when picking a plan.

• Ask your doctor’s office whether any of your services will require prior authorization in 2026, especially if you live in a pilot state.

• Consider using the monthly drug payment option if you expect high medication costs.

• Make sure your plan has your most up-to-date contact information on file. You don’t want to miss out on notices about network updates, renewals, or other changes to your plan.

In 2026, Medicare brings improvements for older adults, especially related to prescription drug affordability and protections for those enrolled in Medicare Advantage. Though the prior authorization pilot program may bring some extra steps for those in pilot states, the changes are aimed at making Medicare more reliable, transparent, and affordable.

Projected 2026 Costs (Subject to Final CMS Announcement)

Note that the Centers for Medicare & Medicaid Services (CMS) has not yet released the premium, co-pay, and deductible costs for Medicare in 2026. However, some of these costs are projected to increase, according to several sources. For example:

• The Medicare Part B monthly premium is projected to be $206.50 (up from $185 in 2025), and the annual deductible about $288 (versus $257 in 2025).

• The Medicare Part D plan deductible is expected to rise as well, to a maximum of about $615 (up from $595 in 2025).

Again, all official final figures have yet to be released by the CMS and are due to be confirmed later this year. Check back for updates.

Additional Reading

For additional reading on topics related to Medicare, check out the following articles:

• Medicare’s Extra Help Program for Prescription Drug Coverage

• Can People With Medicare Get Alcohol Counseling?

• Medicare Coverage Basics: What You Need to Know

• Can Oregon Launch a Universal Health Care System in the U.S.?

Medicare Open Enrollment Scams: How to Protect Yourself

Takeaways

• Medicare open enrollment periods are a target for scammers who use deceptive tactics to steal personal information or enroll beneficiaries in unauthorized plans.

• Protect yourself by being wary of unsolicited calls, emails, or visits, and by using official Medicare resources or trusted advisors for plan changes and information.

Medicare’s open enrollment period, which runs from October 15 through December 7, is the time for millions of Americans to review their health coverage, compare plans, and make changes for the upcoming year. A second open enrollment period for Medicare Advantage plans will follow from January 1 through March 31.

Unfortunately, these times also bring a surge in Medicare-related scams, as fraudsters exploit a confusing health insurance system and the flood of legitimate marketing to trick beneficiaries into giving up personal information or switching to fake plans.

How Scammers Target Medicare Recipients

During open enrollment periods, beneficiaries are bombarded with advertisements for Medicare Advantage plans and Part D prescription drug plans. This legitimate activity provides cover for scammers, who mimic real insurers and use deceptive tactics to steal personal data, commit identity theft, or enroll people in unauthorized plans. Common scams include:

• Unsolicited phone calls or robocalls: Scammers pose as Medicare representatives or licensed agents, offering “better coverage” or claiming your current plan is expiring. They often pressure you to share your Medicare number, Social Security number, or bank account information.

• Phishing emails and text messages: Fraudsters send messages that look official, often using Medicare logos or similar language. They may direct you to fake websites that collect your personal information.

• Door-to-door visits: Though some legitimate insurance agents do home visits, Medicare itself never sends representatives door-to-door. Scammers may use this tactic to obtain sensitive documents or signatures.

• High-pressure sales tactics: If someone insists you must “act now” or lose coverage, it’s a red flag. Legitimate agents are required by law to give you time to review your options and cannot enroll you without your consent.

• Fake enrollment forms or plan offers: Some scammers mail counterfeit materials that appear to be from Medicare or well-known insurance companies. These forms often ask for personal or financial information that can later be used for fraud.

What to Know About Plan Solicitations

Remember that Medicare will never call you unsolicited to sell a plan, ask for payment, or request personal information. You should also be wary of anyone claiming to be a “Medicare representative.” Though licensed insurance agents may contact you, they must follow strict rules, including getting your permission before calling and providing clear information about the plan they represent.

To make changes to your coverage or explore new options, the safest ways to do so are:

• Visit the official Medicare website at Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

• Contact your State Health Insurance Assistance Program (SHIP). SHIP counselors provide free, unbiased, and confidential help with Medicare choices. Find your local program at shiphelp.org.

• Work directly with your current plan provider using the phone number on your plan card.

How to Protect Yourself From Medicare Scams

You can minimize your risk of becoming a victim by following a few simple precautions:

• Guard your Medicare card and number like a credit card. Only share it with trusted health care providers or verified plan representatives.

• Hang up on unsolicited calls claiming to be from Medicare or an insurance company. Use the official number on your card to verify anything.

• Avoid clicking on links in emails or texts about Medicare plans. Go directly to the Medicare or insurer website instead.

• Do not feel pressured to make quick decisions. Take your time comparing plans and seeking trusted advice.

• Report suspected scams to Medicare at 1-800-MEDICARE or the Senior Medicare Patrol (SMP) in your state (smpresource.org).

Stay Informed, Stay Secure

Medicare’s open enrollment periods offer valuable opportunities to find better or more affordable coverage. But the same openness that benefits consumers can also be exploited by criminals. By staying vigilant, using trusted sources of information, and knowing how Medicare actually operates, you can make informed choices and avoid becoming a victim of fraud.

Additional Reading

For additional reading on topics related to Medicare, check out the following articles:

• Medicare Coverage Basics: What You Need to Know

• Entering and Leaving Medicare Advantage Plans

• Turning 65? What to Know About the 4 Parts of Medicare

• Medigap: Plugging the Holes in Medicare

How the Government Shutdown Could Affect Older Adults

Takeaways

• Many older adults rely on federal programs for income, health care, and support services, making them particularly vulnerable to disruptions caused by a government shutdown.

• While core benefits such as Social Security and Medicare payments are largely protected, administrative functions, customer service, new claims, and certain services (like some telehealth) may experience delays or reductions.

• A prolonged shutdown can lead to increased stress, significant backlogs, cash flow issues for health care providers, and potential long-term changes to certain programs.

• Older adults can mitigate risks by using online tools, planning ahead, documenting interactions, proactively communicating with providers, staying informed, and budgeting conservatively.

A federal government shutdown affects more than just the headlines; it creates deep uncertainty for many Americans. Perhaps no group of Americans feels the effects more than older adults, since many of them rely on federal programs for income and health care coverage. The effects of the federal government shutting down may not always seem direct or immediate, but the risks and disruptions are real.

Why Older Adults Are Especially Vulnerable

Older Americans tend to rely on federal programs for their primary income (Social Security, Supplemental Security Income), health coverage (Medicare, Medicaid), and support services (nutrition assistance, long-term care, home- and community-based services). That means even modest disruptions in government operations can ripple through their finances, access to care, and quality of life.

During a shutdown, programs funded through mandatory spending (essentially, those with existing, continuous funding) are more protected than those that rely on discretionary appropriations (annual budget allocations). But protected does not always mean unaffected. Administrative slowdowns, reduced staffing, delays in processing, and uncertainty are all possible, even in mandatory programs on which many older Americans rely.

Social Security and Supplemental Security Income Payments

Social Security and Supplemental Security Income (SSI) are considered mandatory spending, which means they don’t depend on yearly government funding bills. If you receive these benefits, your checks should continue arriving on schedule. Local Social Security Administration (SSA) offices will also remain open.

Because of staff reductions during the shutdown, some administrative and customer service functions might slow down or pause. The SSA may temporarily reduce or delay noncritical services like:

• Verifying benefits

• Making corrections to earnings records

• Handling and overpayment reviews

These delays can make it harder to get help with certain issues and may cause worry among seniors concerned about their payments.

In addition, the shutdown could delay the 2026 cost-of-living adjustment (COLA) announcement. COLA works like an annual raise that helps Social Security and SSI recipients keep up with the rising cost of things like food, gas, and housing. The COLA depends on inflation data from the U.S. Bureau of Labor Statistics, which has paused some operations during the shutdown.

This delay means seniors won’t know their exact benefit increase as early as usual, making it harder to plan their budgets for the coming year.

Though many SSA operations will continue, there could be delays for things such as new claims, appeals, and appeals hearings, especially if the shutdown continues for a long period. People already receiving benefits are mostly protected in the short term, but those applying for benefits, making corrections, or needing other administrative help might experience disruptions.

Medicare Coverage

Medicare is partially protected from the effects of the shutdown, but not entirely immune. If you’re enrolled in Medicare, you should still be able to see your doctor, go to the hospital, and fill prescriptions as usual. Your core Medicare coverage remains intact.

Medicare relies on Medicare Administrative Contractors (MACs). These are private companies that help the federal government run the program by processing claims and handling other key functions. Because this work is considered essential, many of their operations keep going during a shutdown.

However, the Centers for Medicare & Medicaid Services (CMS) has asked MACs to temporarily delay payments to providers for up to 10 business days. This short pause is designed to give Congress time to restore funding or pass a temporary spending bill, and to prevent the need for MACs to reprocess claims later. This delay affects payments to doctors and hospitals, not your coverage. You can still receive medical care, and you won’t receive a bill because of this delay.

Other essential functions and some oversight activities will continue, but could experience delays amid reduced staffing in certain areas.

Telehealth coverage may be more affected. Medicare’s pandemic-era telehealth waivers expired on September 30, just before the government shutdown began. Medicare will continue to cover some telehealth services, such as for mental health and substance use disorder treatment.

However, other types of visits may not be covered. Contact your health care provider to confirm which their telehealth services remain covered under your plan.

Some oversight and quality monitoring activities, such as complaint resolution or enforcement, may be paused, which could lead to delays in resolving problems. The shutdown also means Medicare won’t issue replacement Medicare cards. However, you can still print an official copy from your online Medicare account.

If you are turning 65 soon or enrolling during Medicare’s open enrollment period, you may face longer wait times and slower assistance. Start the process early and use online resources whenever possible.

Medicaid and Related State Programs

Medicaid is a bit more complicated because, while the federal government provides much of the funding, states run and manage the program. This means the shutdown can affect Medicaid differently depending on your state.

If you’re enrolled in Medicaid, your coverage for required services should continue without interruption because existing funding typically remains in place.

However, some states may experience slower processing of new applications or changes in eligibility, especially if they depend on federal systems, guidance, or staff that are affected by the shutdown. This could make it harder to get help with complex cases or to update your benefits quickly.

Other programs that depend on discretionary federal grants or contracts, such as aging services, meal services, or home- and community-based care, are at higher risk. If funding runs out, these state and local services may face cuts or pauses.

Veterans Affairs medical centers are generally considered essential services and will continue operating. However, nonurgent services, support programs, or new applications could face delays.

Possible Longer-Term or Secondary Effects

Even as many core benefits continue, a prolonged or repeated shutdown can deepen risks on multiple levels. These include:

• Uncertainty and stress. Seniors living on fixed incomes may worry about whether future benefits or services will continue, making budgeting and planning harder.

• Administrative backlogs that persist. Administrative delays can quickly accumulate. Once services resume fully, it may take months to catch up on appeals, corrections, and new claims.

• Effects on health care providers. Health care providers, home health agencies, and community service contractors may face cash flow issues if reimbursements are delayed, potentially forcing service reductions or closures, especially in rural or low-margin settings.

• Interdependence of programs. Some services depend on multiple governmental layers (federal, state, local). Disruption in one layer can cascade to other layers.

• Political changes. Repeated shutdowns or budget instability may spur reevaluation of program structures or cost controls, which could lead to future program changes affecting older adults.

What Older Adults Can Do to Mitigate Risk

Even though most essential programs, such as Social Security and Medicare, will continue during the shutdown, service disruptions and delays can still cause real stress. Here are some practical steps for those affected by the current government shutdown:

• Use online tools first. For Social Security, Medicare, or SSI matters that don’t require in-person visits, use secure online portals, such as mySocialSecurity, to avoid making a trip to an office that might be closed.

• Plan ahead as much as possible. If you are nearing a deadline for applying, enrolling, or changing an address (such as during Medicare open enrollment), try to start the process early, and expect longer wait times for things like processing new claims.

• Keep detailed documentation. Save records of claims, applications, denials, and correspondence. If delays occur, it helps to have evidence.
  You may also want to keep copies of your personal records, including your Medicare card or proof of benefits letters, on hand. This can be helpful to show proof of coverage during service slowdowns.

• Ask providers in advance. Do you have upcoming medical care or prescriptions you need to fill? Ask your doctors and pharmacies if the shutdown might affect scheduling, billing, or coverage. If you use virtual care, check with your provider to confirm whether the specific services you rely on are still covered.

• Stay informed. Follow official updates from agencies like the SSA and CMS, and trusted advocacy groups, for alerts about service changes or temporary policies.

• Budget conservatively. Monthly payments for core benefits should remain intact, so use cash reserves for noncovered costs and refrain from major spending decisions until benefits increases are confirmed.

During the government shutdown, administrative delays, reduced customer service, delayed data and announcements, and strain on provider networks all pose real risks, especially for those entering programs or needing more intensive assistance.

In a best-case scenario, the shutdown will be short and agencies will recover quickly. But if the shutdown lingers, the ripple effects could compound, making life harder for older Americans who are least able to absorb uncertainty or interruption. With thoughtful planning, you may be able to lessen some of the negative effects.

Additional Reading

For additional reading on topics related to government benefits for older adults, check out the following articles:

• Get Social Security Benefits by Check? Prepare for Change

• How to Apply for Social Security Retirement Benefits

• How Do You Qualify for Social Security Disability Benefits?

• Are Social Security Benefits Taxed?

• Medicare Coverage Basics: What You Need to Know

Emotional Wellness Among Older Adults in Long-Term Care

Takeaways

• Emotional wellness is critical, but often overlooked, for older adults in long-term care.

• Approaches that do not involve medications (e.g., gardening, reminiscence therapy, social activities, and technology) show promise in improving emotional well-being.

• Families can also play a vital role in supporting residents' emotional health through visits, advocacy, and promoting autonomy.

Mental and emotional health affect every stage of life — especially older adulthood. For millions of older Americans, especially those living in long-term care settings such as nursing homes, assisted living communities, or memory care facilities, emotional wellness is vitally important, yet often overlooked.

The Growing Challenge

Older adults in long-term care face notable emotional health challenges. According to data from 2022, depression affects more than 25 percent of residential care community recipients. A 2024 study found that up to 56 percent of residents in long-term care report loneliness.

These conditions often go unrecognized or untreated for reasons that can be complex. For one, many long-term care facilities don’t have systemic screening protocols for depression. Staff in these settings may also lack mental health training. Symptoms that could signal depression may be mistaken for “normal” aging.

The COVID-19 pandemic amplified these challenges. Many residents spent months isolated from loved ones and with communal activities restricted. Rebuilding connection and community has since become a central focus for many facilities.

What Can Help

A growing body of research points to approaches that support mental wellness without relying solely on medication. A recent study found that therapies such as gardening and exercise reduced depressive symptoms in long-term care residents.

Gardening in particular has proven effective. This may include having residents tend to small indoor plants, help maintain a garden, or simply spend time outdoors. Forms of therapy that encourage older adults to share life stories, photos, or music from their past, can also rekindle meaning and connection.

Social connections are also essential. Facilities that combine group-based and leisure activities delivered face-to-face may be especially effective at reducing loneliness. Activities such as group exercise classes or art projects may help residents reconnect with others and strengthen community bonds.

Emerging Innovative Approaches in U.S. Senior Communities

Across the country, long-term care providers are rethinking how to make emotional wellness a core part of daily life. Some facilities are piloting “small household” models, like the Green House Project. In these settings, about a dozen residents live together in a home-like environment with consistent staff, shared meals, and flexible daily routines. These models have been linked to higher satisfaction and lower depression rates compared with traditional institutional settings.

Health care settings are also using technology creatively. Virtual reality experiences, for example, let residents “travel” to destinations from their past or explore calming natural settings. Some facilities use robotic pets or sensor-based music therapy to soothe agitation in residents with dementia. While these tools are still emerging, early results suggest they can supplement, though not replace, human connection.

Other programs integrate emotional wellness directly into daily life through mindfulness workshops, stress management sessions, and peer support groups. Such initiatives reflect a growing understanding that mental wellness is not a luxury — it’s necessary for healthy aging.

The Family’s Role in Emotional Health

Families remain a cornerstone of emotional wellness for residents in long-term care. In the U.S., family caregivers for older adults rose from about 18 million in 2011 to over 24 million in 2022. Many continue to visit, advocate for, and emotionally support their loved ones even after a transition to residential care.

Regular visits, meaningful conversations, and shared activities have profound benefits. Bringing photo albums, familiar music, or mementos can spark memories and conversation. For some residents, a 10-minute chat about old times can lift spirits more effectively than any medication.

Families can also play an active advocacy role to help ensure that emotional wellness remains a care priority. They may ask facility staff how they monitor depression and loneliness or suggest therapies like gardening. Supporting a loved one’s sense of autonomy is also important. For example, older adults should be able to make choices about their daily routine, meals, or activities whenever possible.

At the same time, families must care for themselves. Caregiver stress and burnout are widespread. Support groups, counseling, and respite services can help family members maintain their own mental health while remaining engaged advocates.

Barriers and Opportunities

Despite progress, challenges remain. Many long-term care facilities still face staffing shortages, and caregivers often lack formal training in geriatric mental health. Other disparities also persist. For example, Black and Latino long-term residents often have less access to quality resources.

Addressing these issues may be possible through several strategies:

• Expanding routine mental health screening in long-term care facilities

• Increasing reimbursement for therapies that don’t involve medication

• Investing in staff education on how to recognize and respond to depression and loneliness

• Advocating for lawmakers to view emotional well-being as an important measure of quality in long-term care

The Path Forward

Emotional wellness in older adults is not just about preventing depression. It also involves helping them feel connected, valued, and alive. For long-term care residents, even small steps can make a significant difference. These might include a garden walk, a shared story, a visit from family, or a moment of laughter in a group activity.

As the U.S. population ages, emotional wellness must be seen as a central pillar of quality care. The goal is not simply to sustain life but to enrich it by ensuring that older Americans in long-term care have opportunities to feel purpose, joy, and belonging each day.

Additional Reading

For additional reading on topics related to emotional wellness, check out the following articles:

• Make New Friends and Keep the Old: It’s Good for Your Health

• The Loneliness Epidemic: Helping Seniors Stay Connected

• How Mental Health Apps Can Help Older Adults

Getting Help for a Parent With Memory Loss

Takeaways

• Seeking a timely diagnosis for memory loss or cognitive decline in an aging parent is crucial for early intervention and future planning.

• Despite potential challenges like the parent’s denial or fear, adult children can encourage seeking professional help through sensitive conversations and by utilizing at-home cognitive tests as a prompt for medical evaluation.

When an aging parent shows signs of memory loss, confusion, or cognitive decline, getting them to seek help can be a challenge. Delays in obtaining a diagnosis of dementia are common, with Sci Tech Daily reporting that it takes an average of three-and-a-half years between noticeable symptoms of cognitive decline and a diagnosis.

Yet obtaining timely diagnoses can be crucial. Accessing early interventions can lead to better outcomes. As Time reports, Alzheimer’s treatments implemented early are more effective.

When families know a loved one has dementia, they can prepare for decisions about long-term care and caregiving roles. The older adult may also still have time to execute a valid power of attorney nominating a trusted decision-maker.

While helping a parent with cognitive symptoms can be challenging, children of older adults with such symptoms can take steps to help their parents seek out a medical evaluation.

What Is Dementia?

Approximately one in 10 of adults 65 and older have dementia. Dementia describes a group of progressive illnesses that affect thinking and memory and involve damage to nerve cells or their connections in the brain.

The most prevalent cause of dementia is Alzheimer’s disease. The Alzheimer’s Association reports an estimated 7.2 million people in the United States live with Alzheimer’s. Other types of dementia include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia, which has multiple causes.

Sometimes, dementia-like symptoms are caused by an underlying medical condition. For instance, urinary tract infections can cause confusion, especially for older adults. Treating the underlying condition may help restore cognitive function.

Dementia Symptoms

According to the Mayo Clinic, symptoms of dementia, which may get worse over time, include:

• Noticeable memory loss

• Difficulty communicating or finding words

• Getting lost more easily

• Reasoning or problem-solving challenges

• Trouble planning and performing complex tasks

• Diminished coordination

• Confusion and disorientation

• Psychological changes like agitation, paranoia, anxiety, and depression

Many people mistake dementia symptoms for normal aging. However, memory problems and marked cognitive decline are not considered a normal part of aging and should be assessed by a medical professional.

Why Parents May Delay Getting Help

Convincing a parent to accept that they may need a medical evaluation can prove challenging. Parents may dismiss memory issues and cognitive challenges as a normal part of getting older. When an older adult experiencing early-stage dementia recognizes signs that something may be wrong — misplacing objects, forgetting names, repeating the same story — they may deny their symptoms because of fear of social stigma, loss of independence, or burdening family members. People with dementia that has progressed further may lack insight into their condition, not understanding that they need help.

Encouraging a Parent to Seek Help

Adult children of individuals who may be showing signs of dementia can encourage them to seek help. But there are several important considerations that can shape how the parent responds.

When a parent is in the early stages of cognitive decline and still able to recognize a problem and make decisions, one strategy is to plan a conversation with them. The Alzheimer’s Association recommends preparing for the conversation by noting what symptoms the individual seems to be experiencing and if anyone else has noticed a change.

The adult child may have the conversation or ask another trusted individual to do so. Because of family roles and expectations, some people may be more receptive to another older family member or friend than their child. Whether the adult child or someone else is stepping in, the conversation should be intimate. Staging a large intervention risks alienating and angering the parent.

The conversation should take place as soon as possible, but when the individual is comfortable, calm, and alert. During the conversation, the child or other trusted person can gently bring up the symptoms they have noticed and offer to go with them to the doctor for an evaluation. It may be necessary to have multiple conversations.

At-Home Cognitive Tests

For families navigating this complex situation, at-home cognitive tests can be a helpful starting point. While an at-home test cannot diagnose Alzheimer’s disease or another cause of dementia, a test may prompt a family to seek professional help for their loved one.

One popular test that helps family members assess whether their loved one might be experiencing dementia is the Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly. It includes 16 questions that aim to shed light on the loved one’s cognitive ability. The informant is asked to consider how their loved one’s cognitive abilities have changed compared with 10 years ago.

Another short cognitive assessment is a self-test: The Self-Administered Gerocognitive Exam (SAGE). Developed by Ohio State University, the SAGE test includes questions that capture different cognitive skills. It includes a question about how to draw a clock, which can illustrate problems with spatial awareness and memory.

Potential Downsides to Self-Tests

Since at-home cognitive tests are not diagnostic, they might also provide false reassurance. This is why it is best to seek medical advice from a doctor and obtain a referral for an evaluation by a neurologist or other professional. If you or a loved one chooses to use a self-test, it can be helpful to bring it with you to the appointment.

Ensure Your Elder Law Attorney Understands Medicaid Planning

Takeaways

• Working with an experienced elder law attorney who understands Medicaid is crucial for long-term care planning and applications.

• Red flags indicating an attorney’s inexperience include a lack of specific Medicaid knowledge, inadequate assessment of individual situations, and insufficient planning for asset protection.

• Unprofessional consultations and a lack of clarity regarding legal timings and processes can also signal an attorney’s inexperience in handling Medicaid cases effectively.

Navigating the Medicaid program can be daunting. You may be seeking help with long-term care planning for a senior family member or are ready to apply to Medicaid yourself. In either case, working with an experienced elder law attorney who understands the complexities of Medicaid is crucial.

Why You Need an Expert in Medicaid Planning

Nursing home care in the United States can cost more than $10,000 a month depending on where you live. Medicaid has become the default form of long-term care coverage for millions of aging Americans. However, an estimated $1 trillion in Medicaid cuts are likely in store over the next decade.

Meanwhile, many people mistakenly believe that Medicare, a different program, will cover the costs of long-term care. However, Medicare does not cover long-term custodial care. (Custodial care includes assistance with daily living activities such as getting dressed, eating, and moving from place to place safely, such as from a bed to the bathroom. It does not encompass medical treatment that requires a licensed nurse or doctor.)

Medicaid planning is a complex area of elder law that focuses on qualifying for Medicaid benefits without depleting one’s assets unnecessarily. To be eligible for the program, you must meet strict income and asset limits. In most states, you cannot receive Medicaid benefits if you have more than $2,000 in countable assets to your name.

In part, this is why Medicaid planning is so important. Planning involves reviewing all your assets, including bank accounts, retirement accounts, real estate, vehicles, and life insurance. A professional can help you with this and with distinguishing between your “countable” and “noncountable” assets. In addition, with the help of an expert, you can pursue legal strategies that allow you to spend down your assets so that you can qualify for the program.

5 Hidden Red Flags

Here are five red flags that may indicate an attorney’s inexperience with Medicaid planning.

1. Lack of Specific Medicaid Knowledge

Elder law is a specialized field, and not all attorneys have the expertise required to handle Medicaid cases effectively.

• Vague answers on Medicare coverage. If the attorney cannot clearly explain what Medicaid covers with regard to long-term care services, this may signal a lack of familiarity with elder law nuances.

• Ignorance about recent program changes. Medicaid policies can change frequently. An adept elder law attorney should be aware of and able to discuss the latest updates and their implications.

2. Inadequate Assessment of Individual Situations

Every Medicaid consultation requires a personalized approach, given that financial and health care needs vary widely among seniors.

• Generic advice. An elder law attorney lacking experience might offer broad, generalized advice instead of recommendations tailored to your individual circumstances.

• Failure to ask detailed questions. A seasoned attorney in this area of law will dig deep into the client’s financial well-being, health needs, and family circumstances to offer precise guidance.

3. Insufficient Planning for Asset Protection

Protecting assets while qualifying for Medicaid is a key aspect of elder law.

• No strategy for asset transfers. If an attorney cannot provide a clear plan for how to legally transfer or protect assets, this can indicate a lack of expertise.

• Ignoring look-back periods. An attorney experienced with Medicaid knows the importance of the Medicaid look-back period and should clearly explain how it affects eligibility.

4. Unprofessional Consultations

The manner in which consultations are conducted can reveal much about an attorney's professionalism and experience.

• A lack of documentation. An attorney’s failure to provide written summaries or detailed documentation post-consultation can be a red flag.

• Poor communication skills. An inability to communicate complex concepts in an accessible way may reflect inexperience or insufficient expertise.

5. Misunderstanding Legal Timings and Processes

Understanding the timelines and processes involved in Medicaid applications is crucial.

• Confusion about application timelines. If an attorney is unsure about when or how long it takes to file a Medicaid application, this can indicate inexperience.

• Inaccurate processing guidance. Misguidance about the steps involved can jeopardize the outcome of your application.

Additional Reading

Engaging with a skilled elder law attorney who is well-versed as a Medicaid planner is vital. Checking for these red flags can help ensure you or your loved ones receive knowledgeable and effective legal support.

Learn more about the various aspects of Medicaid as well as long-term care. Visit the Medicaid website to determine whether you are eligible and check out the following articles:

• Survey Shows Long-Term Care Costs Continue to Rise

• Medicaid’s Benefits for Assisted Living Facility Residents

• Pros and Cons of a Medicaid Asset Protection Trust

• Medicaid Applicants: Protecting Your Healthy Spouse in 2025

• What a Good Long-Term Care Insurance Policy Should Include

• Medicaid’s Coverage of Nursing Home Care