When families in Edmonds, WA and across the Greater Seattle Area begin thinking about long-term care, understanding the difference between Medicare and Medicaid is essential. Both programs offer support for medical care, but when it comes to covering the extended costs of a nursing home or assisted living facility, the distinctions are critical—especially for those in the Puget Sound region hoping to preserve assets while securing quality care.

At Washington Elder Law, we specialize in helping Washington seniors and their families plan ahead, ensuring that they qualify for benefits while safeguarding their financial legacy.

Medicare vs. Medicaid: What’s the Difference?

While both programs provide medical coverage, their structure and eligibility are quite different:

Medicare is a federal entitlement program. Anyone age 65 or older who qualifies for Social Security benefits is automatically eligible. It’s designed to help with general healthcare costs.
Medicaid is a means-tested public assistance program. It supports those with limited income and assets and is jointly administered by the federal government and the state of Washington.

Understanding the distinction between these programs is key for effective elder law planning.

Administration and Coverage in Washington

Medicare is managed entirely at the federal level, while Medicaid programs are coordinated between the federal government and individual states. In Washington State, Medicaid plays a vital role in helping seniors receive extended care services that Medicare simply doesn’t cover.

States that participate in Medicaid—like Washington—must meet federal requirements to receive matching funds, but they also have the flexibility to set their own income and asset eligibility rules. That’s why working with a local elder law attorney who understands the intricacies of Washington’s Medicaid guidelines is so important.

What About Long-Term Care?

Here’s where the difference becomes more pronounced for families in the Puget Sound area.

Medicare offers very limited long-term care coverage. It only pays for up to 100 days in a skilled nursing facility and only after a hospital stay of at least three days. Plus, a daily copayment kicks in after day 20—currently set at over $167 per day.
Because of the restrictive rules and high copays, very few people in Edmonds or Seattle receive Medicare coverage for the full 100 days.
Medicaid, on the other hand, does cover long-term nursing home care for individuals who meet the financial eligibility criteria. Whether it’s for a few months or many years, Medicaid will continue to provide coverage as long as you qualify. Not surprisingly, it has become the largest single payer of nursing home care in the U.S.

Do You Qualify for Medicaid in Washington?

If your income and assets fall below Washington’s Medicaid thresholds, you may already qualify. However, if you exceed those limits, early and careful planning becomes crucial. You cannot simply transfer your assets weeks before needing care; Medicaid enforces a strict five-year look-back period, and improper transfers during that time can result in penalties and delays.

This is where Brian G. Isaacson and our team at Washington Elder Law can help. As experienced elder law attorneys serving Edmonds and the Greater Seattle Area, we guide families through legal strategies that make them Medicaid-eligible while protecting what matters most.

The Bottom Line for Families in the Greater Seattle Area

Medicare may cover short-term rehabilitation after a hospital stay, but for most long-term care needs—such as permanent residence in a nursing facility—Medicaid is the only realistic option. With the cost of care skyrocketing in the Puget Sound region, proper planning can make all the difference.

Whether you’re planning for your own future or helping an aging parent, don’t wait until a crisis hits. Contact Washington Elder Law today to schedule a consultation. We’re here to help you plan, protect, and provide for generations to come.

As seniors in Edmonds, WA, and across Washington State face increasing healthcare needs, the cost of in-home care and nursing facilities continues to climb. Fortunately, Medicaid provides a crucial safety net for many aging residents in the Puget Sound region, helping cover services like skilled nursing, hospital stays, and long-term care.

At Washington Elder Law, we specialize in helping seniors qualify for Medicaid without sacrificing their hard-earned assets. One key tool we often recommend is a Medicaid spend-down strategy—a way to meet Medicaid’s eligibility thresholds without simply losing your wealth to the cost of care.

What Is a Medicaid Spend-Down?

Many people mistakenly believe they must be completely impoverished to qualify for Medicaid. But the truth is, strategic spend-downs allow you to convert countable assets into exempt ones, preserving value for your future and your family.

Rather than giving everything to a nursing home, spend-downs help you redirect your assets in meaningful ways—while ensuring you remain eligible for care when you need it most.

Strategic Ways to Spend Down in the Puget Sound Region

Here are some of the most effective strategies we use with clients throughout Edmonds, Seattle, and the Greater Seattle Area:

1. Pay Off Debt

Paying off a mortgage, personal loan, or credit card can reduce your countable assets while improving your overall financial standing. This also eases the burden on your family later on.

2. Purchase or Upgrade a Vehicle

In Washington State, Medicaid allows one vehicle to be exempt. If you have an older car, upgrading to a newer, safer vehicle is a smart use of resources that converts cash into an exempt asset.

3. Pay Income Taxes

Yes, even paying your taxes can serve as a Medicaid strategy. Settling your tax obligations reduces your income and can help meet eligibility criteria.

4. Invest in Home Improvements

Your home is often considered an exempt asset under Medicaid rules, and enhancing it through updates—such as safety features, accessibility ramps, or energy-efficient upgrades—not only improves your quality of life but also lowers countable assets.

5. Prepay Funeral Expenses

Planning ahead for funeral expenses is both emotionally responsible and financially strategic. In Washington State, you can prepay for your own services and those of your spouse or immediate family members. These funds become exempt assets under Medicaid.

🧠 Planning Tip: These strategies must be implemented carefully to avoid violating Medicaid’s five-year look-back rule. That’s why working with a knowledgeable elder law attorney is essential.

Helping Washington Families Preserve Their Legacy

At Washington Elder Law, we help families in Edmonds and the Puget Sound area navigate Medicaid eligibility with customized planning strategies. Spend-downs aren’t about losing everything—they’re about smart planning, legal compliance, and preserving what matters most.

By paying off debt, upgrading assets, prepaying key expenses, or investing in your home, you can reduce your countable assets without compromising your financial future.📞 Ready to explore how Medicaid planning can work for your family?Contact Washington Elder Law today to schedule a consultation. We’re here to help you protect your legacy while securing the care you need.

Many people are surprised to learn that their Social Security benefits can be subject to federal taxation. Whether your benefits are taxed depends on what is known as your “provisional income.” This is your adjusted gross income (not counting Social Security benefits) plus nontaxable interest and half of your Social Security benefits.

For people filing as individuals or heads of households with provisional incomes of less than $25,000, Social Security benefits are not taxed. For couples filing joint returns, the figure is $32,000. Unfortunately, individuals with provisional income of between $25,000 and $34,000, or couples filing jointly with provisional income of between $32,000 and $44,000, up to 50% of Social Security benefits may be taxable. In the case of individual filers with provisional incomes above $34,000 or joint filers whose provisional incomes exceed $44,000, up to 85% of Social Security benefits may be subject to taxation.

The information above concerns federal taxes. 13 states levy their own taxes on Social Security income, although they do so in varying degrees. These states are Colorado, Connecticut, Kansas, Minnesota, Missouri, Montana, Nebraska, New Mexico, Rhode Island, North Dakota, Vermont, Utah, and West Virginia. (Taxation of Social Security benefits is being phased out in West Virginia. Most residents won’t be taxed on their benefits as of the 2021 tax year.)

An article on kiplinger.com offers some strategies to avoid, or at least mitigate, taxes on Social Security benefits.

Withdraw money from your tax-free Roth IRAs

Tax-free withdrawals from a Roth IRA or Roth 401(k) are not included in your adjusted gross income. Rolling over money from your traditional IRA or 401(k) to a Roth IRA years before you start receiving Social Security benefits is an excellent way to avoid taxes later in retirement. Of course, you will have to pay income taxes when you make the conversion, but you can tap the account tax-free after that.

Purchase a Qualified Longevity Annuity Contract

You can invest up to $130,000 from your IRA or 401(k) in a deferred-income annuity called a Qualified Longevity Annuity Contract (QLAC). The money in your QLAC is ignored when figuring your required minimum distribution, so you can reduce the size of your distribution, lower your income and cut your tax bill.

Give your required minimum distribution to charity

If you are 70½ or older, you can give up to $100,000 per year to charity from your IRAs tax-free.

Your gift counts as the required minimum distribution but is not included in your adjusted gross

income.

Be careful with income investments

You can structure your portfolio to minimize the income it generates. This approach makes particular sense if your portfolio’s income is being reinvested.

Save money, use financial strategies, and get help from Washington Elder Law.

Your best option is attending two helpful workshops provided by the Edmonds Elder Law team, at Washington Elder Law. The workshops are online, and they are free. Advice is offered for seniors and their families. We answer your questions about how to refrain from paying taxes on your income. Find out how you can avoid the Washington State long-term care tax.

We tell you how to access the funds provided by the state of Washington. We prepare the documents you require to receive benefits. Then, we follow through with the documents to make sure your information is complete.

Benefits available in King County are over $9,000 a month if you know how to access them. We can access these benefits for most people. Find out how you can maximize your money and pass it down.

We teach families how to access Medicaid benefits to pay for medical and long-term care costs while preserving their wealth.

Washington Elder Law workshops include:

Medicaid – Medicaid planning helps pay for long-term care. It is a federally funded health insurance program based on income. Even if you make more than the exceeded amount, you still may qualify. We can help you understand possible exceptions and discover the aid you require.

Estate Planning – You want to protect the legacy that goes to your family. Without proper estate planning, money is often collected and distributed to the government. We teach you how to maximize the money you have. We make sure you have Power of Attorney to avoid losing control of guardianships. You’ll learn how to protect your assets from the government. We will even show you how to receive a higher quality of long-term care. All of these very important financial choices are available to you. Attend our free workshops to find out more.

Thanks to improvements in medical science and healthier lifestyles, Americans are living longer than ever before. Unfortunately, many of us will require long-term care at some point in our lives, and one in five of us will require long-term care for at least five years.

According to Genworth Financial, the median cost of long-term care nationwide ranged from $51,480 to $102,200 per year in 2019, depending on the type of care needed. (Care costs also vary widely based on where you live. To see the cost of care in your area, visit https://www.genworth.com/about-us/industry-expertise/cost-of-care.html.)

A current study reports that King County residents pay over $10,000 a month in long-term care expenses. 98% of the population are concerned about running out of money when a family member needs extending medical care or services.

Long-Term Care (LTC) Costs

Stay home ($500 – $18,000/month)
Assisted living ($2,500 – $5,500/month)
Nursing Home ($9000 – $14,000/month)

The median cost of in-home care provided by a home health aide was more than $52,000 in 2019, while care in a nursing home can easily top $100,000 per year. Worse, experts predict that the cost of nursing home care will more than double over the next twenty years. Tragically, many families exhaust their life savings within a few years of a family member entering a nursing home.

Ready for some good news? Through proper planning, you can protect your hard-earned assets against the cost of long-term care. You can also receive assistance from Medicaid and other sources to cover the cost of your care, even if you or a loved one is already in a nursing home.

Long Term Care Planning Options

Long-term care insurance

Many families consider purchasing long-term care insurance in advance to help pay for long-term care in the future. However, this type of insurance can be expensive. Typically, the younger you are when you apply for coverage, the cheaper your policy. Of course, the benefits of the lower premium must be factored against the amount of time a younger person will likely continue to pay premiums without requiring long-term care. Similarly, you can reduce the cost of your policy by choosing a longer waiting period. But a longer waiting period means you’ll need to pay the bills yourself before you receive any benefits. Most people interested in purchasing long-term care insurance should consider a 60-day or 90-day waiting period, which keeps premiums manageable but limits out-of-pocket costs. It is important to note that if you wait too long to apply for coverage or until you have developed medical problems, you may not be able to qualify for a policy at all.

Reverse mortgages

A reverse mortgage is a special type of home equity loan that allows you to receive cash against the value of your home without selling it. You can choose to receive a lump-sum payment, a monthly payment, or a line of credit. In the case of monthly payments, as long as you spend the payments you receive in the month that you receive them, the money is not taxable and does not count towards income or affect Social Security or Medicare benefits, nor does it count as income with respect to Medicaid eligibility. There are no restrictions on how you use the money, and you can continue to live in the home while retaining title and ownership of it. The amount of the loan does not become due until the last borrower, usually the last remaining spouse, dies, sells, or permanently moves out of the home. If your heirs want to keep the home, they can repay the reverse mortgage. They can also keep the difference if the home’s sale price is greater than the reverse mortgage loan balance when they repay the loan.

Life insurance

Some insurance companies have begun to offer life insurance policies that can help pay for long-term care services. The options include combination life/long-term care products, accelerated death benefits, life settlements, and viatical settlements. Combination products are relatively new, and the features change constantly as the products evolve.

Annuities

You may choose to enter into an annuity contract with an insurance company to help pay for long-term care services. In exchange for a single payment or a series of payments, the insurance company will send you an annuity, which is a series of regular payments over a specified and defined period of time. There are two types of annuities, Immediate Annuities and Deferred Long-term Care Annuities.

You can learn more about long-term care insurance, reverse mortgages, life insurance, and annuities by visiting the government’s long-term care website, http://longtermcare.gov. If you are thinking about using one or more of these options, please contact us first. They may not be the best approach in your particular situation.

Obtaining Assistance from Medicaid

It is estimated that in the United States 60 percent of nursing home residents rely on Medicaid to finance their nursing home care. Even so, many families do not try to obtain such assistance because they believe they have too many assets or too much income to qualify. Others simply give assets away in the hope of becoming eligible. While you are certainly free to give away anything you want, doing so improperly can make you ineligible to receive Medicaid assistance for months, even years.

Fortunately, it is possible to protect your assets and receive the assistance you need with proper planning. We can use a wide range of tools and strategies to structure your estate in such a way that you will meet the government’s asset and income requirements. These tools and strategies include exemption planning, strategic gifting, irrevocable trust development, and more.

What If You Are Already in a Nursing Home?

Perhaps you or a loved one is already in a nursing home or must enter one very soon, and you have been told that you own too many assets to qualify for assistance from Medicaid. Do not give up. This situation, known as a Medicaid crisis, is more common than you might think. The information provided to you by friends, nursing home intake staff, and even social workers may very well be outdated or simply inaccurate. You are not alone during this difficult time. We may still be able to protect your assets for yourself, your spouse, and your heirs while at the same time obtaining assistance from Medicaid to pay for your nursing home care.

Washington Elder Law helps you manage the high cost of long-term care.

Benefits available in King County are over $9,000 a month if you know how to access them. We can access these benefits for most people. Find out how you can maximize your money and pass it down.

We show you how to protect your money with two online workshops. The workshops are free, and best of all, you learn from home.

Our workshops include:

Medicaid

Medicaid planning helps pay for long-term care. Learn how to access your benefits.

Teach you some easy Medicaid definitions
Help you learn about coverage and eligibility
Let you know the advantages of a Medicaid Trust
Offer ways to get help with your application
Let you know what Washington Elder Law offers

Estate Planning

You want to protect the legacy that goes to your family. Without proper estate planning, money is collected and distributed to the government. We teach you how to maximize the money you have. We make sure you have Power of Attorney to avoid losing control of guardianships. Learn how to protect your assets from the government.

Add significant value to financial benefits by talking about it early
Avoid losing control of guardianships by creating a Power of Attorney
Understand how trusts simplify the administration of your estate
Access higher quality long term care
Maximize money for yourself and your family
Avoid probate
Protect your assets from the government

For more information and to register for workshops:

Medicaid Workshop

Estate Planning Workshop

Lynnwood/Edmonds Elder Law resources for Estate Planning, Long Term Care Planning, and Trusts.

When we hear the word legacy, many of us think of money left to people and institutions that have come to mean the most to us throughout our lives. But your legacy is much more than that. It includes your memories, values, wisdom, family history, and more that do not necessarily have a monetary value. How can you pass those on to future generations?

You could begin by writing down or making a recording of yourself sharing stories about your parents, grandparents, and other relatives. Don’t just talk about where they lived and what they did for a living. Try to convey a sense of who your family members were, what was important to them in life, and the values they held dear.

You’ll want to take a similar approach in telling your own story. Describe why you made certain decisions, what you learned from mistakes, how you achieved success, and what you would do differently if you could. It’s been said that a picture is worth a thousand words, so be sure to preserve photos that depict your history and that of other family members. You might even want to create a website featuring your stories and photos and invite family members to contribute to it.

Now let’s consider items that may not be worth much money but have a great deal of sentimental value: an old watch owned by your uncle, for instance, or the rocking chair that your mother used for many years. You’d be surprised at how many family disputes arise over items like these. If one of your children has shown interest in such an object, you could specify in your will that he or she receives it when you pass away. Regarding sentimental objects that have not been “claimed” by your children, consider using an estate planning letter to designate the person you would like to inherit it and why.

What about your values, is there a way to increase the likelihood that these will be passed on as well? One approach is to use an estate planning tool, such as an Incentive Trust, to encourage certain behaviors while discouraging others. For example, your trust could reward your children for graduating from college, entering a certain profession, purchasing a home, or doing charitable work.

In the end, you may be surprised by how much your values, wisdom, and family history—the nonmaterial aspects of your legacy—mean to the people you love and future generations.

Call Washington Elder Law for more information about securing your legacy and providing your family with peace of mind.

Washington Elder Law is a caring and trustworthy team of Lynnwood/Edmonds Elder Law professionals who offer the tools to easily and understandably guide you through estate planning. The team is motivated to educate and give clients the tools needed to make the best choices to positively impact their future finances.

We teach you how to build a positive legacy for your loved ones in our Free Estate Planning Workshops. We also include a Free Medicaid workshop to help you claim the benefits that you can use to plan your future financial goals. Registration information is available below.

After a completed workshop, vision meetings are available to you. Ask how you can prepare for your vision meeting.

Workshop Benefits:

OUR GOAL:

– Identify if your current plan meets your goals.

– Understand what it takes to protect you and your stuff.

– Show you how to get what’s missing.

-Let you know what Washington Elder Law offers.

Included Estate Planning information

Add significant value to financial benefits by talking about it early
Avoid losing control of guardianships by creating a Power of Attorney
Understand how trusts simplify the administration of your estate
Access higher quality long term care
Maximize money for yourself and your family
Avoid probate
Protect your assets from the government

Strong solutions to financial issues.
A structured family committee that keeps members informed
Access to benefits
We prepare and provide the proper documentation to secure your benefits.

We always follow through with your application for your benefits.

For more information see:

Join an Estate Planning Online Workshop scheduled every Tuesday at noon.

Join a MEDICAID Online Workshop every Wednesday at noon.

One of the most heartfelt problems Covid-19 has caused is separation from family members. Unfortunately, the elderly have felt the strain of being on quarantine more than anyone. Seniors, cut off from the care of family, friends, and daily resources, are dealing with extended isolation.

The problem with leaving seniors alone is that they have routines and regimens to keep them healthy. Loneliness and psychological effects can be harmful.

“As the pandemic continues, it will be critical to pay attention to how well we as a society support the social and emotional needs of older adults.” -John Piette, Ph.D., University of Michigan’s Institute of Healthcare Policy & Innovation.

An article from the scientific research journal PLOS ONE states, “Amongst the most robust consensus related to the COVID-19 disease is that the elderly are by far the most vulnerable population group.” The journal also describes that the social distancing recommendations for the elderly were hard because people must leave their homes to stay happy and active.

People in assisted living communities struggled deeply with not seeing and spending time with their families. However, strict policies enforced keep seniors safe and alive. The CDC Guidance for Older Adults reports that 78% of Covid deaths in May-Aug 2020 were seniors 65 and older.

You can ease the burden for yourself and your elderly family members with a few simple steps and a whole lot of love.

Here are a few tips to show you care for your elderly family members during quarantine:

1.) Be sure to make frequent contact with your loved ones if they are alone or in an assisted living facility. It makes them feel so much better, and you will also experience relief. We recommend these ideas and remedies that will help someone feel better fast.

If you absolutely can not visit with a loved one, have a staff member set up a Zoom meeting between yourself and your family member.
Care packages are a great way to lift a person’s spirits if alone or without family.
Send flowers, puzzles, books, games, cards, and anything to let them know you are thinking about them. It also keeps their minds engaged.
Window visits have become very popular and guarantee a smile.
Make a movie of yourself and your family and send it to them.

2.) Be sure wills, estate planning, healthcare plans, and power of attorney are intact. Estate planning for yourself or a loved one is the best way to avoid stress when approaching financial matters that revolve around illness or death.

Washington Elder Law provides an easy 3 step process that will teach you about wills, trusts, power of attorney, healthcare directives, and beneficiary designations.
You can call anytime if you have any questions regarding estate planning, Medicaid, or tax law. (206) 448- 1011

3.) You and your favorite senior are welcome to join us for our FREE webinars! We have three classes that you can watch at home or anywhere that has Internet access. Classes include:

Washington Elder Law strives to be the very best team of Medicaid planning & tax professionals. We are dedicated to providing peace of mind for our clients. Call for more information. (206) 448-1011 or 📧email: info@washingtonelderlaw.net

Retirees have been hearing a steady drumbeat of warnings about the threat of high long-term health care expenses. Many articles about long-term care discuss strategies from the perspective of retirees who eventually might need care near the end of their lives. These articles encourage retirees to take responsible steps to pay and arrange for care, so they won’t be a burden on their families or society.

And indeed, that’s a necessary and noble goal.

Turn the issue on its head, however, and consider the caregiver’s perspective: You could be doing everything right regarding your own finances — and then have your plans derailed by the needs of a family member, such as a parent or sibling, who didn’t plan ahead.

A recent study by the Transamerica Institute found that care-giving is risky business for those who step in to help an aging parent or relative. Here are some telling statistics from the study about the potential strains on caregivers:

Fifty-two percent are working full or part time. Of these working caregivers, more than three-fourths report making some type of an adjustment to their employment — using sick time or vacation days, working fewer hours or quitting their jobs or retiring. More than one-fourth of working caregivers’ employers have reacted negatively to the workers’ caregiving responsibilities.
Caregivers spend a median of $150 per month to cover expenses for the recipient. Almost half of all caregivers (43 percent) say they’re “just getting by” with their finances.
More than half (56 percent) say their own health is taking a back seat to the health of their recipient.

Caregivers also report being unprepared for their roles. Almost half (49 percent) of caregivers perform medical- or nursing-related tasks, but only about half of these caregivers learned how to carry out these tasks from hospital or doctor staff.

“Many caregivers are in need of formal training to perform their caregiving duties, especially those involved in medical- or nursing-related tasks,” said Hector De La Torre, executive director of Transamerica Center for Health Studies. “Without adequate training, they are putting both the care recipient and themselves in harm’s way.”

A recent study by Merrill Lynch and Age Wave confirms the challenges caregivers face, finding that 20 million Americans became unpaid caregivers during 2016. Of them, 30 percent cut back on their living expenses, 24 percent had trouble paying their bills, 21 percent dipped into their savings and 18 percent couldn’t contribute to other expenses or savings.

As if these strains aren’t enough, two recent lawsuits show that responsibility for paying for long-term care can spread beyond the individuals who need care or their spouses. One ruling determined that a man was responsible to pay for his mother’s outstanding debt to a nursing home. Another ruled that all siblings could be responsible to pay for a parent’s care.

And speaking of costs, Genworth recently released its “2017 Annual Cost of Care Survey,” which shows that long-term care costs continue to rise. The survey reports the following median nationwide rates:

Home health aide services: $21.50/hour
Homemaker services: $21/hour
Adult day health care services: $70/day
Assisted living facilities: $3,750/month
Semi-private room nursing home care: $7,148/month
Private room nursing home care: $8,121/month

While all of this might seem depressing, that’s no reason to ignore your better judgement and not plan ahead. As you’re preparing for retirement, you’ll want to incorporate strategies to cover the cost of long-term care for yourself and spouse, if you’re married. This can include buying long-term care insurance and setting aside assets or holding home equity in reserve to pay for care.

In addition, noted Cynthia Hutchins, director of Financial Gerontology for Merrill Lynch Wealth Management, “Make sure to review and update relevant legal documents, including a will, an advance medical directive, a durable power of attorney (which designates someone to make legal and financial decisions) and a health care proxy (transferring legal authority for medical decisions).”

If you’re a potential caregiver, you’ll want to factor the financial stresses into your own retirement planning. You’ll also want to learn about all the resources available should you need help. For example, your local Area Agency on Aging or senior citizen center can help you navigate the various community and government resources.

For most people, taking care of older relatives and friends is simply the right thing to do, regardless of the serious challenges. The Merrill Lynch/Age Wave survey provides confirmation: 65 percent of caregivers say it has brought meaning and purpose into their life, and 77 percent say they would gladly take on being a caregiver again. An overwhelming number — more than 90 percent — said they were grateful to provide care.

@2017 Steve Vernon

Source: https://www.cbsnews.com/news/long-term-health-care-costs-retirees-caregivers/