Medicaid – With A Community Spouse Annuity You Don’t Have to Wait Five Years

By Stanley M. Vasiliadis, Esq., CELA

Nursing homes in the Lehigh Valley cost $140,000 – $180,000 a year. Medicare and health insurance don’t pay for this. Fortunately, Medicaid does. But impoverishment is the price of admission into the Medicaid program.  While most spend themselves broke, a savvy few manage to qualify for Medicaid without forfeiting their estate.  One way to for a married person to do that is to use the couple’s excess at-risk assets to buy a Medicaid – compliant single premium immediate annuity, or “CS SPIA”. Annuity payments go to the Medicaid applicant’s “community” spouse.

Here’s how it works. Instead of a married couple spending down excess at-risk assets, the money is paid instead as a lump-sum premium to an insurance company. Beginning the following month, the insurance company makes monthly payments to the community spouse for a fixed term, perhaps two years. The payments, made in equal monthly installments, represent a return of principal together with some interest. They are almost completely tax-free. The institutionalized spouse seeking Medicaid qualifies for benefits the day after the CS SPIA is purchased! The assets that would have been paid to the nursing home are instead preserved for the community spouse.

How can this be, you ask?  Isn’t there a Medicaid penalty imposed in the form of a period of ineligibility for benefits? Not in this case, because assets transferred to or for the benefit of a Medicaid applicant’s spouse are not penalized. But what about all the annuity payments. Doesn’t all that money paid back to the community spouse preclude Medicaid? No, because although the assets of both spouses count, the income of a Medicaid recipient’s spouse can be unlimited. Medicaid treats the full annuity payment as income even though it is essentially a return of principal for income tax purposes. Finally, the recouped excess resources in the name of the community spouse don’t pose a problem because the community spouse’s assets are not counted as an available resource beginning the month after Medicaid eligibility.

Contact Vasiliadis Pappas Associates to learn more about your options and other measures to protect yourself.

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 STANLEY M. VASILIADIS is a Certified Elder Law Attorney as accredited by the Pennsylvania Supreme Court.  He is a long-time member of the National Academy of Elder Law Attorneys, charter member of the Academy of Special Needs Planners, and Past-President of the Pennsylvania Association of Elder Law Attorneys.  Vasiliadis successfully litigated the landmark elder law case, Mertz v. Houstoun, and has received numerous awards in his field, including the Excellence in Elder Law Award by the Pennsylvania Bar Association and recognition as a Pennsylvania Super Lawyer by Philadelphia Magazine every year since 2005.  He is Of Counsel with Vasiliadis Pappas Associates LLC, located in Bethlehem.  The firm serves clients in the fields of long-term care planning, trust & estate administration, estate & tax planning, asset protection planning, and special needs planning.