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5 Steps to Combine Medicare and Medicaid for Long-Term Care

For most families, the moment Medicare and Medicaid have to work together is the moment everything is already on fire.

The trigger is usually the same. A hospital stay. A skilled nursing admission. A discharge planner saying “the family will need to start covering long-term care costs” sometime in the next four weeks. Suddenly the abstract conversation about Medicaid eligibility is concrete, the timer is running, and the family is trying to learn an application process that rewards five-year planning while operating on a four-week deadline.

This post is the version that turns that scramble into a sequence. Five practical steps to coordinate Medicare and Medicaid for a parent who needs long-term care, with the timing, documentation, and decision points each step requires. Use it as a checklist — pace yourself through it — and pull in expert help where it pays off.

If you haven’t already, the foundational reads:

[Read more…] about 5 Steps to Combine Medicare and Medicaid for Long-Term Care

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Preventing Family Feuds Over Power of Attorney

The fights I’ve watched between adult siblings rarely start with the will. They start with the Power of Attorney.

The POA is the document that grants one person the legal authority to act on a parent’s behalf — to write checks, sign contracts, make medical decisions, sell assets — when the parent can no longer act on their own. Whoever holds it has effectively been handed the steering wheel. And in a family where the parent has cognitive decline or serious illness, the steering wheel matters in a way the will doesn’t yet.

A sibling who feels excluded from the POA decision — “why was Sister chosen and I wasn’t?” — often doesn’t wait for the parent to die before the resentment surfaces. The conflict starts when the POA gets exercised. When Mom’s accounts get consolidated and Brother wasn’t told. When the family home gets put on the market and not everybody agrees. When medical decisions get made and one sibling thinks they should have had a say.

This post is about preventing that. What a Power of Attorney actually is. The two kinds (financial and healthcare) and how they typically get assigned. Why POAs become flashpoints, and the structural choices that keep them from becoming family feuds. And what to do if you’re already inside one.

If you haven’t read it, the foundational read: Estate Planning Checklist for Adult Children. [Read more…] about Preventing Family Feuds Over Power of Attorney

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How to Check If Your Parent Qualifies for Dual Eligibility

Most adult children only learn about dual eligibility after their parent has already paid for years of things they didn’t have to.

Medicare Savings Programs — the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs that pay Medicare premiums and cost-sharing for low-income beneficiaries — sit in a quiet corner of the system that few families notice until someone tells them about it. A parent on a modest fixed income may have been paying $185/month in Part B premiums for three years that the state would have paid on their behalf, if anyone had bothered to apply.

This post is the screening guide. Five quick questions to figure out whether your parent might qualify, the income and asset benchmarks that drive the answer, and the three calls that turn a hunch into an application. It takes about ten minutes.

If you haven’t already, the foundational read: Medicare vs Medicaid: Understanding Dual Eligibility. [Read more…] about How to Check If Your Parent Qualifies for Dual Eligibility

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Medicaid Updates: How Recent Changes Are Impacting Family Caregivers

Medicaid changes faster than most adult children realize. Federal rules shift, state programs expand or contract, eligibility thresholds adjust with cost-of-living updates, and entirely new programs sometimes appear in response to federal incentives or state-level reforms. The version of Medicaid that existed when your parent first got involved with the program is not the version of Medicaid in force today.

For families navigating long-term care, dual eligibility, or family-caregiver compensation programs, these changes can mean meaningful differences in what’s covered and what isn’t, who qualifies and who doesn’t. The mistake adult children make most often is treating their understanding of Medicaid as fixed. It isn’t.

This post is a working summary of the recent and ongoing Medicaid changes that affect family caregivers most. It will be updated periodically — what’s accurate today may have shifted in six months. For the foundational understanding, start with Medicare vs Medicaid: Understanding Dual Eligibility and 5 Steps to Combine Medicare and Medicaid for Long-Term Care.

What’s been changing.

Five areas of Medicaid policy that have seen meaningful change recently:

1. Home and Community Based Services (HCBS) expansion. HCBS waivers — the Medicaid programs that pay for in-home care, personal aides, adult day services, and other community-based supports as alternatives to nursing home placement — have been expanding in many states. Federal funding under the American Rescue Plan and ongoing initiatives has incentivized states to grow HCBS capacity, reduce waitlists, and extend eligibility. The pace varies; some states have made dramatic progress, others have moved more slowly.

For families: if your parent needs long-term care but wants to stay at home, HCBS is increasingly viable in many states. If your last understanding of HCBS waitlists in your state was more than two years ago, revisit it — capacity may have grown.

2. Family caregiver compensation programs. A growing number of states allow Medicaid to pay family members directly for caregiving, under specific programs and conditions. The structures vary — some states have “Cash and Counseling” or “Self-Directed Personal Assistance” options under Medicaid HCBS, some have separate programs (the federally established “Structured Family Caregiving” model is one example), some have state-specific innovations.

For families: if you’re providing substantial unpaid caregiving for a Medicaid-eligible parent, check whether your state has a family caregiver compensation pathway. Eligibility and rates vary widely. The Area Agency on Aging (AAA) is the right starting point.

3. Medicaid eligibility threshold updates. Income and asset limits for Medicaid programs adjust periodically — usually annually — with federal poverty level (FPL) updates. The Medicare Savings Programs (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualifying Individual) all use FPL-based thresholds that shift each year. Long-term care Medicaid limits also adjust, usually less dramatically.

For families: if your parent was previously not quite eligible for a Medicaid program, the thresholds may have moved. Re-screen annually, especially around the federal poverty level update each year. See How to Check If Your Parent Qualifies for Dual Eligibility.

4. Spousal protection updates. When one spouse needs long-term care Medicaid and the other doesn’t, the “community spouse” rules — the Community Spouse Resource Allowance (CSRA) and Minimum Monthly Maintenance Needs Allowance (MMMNA) — protect a portion of assets and income for the spouse remaining at home. Both figures adjust annually within federal floors and ceilings, and some states have moved more aggressively to protect community spouses.

For families: if your parents are married and one is approaching long-term care, the spousal-protection math may have changed since the last time the family looked at it. An elder law attorney can advise on current numbers and strategy.

5. Estate recovery program activity. After a Medicaid recipient dies, federal law requires states to attempt to recover Medicaid long-term care costs from the estate. The aggressiveness of recovery, the assets subject to recovery, and the protections available vary by state — and some states have recently moved to limit estate recovery while others have expanded it.

For families: estate recovery is real and can claim the family home after a Medicaid recipient’s death. The timing of asset planning matters enormously. An elder law attorney can structure home ownership and other assets to mitigate estate recovery risk where allowed by state law.

What hasn’t changed (and probably won’t soon).

Some Medicaid fundamentals have been stable and are likely to remain so:

  • The 5-year (60-month) look-back period on asset transfers for long-term care Medicaid is federal and longstanding. Don’t expect this to change.
  • The basic structure of dual eligibility — Medicare for medical, Medicaid for long-term care — remains the architecture.
  • State-by-state variation in Medicaid programs is part of the program’s design. There is no near-term federal initiative to standardize Medicaid across states.

These are the parts of Medicaid you can plan around with reasonable confidence. The parts above are the parts you need to revisit periodically.

What might change.

Several areas of policy debate that could affect family caregivers in the medium term:

  • Federal Medicaid funding reform. Periodic policy debates about block-granting Medicaid, per-capita caps, or work requirements have surfaced over the past decade. Each would change state flexibility and program scope. Whether and when any of these become law is genuinely uncertain.
  • Long-term care financing reform. Several federal proposals have aimed to address the broader long-term care financing gap that Medicaid currently absorbs. A federal long-term care insurance program has been proposed multiple times and has not yet passed; whether and when one might is uncertain.
  • State-level expansions of family caregiver compensation. This is where more change is likely in the near term. More states are exploring or implementing family caregiver compensation pathways.
  • HCBS waiver structure. Federal incentives may continue to push HCBS expansion; state response varies.

For adult children, the practical implication: the program your family relies on now may look different in five years. Don’t lock in long-term assumptions on policy that’s actively shifting.

The annual review every adult-child caregiver should do.

If your parent is on Medicaid or might qualify for Medicaid:

  1. Review Medicaid Savings Program eligibility annually in early January (when FPL updates take effect). New thresholds may now include your parent.
  2. Revisit HCBS waiver availability annually. Capacity, waitlists, and program scope can change.
  3. Check whether your state has added a family caregiver compensation pathway — these programs proliferate.
  4. Review your parent’s spousal protection allowances if applicable.
  5. Stay current on estate recovery rules in your state, especially if the family home is involved.
  6. Schedule an elder law attorney review every 2–3 years even if nothing seems to have changed in your family — sometimes the program changes are what affect the right strategy.

The Area Agency on Aging is the easiest starting point for most of these reviews. SHIP (State Health Insurance Assistance Program) counselors can help with the Medicare side. Both are free. (Find your AAA via Eldercare Locator; Find your state SHIP.)

“The version of Medicaid that existed when your parent first got involved with the program is not the version of Medicaid in force today. The mistake adult children make most often is treating their understanding of Medicaid as fixed. It isn’t.”

FROM A PROGRAM THAT CHANGED IN OUR FAVOR:

One of the patterns I’ve watched across fifteen years of caregiving is how often families benefit — or could have benefited — from Medicaid program changes they didn’t know about.

When my stepmother entered the skilled nursing facility, the rules around long-term care Medicaid were one set of numbers. When my dad followed her into the same facility several years later, the numbers had shifted. The eligibility math wasn’t the math we’d memorized. It had moved. Some of the changes worked in our favor; some required adjustments. The point isn’t which direction the shifts went — it’s that assuming the program is the same as it was the last time we looked at it would have cost us money and options.

What I’ve watched in other families I’ve worked with through ElderHonor is the version where adult children make decisions based on what they understood about Medicaid five or ten years ago — usually from a relative or friend’s experience — and discover only later that the rules had changed in ways that mattered. Sometimes a program had been added that they could have used. Sometimes a threshold had moved that they could have qualified under. Sometimes a recovery rule in their state had loosened in ways that affected the family home.

The lesson, if there is one: Medicaid is not a static system. The annual review is the cheapest insurance an adult-child caregiver can buy. An hour with a SHIP counselor each year, or a quick check-in with the Area Agency on Aging, costs nothing and prevents most of the surprises.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes staying current on the systems that shape their care — even when the systems are tedious, even when nothing in the family situation has changed. The system has changed. Knowing what changed is the work.

Where to start today.

If your parent is on Medicaid or recently became eligible:

  1. Confirm current program enrollment is accurate — Medicare Savings Program tier, HCBS waivers, full Medicaid, whatever applies.
  2. Schedule an annual review with the AAA or SHIP counselor — this should be a standing calendar item.
  3. Verify the family is taking advantage of all programs your parent qualifies for — many families miss benefits they’re entitled to.

If your parent is not yet on Medicaid but may need it:

  1. Run a screening this year even if you don’t think they’ll qualify yet. Sometimes the screening reveals a Medicare Savings Program eligibility you didn’t know about.
  2. Schedule annual re-screening as a standing calendar item.
  3. Engage an elder law attorney if the family has assets that need protection planning ahead of any future Medicaid application. The 5-year look-back rewards early planning.

If your parent has passed and the family is dealing with estate recovery:

  1. Get an attorney before responding to any state recovery action.
  2. Review state-specific protections that may apply (some states protect the home from recovery in certain circumstances).
  3. Don’t ignore notices. Recovery proceedings have deadlines.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through the annual Medicaid review checklist, the document inventory the AAA or SHIP counselor will need, and the cadence of program review that keeps the family ahead of policy changes — built so what changes in the system doesn’t catch your family off guard.

See the toolkit →

Some additional articles for further reading, some of which have already been referenced above.

Some additional notes:

  • HCBS expansion is broadly accurate as a trend but specific state programs and waitlist conditions vary; verify state-by-state status.
  • Family caregiver compensation programs vary so dramatically by state that any specific dollar figures should be sourced from state Medicaid agencies. The federal “Structured Family Caregiving” model is real but state implementation varies.
  • Medicare Savings Program thresholds update annually with FPL; verify current numbers against Medicare.gov MSP page.
  • Spousal protection figures (CSRA and MMMNA) update annually; verify current federal floor/ceiling at the Medicaid.gov long-term services page.
  • Estate recovery rules vary substantially by state, verify them in your state.
  • The American Rescue Plan HCBS funding was passed in 2021; its long-term effects are still unfolding. Verify them before relying on any published numbers.
  • Federal Medicaid reform proposals (block grants, per-capita caps, work requirements) — these change frequently and you must verify the current state of any active proposals before relying on them.

Back to the Caregiver Library. Read more on Money, Medicare & legal.

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Medicare and Long-Term Care: What Families Should Know

There’s a cliff in the middle of the Medicare program. Most adult children don’t see it coming.

Medicare gives you a lot. Doctor visits, hospital stays, surgeries, prescriptions, rehab, hospice — all covered, often generously. But somewhere between “Medicare paid for the rehab after Mom’s stroke” and “why is the nursing home asking the family for $9,000 a month,” there’s a gap that swallows whole family savings. That gap is long-term custodial care, and Medicare doesn’t fill it.

This post is the version of that conversation you can have before the gap opens up. What Medicare actually covers when it comes to long-term care. What it doesn’t. Where the cliff is. And how to plan for it.

The line Medicare draws.

Medicare distinguishes between two things that, to families in the moment, look identical:

  • Skilled care — services that have to be performed by a licensed nurse, therapist, or doctor. Wound care, IV medications, post-surgical rehab, monitoring of an unstable medical condition.
  • Custodial care — help with the activities of daily living. Bathing, dressing, eating, transferring, toileting, supervision because of cognitive decline. Most long-term care is custodial.

Medicare covers skilled care, with limits. Medicare does not cover custodial care. That’s the cliff.

The bedside reality is that the same person — your mother, in a memory care unit, with advanced Alzheimer’s — needs both kinds of care every day. The medical care she needs is covered. The supervision and personal care she needs to live safely is not. Families pay for one of those out of pocket. The bill gets large fast.

What Medicare actually covers in long-term care contexts.

Here’s the realistic map of what your parent’s Medicare will and won’t pay for, by setting:

Hospital stays (Part A): Covered. Inpatient stays of any length needed are covered, with deductibles and coinsurance kicking in past day 60. Most hospitalizations end well before that.

Skilled nursing facility (SNF), up to 100 days (Part A): Covered with conditions. You need a qualifying inpatient hospital stay of three days or more, the SNF stay has to begin within 30 days of discharge, and your parent has to be receiving skilled care AND making measurable progress. Days 1–20 are fully covered; days 21–100 require a daily coinsurance (roughly $200/day in 2025); after day 100, Medicare pays nothing.

Home health care (Part A or Part B): Covered with conditions. If your parent is homebound, needs intermittent skilled nursing or therapy, and has a doctor certifying the need, Medicare covers part-time skilled services and a limited number of home health aide hours as long as skilled care is also being received. When the skilled need ends, the home health aide hours end too. Medicare’s home health benefit is medically driven, not custodial.

Hospice (Part A): Generously covered. If your parent is certified as having a prognosis of six months or less and elects to forgo curative treatment, Medicare’s hospice benefit is one of the most comprehensive things the program offers — nursing visits, aide services, social work, chaplain, medications related to the terminal illness, durable medical equipment, and bereavement support for the family. For most families, this is the one Medicare benefit that delivers more than expected. See Family Caregivers and Hospice Teams for the full picture.

Assisted living, memory care, custodial nursing home stays: Not covered. None of it. Medicare pays nothing toward the room, the supervision, the personal care, or the long-term residency. This is the single biggest expense category most families face — and Medicare is silent on it.

Long-term in-home personal care, adult day programs, family caregiver respite: Not covered. Medicaid sometimes covers these via HCBS waivers (state-by-state). Long-term care insurance covers these if your parent has a policy. Medicare does not.

The 100-day rule. The trap most families fall into.

Even within the limited skilled nursing benefit Medicare provides, there’s a second trap. The 100 days are not guaranteed. They depend on continuous, measurable improvement.

The day the therapist documents that your parent has plateaued — that they’re not making further progress — Medicare’s SNF coverage ends. Sometimes that’s day 14. Sometimes day 47. Almost never day 100.

The discharge planner’s job is to tell you when this is happening and to help plan for what comes next. The family’s job is to be ready. Most families aren’t, because nobody warned them the 100 days were conditional.

If your parent is in a SNF on Medicare, three things to know:

  • Track the progress reviews. They happen every 14 days. Ask when the next one is and what the team is documenting.
  • Plan the transition early. Don’t wait until the day Medicare stops paying to start exploring options. Memory care or assisted living placement, in-home care, family logistics — start the conversation by week three.
  • Know the appeal rights. If you disagree with the discontinuation decision, you have the right to appeal. The hospital and SNF must give you written notice and an appeal pathway.

The home health benefit is narrower than it sounds.

Home health is the area where families most often misunderstand what Medicare provides. The shorthand version: “Medicare covers home health for older adults.” The accurate version: Medicare covers part-time skilled home health for older adults who are homebound and being treated for a specific medical condition.

What that means in practice:

  • A nurse may visit a few times a week to manage your parent’s wound, IV, or condition.
  • A physical or occupational therapist may visit to work on a specific recovery goal.
  • A home health aide may help with bathing or personal care only as long as a skilled need exists, and only for limited hours per week.
  • The day your parent’s skilled need ends — they’re no longer homebound, the wound has healed, the therapy goal is met — all home health support ends. Including the aide.

Medicare’s home health benefit is excellent for episodes of recovery. It is not a long-term in-home care solution. Families who need ongoing in-home help are looking at private pay, long-term care insurance, Medicaid HCBS waivers, or family-provided care.

Hospice is the exception. Use it earlier than you think.

Of all the Medicare benefits, hospice is the one most families underuse. The benefit is comprehensive: a full team of nurses, aides, social workers, chaplains, and bereavement counselors visits your parent (wherever they are — usually at home), most medications and equipment are covered, and the family gets support too.

The benefit is for prognoses of six months or less. In practice, hospice teams are unanimous: most families call too late. Patients admitted to hospice earlier have better symptom control, fewer hospitalizations in the final months, and higher family satisfaction (National Hospice and Palliative Care Organization, Facts and Figures).

If your parent’s doctor has stopped recommending curative treatment, or treatments aren’t working, or your parent has been hospitalized multiple times in the last six months — the hospice conversation is overdue. You don’t need a doctor’s referral to start it. Call a local hospice agency and ask for an evaluation.

Hospice is not giving up. It’s using a Medicare benefit your family already paid for, before the runway gets too short.

What long-term care actually costs.

The reason this matters: long-term care costs are large and steady, and Medicare doesn’t touch them. The 2024 Genworth Cost of Care Survey put national medians at:

  • Home health aide: ~$33/hour (Genworth, Cost of Care Survey 2024)
  • Adult day services: ~$2,100/month
  • Assisted living: ~$5,500/month
  • Memory care: typically $1,500–$2,500/month above assisted living rates
  • Semi-private nursing home room: ~$8,700/month
  • Private nursing home room: ~$10,000/month

Your local numbers will be different — sometimes dramatically — depending on geography. In high-cost coastal markets, memory care can run $9,000–$12,000/month. In lower-cost regions, the same care may be half that.

Medicare pays $0 toward any of those bills. The money comes from your parent’s savings, long-term care insurance if they have it, family contributions, Medicaid (when eligibility is reached), or some combination.

What this means for the family doing the planning.

If your parent is healthy now, this is the version of the conversation to have:

  • Long-term care insurance is worth evaluating in your parent’s late 50s to mid-60s. Premiums get expensive and underwriting tightens past that. Hybrid life/LTC policies are an option for older buyers.
  • Asset planning with an elder law attorney matters most for families with meaningful assets — Medicaid look-back is five years, so plans set up early have much more flexibility than crisis-driven planning.
  • The toolkit’s Documents and Roadmap modules walk through what to gather and what to plan around so the family isn’t reactive when the cliff arrives.

If your parent is already in care or close to it, the version of the conversation shifts:

  • Get clear on the Medicare clock. Where is your parent in the SNF benefit? When does the team expect coverage to end?
  • Build the bridge. Medicaid application, family rotation, in-home care, residential placement — every option takes time to set up. Start now.
  • Don’t drain savings without a plan. Private pay can run for months and disappear faster than families expect. An elder law attorney is more useful than the family imagines, and earlier than the family imagines.

“Medicare covers skilled care, with limits. Medicare does not cover custodial care. That’s the cliff.”

FROM TWO COUPLES, TWO STRATEGIES:

My stepmother qualified for Medicaid when she entered the skilled nursing facility. She had already reduced her assets below the required limit, even though my dad was still living in their home — the spousal protection rules let one spouse remain in the house while the other qualifies for long-term care Medicaid. It worked the way the system is designed to work, but only because the planning had been done years earlier.

My dad followed her into the same facility several years later, after an accident left him unable to care for himself. The staff put them in the same room so they could be together. Medicare covered the medical side; Medicaid covered the residency. They got to spend their last stretch in the same room — which only happened because the financial scaffolding was already in place.

My mom’s path was different. She and her husband moved into a Continuous Care Retirement Community (CCRC) — the kind of community that builds independent living, assisted living, and skilled nursing into one campus, so a resident’s needs can scale up without uprooting them. The community had excellent doctors built into the model; Medicare covered her healthcare. When her husband passed, she was able to stay through a combination of her own financial assets and the community’s continuing-care commitment. The cliff that catches most families never quite caught hers — because the planning had been done.

The pattern across both stories: the families that planned ahead — Medicaid eligibility for one couple, CCRC structure for the other — got more choice and more dignity at the end than families who wait until the system is deciding for them. That’s the version of this conversation I wish more adult children had earlier.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes building the financial and legal scaffolding so the care they need doesn’t bankrupt the family doing the caring. That scaffolding starts with knowing what Medicare will and won’t pay for — and with starting the planning conversation while there’s still time to plan.

You don’t have to figure this out alone.

The agencies and resources that exist for exactly this situation:

  • State Health Insurance Assistance Program (SHIP) — free Medicare counseling in every state. They will walk you through your parent’s specific coverage. (Find your state SHIP.)
  • Area Agency on Aging — local nonprofit network. They help with long-term care planning, Medicaid screening, and connecting families to services. (Find your local AAA via Eldercare Locator.)
  • Medicare Plan Finder — Medicare.gov’s tool for comparing plans, evaluating Medicare Advantage options, and understanding specific coverage. (Medicare.gov)
  • Elder law attorney — for asset planning, Medicaid eligibility strategy, and complex situations involving meaningful assets.

You don’t have to become an expert in Medicare. You have to know the cliff exists, know roughly where it is, and know who to call when you need help. Most adult children don’t know the cliff exists until they fall off it. That’s the gap this post is built to close.

Plan early. Use the benefits your parent has already paid for. Bring in experts when the situation warrants it. Take care of yourself while you take care of them.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through what to gather, when to talk to whom, and how to build the family plan that keeps Medicare’s gaps from becoming Medicare’s surprises. Built so the cliff doesn’t catch you on the wrong side.

See the toolkit →

Some additional articles to help you, some of which have already been referenced above.

Some additional notes:

The Genworth Cost of Care figures (home health aide ~$33/hour, assisted living ~$5,500/month, semi-private nursing home ~$8,700/month, private ~$10,000/month) are from the 2024 survey. Genworth releases new data annually and prices have been rising 3–8% per year. Verify before using any numbers.

The Part A SNF coinsurance amount (~$200/day for days 21–100) is the 2025 figure. Verify the current year’s amount at Medicare.gov coinsurance and deductibles.

The 100-day SNF rule is federal and stable, but the “qualifying 3-day inpatient hospital stay” requirement has had temporary waivers during certain periods (e.g., COVID-19 public health emergency). Check whether any current waivers are in effect.

The hospice prognosis rule (six months or less, certified by physician) is federal and stable, but the specific elections and re-certifications have been adjusted periodically. Verify current rules at Medicare hospice benefit page.

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Estate Planning Checklist for Adult Children

You’re not the parent in this relationship.

That’s the line worth remembering before you start any conversation about your aging parent’s estate plan. The instinct, especially for adult children who run things in their own lives, is to step in and “get this organized.” The instinct is right. The execution is where most adult children get this wrong.

Estate planning isn’t a project you do for your parent. It’s a conversation you help facilitate, a checklist you help complete, and a binder you help maintain — with your parent’s authority, on your parent’s timeline, with your parent’s signature on every document. The version where you take over fast is the version that ends with a parent who hides the will from you and a sibling who challenges everything you touched.

This post is the checklist version. Nine documents every family should have in place before a crisis. The order to tackle them in. Where to keep them. Who needs to know they exist. And the conversation framework that keeps your parent in charge of their own life while you help organize the scaffolding underneath it.

If you haven’t read it, the foundational read on the dynamic: How to Respect Aging Parents’ Independence While Offering Help.

The framing before the checklist.

Three things to say out loud, to your parent, before you start gathering documents:

  • “Mom, I want to help make sure your wishes are clear and protected. I’m not trying to take anything over.”
  • “This is yours. I’m helping you organize it. You decide what goes where, what stays private, and who gets copies.”
  • “If anything doesn’t feel right, tell me, and we slow down.”

The framing matters more than the documents. A parent who feels respected through the process ends up with a complete plan. A parent who feels managed ends up with a partial plan and a lot of friction.

The nine documents.

The list below is the working set most adult children should help their parent organize. Some of these your parent may already have. Some may need to be drafted from scratch. Some may need updating because the documents are 15 or 20 years old and don’t reflect current wishes or current law.

1. Last Will and Testament. The document that directs how your parent’s assets are distributed at death and names an executor (the person who manages the estate through probate). Most adult children don’t realize a will doesn’t avoid probate — it just gives instructions for it. If your parent has assets that should bypass probate, those need to be handled through trusts or beneficiary designations (covered below).

2. Revocable Living Trust (if applicable). For families with meaningful assets — typically homes plus retirement accounts plus investment accounts — a Revocable Living Trust (RLT) can avoid probate, simplify asset transfer at death, and provide privacy that wills don’t. Not every family needs one. An elder law attorney is the right professional to advise on whether the additional cost and complexity are worth it for your parent’s specific situation. See Roles of Elder Law Attorneys in Caregiving.

3. Durable Power of Attorney (DPOA) for Finances. Authorizes a designated person to manage your parent’s financial affairs if they become unable to do so themselves. “Durable” means it remains valid through incapacity. Without a DPOA in place, the family may face guardianship proceedings to gain authority over your parent’s finances — heavy, expensive, public, and often avoidable. The DPOA is the single most important document in caregiving terms.

4. Health Care Power of Attorney (HCPOA). Sometimes called a healthcare proxy or healthcare surrogate. Authorizes a designated person to make medical decisions if your parent can’t. Pair with the next item.

5. Living Will / Advance Directive. Documents your parent’s wishes about life-sustaining treatment, resuscitation, intubation, and other end-of-life care decisions. Format and name varies by state. The HCPOA names a person; the living will provides the wishes that person should follow. Both are needed. See Living Wills: A Guide for Caregivers for the deeper read.

6. HIPAA Release. The Health Insurance Portability and Accountability Act (HIPAA) restricts who can receive your parent’s medical information. Without a signed HIPAA release listing the family members authorized to receive information, hospital staff and doctors are legally prevented from sharing it — even with the adult child standing in the hallway. Many hospitals have their own HIPAA forms; have your parent sign one for each provider, and keep a copy in the binder.

7. Beneficiary designations (current and verified). This is the document category most adult children skip — and the one that most often produces post-death disputes. Every retirement account, life insurance policy, annuity, and Transfer-on-Death (TOD) or Payable-on-Death (POD) account passes outside the will, directly to whoever is named as beneficiary. Beneficiary designations override what the will says. A 30-year-old IRA that still names a long-divorced spouse will pay that spouse, regardless of what the current will instructs. Walk through every account with your parent. Make sure designations match current intent.

8. Property and asset records. Deed for the primary residence (and any other real estate). Vehicle titles. Brokerage and bank account statements (most recent month). Retirement account statements. Life insurance policies (the actual policies, not just the bills). Safe deposit box location and contents. Digital asset access (passwords, two-factor backup codes). Most parents have these scattered across decades and locations. Centralization is the highest-value gift you can give the future executor.

9. Final wishes documents. Letter of instructions for personal effects. Funeral and burial preferences (or written confirmation of cremation arrangements). Obituary instructions, if your parent has preferences. Lists of people to notify. Sometimes called a “letter to family.” Not legally binding, but emotionally invaluable when the moment comes.

The order to tackle them in.

If your parent has none of these in place, the order that minimizes risk and maximizes leverage:

  • First — DPOA, HCPOA, Living Will, HIPAA release. These are the documents that protect your parent if capacity declines. Get these in place before any cognitive concerns surface. Once capacity is in question, the documents are harder (sometimes impossible) to execute properly.
  • Second — beneficiary designations and POD/TOD designations. Quick wins. Easy to update through the financial institution. Massively reduces post-death dispute risk.
  • Third — will and trust (if applicable). These take more time and usually involve an elder law attorney. Worth doing well rather than fast.
  • Fourth — final wishes and asset centralization. Lower-stakes documents that benefit the future executor. Can be assembled gradually.

If your parent already has some of the above, start with the gaps and the documents most overdue for review. A 25-year-old will that names an executor who has since passed away is worse than no will, in some respects.

Where to keep them.

A working system that adult children consistently report works:

  • A physical binder in a known location your parent and the designated executor both know. Originals of all signed documents.
  • A digital backup of scans, in a password-protected folder accessible to the executor.
  • Copies with the elder law attorney if engaged.
  • Copies with the named DPOA, HCPOA, and executor so they have the authority documents in their own hands.
  • A safe deposit box is fine for some assets but not for the original will in many states — accessing a safe deposit box at death often requires probate to open it, which defeats the purpose.

The goal isn’t a perfect filing system. The goal is that the executor and the designated POAs can find every document within an hour, on the day they need it.

Who needs to know.

A short conversation worth having while everyone is healthy:

  • The executor needs to know they’re named, where the will is, and where the asset records are.
  • The DPOA needs to know they’re named, where the document is, and what your parent’s wishes are about financial decisions.
  • The HCPOA needs to know they’re named, where the document is, and what your parent’s wishes are about end-of-life care.
  • The siblings or other beneficiaries need to know, in broad terms, that a plan exists and where the documents are kept. They do not need to see the documents themselves while the parent is alive unless the parent chooses to share them.

The version where the parent dies and one sibling pulls out the will to read it for the first time — to the surprise of the rest of the family — is the version that produces inheritance fights. The version where everyone knew, in broad terms, that the documents existed and had been signed and the wishes were set, produces fewer disputes. See Why Siblings Fight Over Inheritance and How to Avoid It for the family-dynamics layer of this.

When to update.

Documents should be reviewed at minimum every five years, and immediately after:

  • A marriage or divorce in the family
  • A death of a named executor, POA, or beneficiary
  • Significant changes in assets (major sale, inheritance, business sale)
  • A move to a different state (estate planning rules vary)
  • Significant changes in family relationships (estrangement, reconciliation, adult adoption)
  • Changes in tax law that affect your parent’s estate

If it’s been more than ten years since the documents were last touched, a review with an elder law attorney is overdue, regardless of whether anything else has changed.

“You’re not the parent in this relationship. You’re the coordinator. The documents are your parent’s. Your job is to help organize the scaffolding underneath them — with their authority, on their timeline, with their signature on every page.”

FROM TWO PARENTS, TWO STARTING POINTS:

When my mom’s last husband passed, she handed me everything. Account statements, the will, life insurance policies, the safe deposit box keys, passwords I didn’t know existed. She wanted me to take it all. The conversation about “respecting her independence” wasn’t really a conversation — she was actively asking me to step in.

That made the document organization side easy. The hard part wasn’t getting access. The hard part was processing the volume of decades of paperwork, identifying what was current, what was outdated, what mattered, and what didn’t. Even with full access and a willing parent, organizing a lifetime of estate-related paperwork is more work than most adult children expect.

My dad was the opposite. He didn’t want my sister or I touching his finances or his legal documents for years. For most of that stretch, we respected what he didn’t want us touching. I asked, periodically, if he wanted help organizing anything. He’d say no, and I’d let it sit.

Eventually — well after we’d have liked, but at the moment he was ready — he started letting us look at things alongside him. Not all of it. The pieces he was comfortable sharing. What I learned in that stretch is that respect is the helping. Every time we didn’t push him on it, every time we let him say no, we were investing in a future moment where he might say yes.

The lesson: the estate planning checklist is the easy part. The relationship that lets the checklist actually get filled out is the hard part. Adult children who push too fast end up with parents who hide things. Adult children who never push end up with crises they could have prevented. The middle path — ask, accept the answer, ask again later, build trust over time — is harder than both.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes preparing for the moment when we’ll need to act on their behalf — without taking over the part of their lives they’re still running. The checklist above is the structure. The conversation around it is the relationship that makes the structure possible.

What can go wrong if you skip this.

A few of the patterns I’ve seen in families that didn’t have these documents in place:

  • The hospital admission with no HCPOA on file. The family scrambles, the hospital follows default state hierarchy (which may not match the parent’s wishes), and decisions get made by the wrong person.
  • The financial decline with no DPOA. Bills go unpaid, accounts get frozen, the family files for guardianship — a year-long, expensive court process.
  • The beneficiary designation that nobody reviewed. A 30-year-old retirement account pays out to a long-divorced spouse, despite the will saying otherwise. The current spouse and adult children sue. No will revisions can fix it post-death.
  • The safe deposit box nobody could open. Original will inside, executor can’t access it without probate, probate can’t proceed without the will. Months of legal limbo.
  • The fragmented binder. Some documents in one location, some in another, some on a thumb drive nobody can find. The executor spends six months reconstructing what should have been organized in a weekend.

None of those are dramatic. All of them are common. The checklist above is preventive medicine for almost all of them.

Where to start today.

If your parent has none of these documents in place:

  1. Schedule a consultation with an elder law attorney. (Find one via NAELA.) Initial consultations are often free or low-cost.
  2. Have the framing conversation with your parent. Not the document conversation — the “I want to help make sure your wishes are clear” conversation. Get their buy-in before any paperwork.
  3. Start with the four protection documents — DPOA, HCPOA, Living Will, HIPAA release. Get these signed within 30 days.
  4. Move to the estate plan package — will and (if applicable) trust. Within 60–90 days.
  5. Centralize records — the binder, the digital backup, the executor’s copy. Ongoing project.

If your parent has some documents but they’re old or scattered:

  1. Pull what exists into one place. Even if you don’t update them yet.
  2. Schedule the elder law attorney review to identify what needs refreshing.
  3. Update the most overdue documents first.

The goal isn’t perfection on day one. The goal is that within 90 days, your family has the protection documents in place, the asset records centralized, and a plan for the harder updates over the next year. That’s enough to handle almost anything that comes.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through this checklist in the order it’s designed to be tackled, with the conversation scripts, document-tracking templates, and review cadence that keeps the plan current as your parent’s life changes.

See the toolkit →

Some additional articles that might help:

Some additional notes:

Document names and requirements vary by state. The “Living Will / Advance Directive” naming, witness/notary requirements, and specific protections vary; some states use “Health Care Directive” or “Medical Directive” instead. Verify state-specific requirements before relying on anything.

The “safe deposit box / will access” issue is real but state-specific. Some states have streamlined access for the named executor. Check your state.

The HIPAA release form requirements (signed by patient, must list authorized recipients, often provider-specific) are federal but specific provider forms vary. Hospitals and physician offices typically have their own.

Revocable Living Trust (RLT) is a national framework but state-level rules around funding, trustee responsibilities, and creditor protection vary. Don’t quote as universal guidance, verify your State’s requirements before signing any documents.

The Transfer-on-Death (TOD) and Payable-on-Death (POD) account designations are widely available but not in every state for every account type. Some states don’t allow TOD on real estate; check your state before making any decisions.

The “review every 5 years” recommendation is a rule of thumb, not a regulatory requirement. Determine frequently that works for you and your family.

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Probate Court Basics for Inheritance Disputes

The dispute didn’t start the day your parent died. It started years earlier.

Probate court is where the dispute surfaces — but the conditions that produced it were laid down long before. A will written without family conversation. A beneficiary designation that contradicts the will. A late-life remarriage that no one talked about openly. A sibling who feels they were promised something nobody else heard. By the time the petition is filed, the family conflict has been brewing for a decade.

This post is the version of the conversation you can have now, while everyone is still alive. What probate court actually is. How the process works. Why inheritance disputes happen, what gets contested, and what doesn’t. The cost of fighting through probate. And what families can do — both before and during — to keep a difficult moment from becoming a destructive one.

If you haven’t read it, the foundational read: Estate Planning Checklist for Adult Children.

What probate is.

Probate is the court-supervised process of administering a deceased person’s estate. The court:

  • Authenticates the will (or determines that no valid will exists)
  • Appoints an executor (named in the will) or administrator (if no will exists, or the named executor declines)
  • Identifies and inventories the estate’s assets
  • Notifies creditors so debts can be paid
  • Resolves disputes if any arise
  • Distributes the remaining assets to beneficiaries
  • Closes the estate once everything is paid and distributed

In most states, probate takes between 6 and 18 months for a typical estate. Costs run roughly 3 to 7% of the estate’s value when you factor in court fees, executor compensation, and legal fees (American Bar Association — Probate Process Overview). Contested estates take much longer and cost much more.

Not every asset goes through probate. Assets that pass outside probate — life insurance with named beneficiaries, retirement accounts with named beneficiaries, joint tenancy property, assets held in a Revocable Living Trust (RLT), and Transfer-on-Death (TOD) or Payable-on-Death (POD) accounts — bypass the process entirely and pay directly to whoever is named.

This is why beneficiary designations matter so much. A 30-year-old retirement account that names a long-divorced spouse will pay that spouse, regardless of what the will says. No probate court will fix that.

How probate works, in plain language.

Step by step, from the day after death:

Step 1 — Filing the petition. Someone (usually the named executor, sometimes a family member) files a petition with the probate court in the county where the deceased lived. The will (if one exists) is filed alongside the petition.

Step 2 — Notice to interested parties. The court requires that all heirs, beneficiaries, and known creditors be formally notified. This is the moment when family members who weren’t involved in caregiving suddenly find out what’s in the will. Surprises here are a leading source of disputes.

Step 3 — Authentication of the will. The court reviews whether the will meets state requirements (proper signatures, witnesses, notarization where required). If valid, the will is admitted to probate.

Step 4 — Executor or administrator appointed. The court formally grants the executor authority (usually called “Letters Testamentary”). The executor now has legal standing to act on behalf of the estate.

Step 5 — Inventory and appraisal of assets. The executor lists everything the deceased owned, with current values. Real estate may need formal appraisal. Investment accounts get statement values as of date of death.

Step 6 — Creditor period. State law specifies a window — typically 4 to 6 months — during which creditors can file claims against the estate. The executor reviews each claim, pays valid ones, and contests invalid ones.

Step 7 — Tax filings. Final personal income tax return for the deceased. Estate income tax returns for any income earned during probate. Federal estate tax return if the estate exceeds the federal exemption (currently very high — over $13 million for an individual in 2025). State estate or inheritance tax returns where applicable.

Step 8 — Distribution. Once debts and taxes are paid and any disputes resolved, the executor distributes remaining assets according to the will (or state intestacy law if no will).

Step 9 — Closing the estate. The executor files a final accounting with the court, the court approves, and the estate is formally closed.

For a clean, uncontested estate, the entire sequence runs about 6 to 12 months. For a contested estate, multiply that by 2 to 5.

Why disputes happen.

Inheritance disputes that end up in probate court tend to fall into a handful of categories. Recognizing the patterns helps families both prevent disputes and respond to them when they arise.

1. Will contests. A family member challenges the validity of the will itself. Common grounds:

  • Lack of capacity — the claim that the deceased wasn’t of sound mind when signing.
  • Undue influence — someone manipulated the deceased into changing the will.
  • Fraud or forgery — the will isn’t authentic.
  • Improper execution — witness or notarization requirements weren’t met.

Will contests are the highest-stakes disputes. They can void the will entirely and trigger intestacy (state law deciding who gets what), or void specific provisions while keeping the rest.

2. Executor disputes. Beneficiaries challenge how the executor is administering the estate. Claims include:

  • Self-dealing (executor benefiting personally from estate decisions)
  • Failure to inventory or report
  • Unreasonable delays
  • Hidden assets
  • Improper payment of debts

Family members appointed as executor face this scrutiny most often — the perceived conflict of interest is real even when behavior is clean. Professional executors (banks, trust companies) face fewer disputes but cost more.

3. Beneficiary disputes. Beneficiaries fight among themselves about specific bequests, valuations, or interpretation of will language. Sometimes about who gets which house, sometimes about who gets the family heirloom, sometimes about whether a gift to one child counts against their share of the estate.

4. Disinheritance and surprise heirs. A will explicitly leaves out someone who expected to inherit, or names someone the family didn’t know existed. Both produce contests. Surprise heirs are more common than people realize — late-life relationships, previously unknown children, second marriages.

5. Creditor claims. Creditors file claims the estate believes are invalid. This is technically not a beneficiary dispute, but it affects what’s left to distribute, which makes it one in practice.

What can be challenged. What can’t.

Three reality checks worth understanding before any family considers going to court:

You cannot contest the will simply because you disagree with it. Disinheritance is legal. If your parent had capacity and wasn’t unduly influenced, they’re allowed to leave their estate however they want — including in ways the family considers unfair. Disagreement is not grounds for a contest. Evidence of incapacity, undue influence, fraud, or improper execution is.

You cannot contest beneficiary designations through probate. Life insurance, retirement accounts, and TOD/POD accounts pay directly to the named beneficiary outside probate. The probate court has no jurisdiction over those assets. Challenges to beneficiary designations require separate legal action — usually challenging the change itself for capacity or undue influence at the time the change was made.

You cannot challenge a Revocable Living Trust through probate. Trusts are administered outside probate court entirely. Challenging trust terms or trustee actions requires separate trust litigation.

Many disputes that feel valid in family meetings have no legal grounds. A parent’s promise that wasn’t put in writing usually has no enforceability. “Mom always said this house would be mine” doesn’t override what the deed and will say.

What contested probate actually costs.

Will contests and other contested probate proceedings can run $10,000 to $250,000 or more in legal fees, depending on complexity, length, and how many parties are involved. The estate often pays both sides’ fees — meaning the legal fight directly drains what would have been the inheritance.

Beyond financial cost, contested probate consumes time (multi-year proceedings are common) and relationships. The family that walked into the courtroom usually doesn’t walk out the same way.

This is why most experienced probate attorneys steer clients toward mediation and Alternative Dispute Resolution (ADR) before formal litigation. Mediation typically costs a fraction of contested litigation, completes in weeks rather than years, and preserves family relationships in ways litigation can’t.

How to prevent disputes before they start.

Most inheritance disputes are preventable. The patterns that prevent them, in order of leverage:

1. Have the conversation while everyone is alive. Most disputes are surprises in disguise. A parent who’s transparent about their estate plan with adult children — even in broad terms — produces fewer disputes than a parent who keeps it private. “This is what’s in the will. This is why.” See How to Start Beneficiary Conversations with Parents for the conversation framework.

2. Update beneficiary designations. A will that conflicts with beneficiary designations on accounts is the most common source of post-death disputes. Walk through every account with your parent. Make sure designations match current intent. The will doesn’t override the beneficiary designation, no matter what the will says.

3. Use a Revocable Living Trust if appropriate. Trusts pass outside probate, are private (probate is public record), and reduce dispute opportunity. Not every family needs one — talk to an elder law attorney about whether the cost and complexity make sense for your parent’s situation. See Roles of Elder Law Attorneys in Caregiving.

4. Address late-life relationships explicitly. Second marriages, common-law partners, and late-life relationships are a leading source of inheritance disputes. A clear, current will that explicitly addresses the new partner and the adult children from prior relationships prevents most of these. Vague wills produce maximum conflict.

5. Pick the right executor. The right executor is responsive, organized, even-handed, and respected by all heirs. The “right” executor isn’t always the oldest child or the most successful one. A family member who works well with the others is worth more than a family member with the right credentials. Professional executors (banks, attorneys) cost more but bring neutrality.

6. Keep estate documents current. A 25-year-old will that names an executor who has since passed away, or beneficiaries who are now divorced spouses or estranged children, is worse than no will. Review every five years and after every major life event.

What to do if you’re in a probate dispute.

If you’re already in the middle of an inheritance dispute or anticipating one:

Get a probate attorney immediately. This is not the time to handle it yourself. Probate litigation is procedural and the deadlines are unforgiving.

Document everything. Communications with the deceased, witnesses to capacity or relationships, any evidence of undue influence, prior wills or amendments. Memory fades; written records survive.

Consider mediation before litigation. Ask your attorney about mediation or ADR. Most cases resolve faster, cheaper, and more cleanly through mediation than through trial.

Be realistic about strength of position. Will contests succeed less often than people expect. Disagreement isn’t grounds. Evidence is.

Consider the long arc. A pyrrhic legal victory that estranges siblings for the next thirty years isn’t a win. Family relationships often outlast any single inheritance.

“The dispute didn’t start the day your parent died. It started years earlier — in a will written without family conversation, a beneficiary designation that contradicts it, a late-life remarriage no one talked about openly.”

FROM TWO ENDS OF THE PROBATE SPECTRUM:

Across the parents and stepparents I’ve cared for, I’ve watched estate transitions go in two very different directions.

The version that worked: my stepmother’s estate, then my dad’s, ran cleanly. The planning had been done years earlier — current wills, updated beneficiary designations, a clear executor, a family that knew in broad terms what to expect. There was no surprise. There was no contest. The financial part of the transition was the easy part of the loss.

The version that didn’t was with my Mom’s second husband. When he passed during a nap one afternoon, she discovered that his life insurance — which everyone assumed would pass through his current marriage — still named his ex-wife as beneficiary. The designation hadn’t been updated in fifteen years. Hundreds of thousands of dollars went to the ex-wife. She had no recourse — beneficiary designations override wills, override marriages, override everything except a separate legal challenge to the designation itself, which would have required proving capacity issues or fraud at the time the designation was set.

Mom’s response, fifteen years later, was characteristic: “Too bad.” She moved forward. But the lesson sat with me — a fifteen-year-old beneficiary form, never updated, can rewrite a family’s financial future in a way no probate court can fix.

The pattern across both stories: the time to prevent inheritance disputes is now, while everyone is alive. Probate court is where they get expensive, public, and slow. The kitchen table is where they get prevented.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes the unglamorous work of making sure their wishes can actually be honored when the moment arrives — through documents that match each other, beneficiary designations that match the will, and conversations that prevent the surprises that drive most disputes. The post-death moment isn’t the time to fix things. It’s the moment when the work you did beforehand either holds or doesn’t.

Where to start today.

If you’re trying to prevent a future dispute:

  1. Have the conversation with your parent. Even in broad terms. Use How to Start Beneficiary Conversations with Parents.
  2. Walk through every account to verify beneficiary designations match current intent.
  3. Read the will together if your parent is willing — or at minimum, confirm where it’s kept and who the executor is.
  4. Schedule an elder law attorney review if estate documents are more than 10 years old or if the family situation has changed (remarriage, new children, estrangement).

If you’re already in a dispute:

  1. Get a probate attorney — your state bar’s lawyer referral service or the National Academy of Elder Law Attorneys (NAELA).
  2. Don’t act unilaterally in the meantime. Don’t move funds, don’t sell assets, don’t disburse anything without consulting counsel.
  3. Ask early about mediation. Most attorneys can reach out to opposing counsel; many disputes resolve in mediation.
  4. Keep family communication civil to whatever extent possible. The dispute will end. The family doesn’t have to.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through the conversation framework, the document-tracking templates, and the family communication patterns that prevent most inheritance disputes from ever needing a courtroom — built so the post-death moment is one of grief, not legal battle.

See the toolkit →

Some additional articles that might be helpful:

Some additional notes:

The probate timeline (6–18 months) and cost (3–7% of estate value) are national averages. State-specific timelines and costs vary significantly. California probate, for example, is notoriously slow and expensive; many smaller states are faster and cheaper. Look at your State for specifics.

The federal estate tax exemption (over $13 million for an individual in 2025) is set by federal law and adjusts periodically. The 2017 Tax Cuts and Jobs Act provisions affecting this exemption are currently scheduled to sunset at the end of 2025. Verify the current exemption amount before making any decisions.

The “$10,000 to $250,000+” cost range for contested probate is illustrative; individual cases vary widely.

Will contest grounds (capacity, undue influence, fraud, improper execution) are the standard four, but state law varies on burden of proof, who has standing to contest, and time limits for filing contests.

The “estate often pays both sides’ fees” framing is generally true but state-specific. Some states limit fee-shifting; verify for your State.

Mediation and ADR availability varies by state; some probate courts mandate mediation before trial, others don’t.

Small-estate procedures (simplified probate for estates under a state-specific threshold) exist in most states but with widely varying limits. Verify with the State the estate is located.

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Medigap Costs: Average Premiums Explained

If you’ve been told “Medigap is expensive,” you’ve been told a half-truth.

Medigap premiums in the United States span a range that dwarfs most insurance categories. Two 65-year-olds, on the same letter plan, in the same state, can pay premiums that differ by two or three times depending on which insurer they pick and how that insurer prices Medigap. That spread isn’t a quirk. It’s the central feature of how this market works — and the reason most adult children helping a parent shop for Medigap leave a lot of money on the table without realizing it.

This post is the version of the conversation you’d have with someone who’d already shopped Medigap for two parents and a stepparent. What Medigap actually is. The pricing structures that drive premium variation. What the average premium really tells you. And how to shop in a way that keeps your parent’s premium reasonable for the long haul.

Medigap in plain language.

Medigap (also called Medicare Supplement Insurance) is private insurance that pays the gaps Original Medicare leaves behind — the deductibles, coinsurance, and copays that Parts A and B require the patient to pay out of pocket.

Medigap is only for people on Original Medicare (Parts A and B). It does not work with Medicare Advantage. If your parent has Medicare Advantage, they cannot also have Medigap. If they want Medigap, they need to be on Original Medicare.

Medigap is sold by private insurers but the plans themselves are federally standardized. A “Plan G” from Insurer A and a “Plan G” from Insurer B cover exactly the same things. The difference is the premium and the customer service. This is the central insight of Medigap shopping: identical coverage, different prices.

The standardized plan letters.

There are ten standardized Medigap plans, identified by letter: A, B, C, D, F, G, K, L, M, N. (Massachusetts, Minnesota, and Wisconsin have their own standardized systems; the rest of the country uses these ten.)

Two important changes:

  • Plans C and F are no longer sold to new enrollees who became eligible for Medicare on or after January 1, 2020. People already enrolled in C or F before that date can keep them.
  • Plan G is the most popular Medigap plan for new enrollees — it covers everything Plan F covered except the Part B deductible, which the enrollee pays out of pocket once a year (around $257 in 2025).
  • Plan N is a popular lower-premium alternative to Plan G — it covers most of the same things but adds small copays for some doctor visits and emergency-room trips, and it doesn’t cover Part B excess charges.

For most adult children helping a parent shop, the realistic choice is between Plan G and Plan N, with a smaller minority looking at high-deductible Plan G or the lower-premium Plans K, L, or M.

Why two identical plans cost very different amounts.

Three pricing methods determine how Medigap premiums grow over time. Insurers in the same state can use different methods, which is the single biggest source of premium variation between insurers offering the same letter plan.

  • Community-rated (also called no-age-rated): Everyone pays the same premium regardless of age. Premiums increase only because of inflation, not because the policyholder is getting older. Lowest long-term cost trajectory in many cases — but the entry premium is higher than other methods at age 65.
  • Issue-age-rated: Premium is based on the age your parent first bought the policy. If they bought at 65, they keep the 65-year-old rate (with inflation increases). Premiums don’t go up because of age. Good middle-ground — locks in age-65 pricing.
  • Attained-age-rated: Premium is based on your parent’s current age and goes up every year as they get older — on top of inflation increases. Lowest premium at age 65 of the three methods. Highest premium at age 80.

Most Medigap policies sold today are attained-age-rated. It’s the structure that looks cheapest when your parent first signs up. It’s also the structure that gets dramatically more expensive over time. Adult children helping a parent enroll often default to whichever insurer quoted the lowest premium without realizing the premium will compound aggressively for the next 20 years.

The extra ten or fifteen dollars a month for an issue-age-rated or community-rated plan often saves thousands over the life of the policy. Ask the agent which pricing method each plan uses. It’s often not on the comparison page.

What “the average Medigap premium” actually tells you.

National averages for Plan G typically run $120–$220 per month for a 65-year-old, but that average obscures more than it reveals. Real-world pricing in the same zip code, same plan letter, same age, can range from about $90 to $300 depending on insurer.

The factors that move premiums:

  • State. Big variation between states. Florida, New York, and California tend to run high. Hawaii, Iowa, and several Midwestern states tend to run lower.
  • Insurer. Within the same state, premiums for identical plans can differ 50% or more between insurers.
  • Age. Attained-age-rated plans get more expensive every year.
  • Gender. In most states, women pay slightly less for Medigap than men do at the same age. (A few states ban gender-based pricing; check your state.)
  • Tobacco use. Tobacco users pay 10–25% more in most states.
  • Household discount. Many insurers offer a 5–12% discount when both spouses have Medigap with the same insurer. Worth asking about — easy to miss.
  • Underwriting. Inside the open enrollment window, your parent’s health doesn’t affect the premium. Outside it (more on that below), insurers can charge more or refuse coverage.

The one number that means more than the average premium: the spread between the highest and lowest premium in your parent’s state for the same plan. That’s the savings on the table.

The Medigap Open Enrollment Period. The single most important window.

When your parent first enrolls in Medicare Part B at age 65 or older, they have a six-month Medigap Open Enrollment Period. During that window:

  • They can buy any Medigap plan available in their state from any insurer
  • The insurer cannot use medical underwriting (cannot charge more or refuse coverage based on health)
  • This is the one time the entire Medigap market is open to them on equal terms

After the six months close, in most states, insurers can use medical underwriting. They can charge more, exclude pre-existing conditions, or decline to sell a policy at all. A parent with diabetes, atrial fibrillation, cancer history, or other common conditions may find Medigap unavailable or unaffordable later.

A few states have stronger protections — Connecticut, Massachusetts, Maine, New York, and a handful of others have year-round guaranteed-issue rights or other Medigap protections. In most states, the Open Enrollment Period is the only window where your parent can shop without underwriting. Skipping it because your parent feels healthy at 65 is a decision that affects their options at 80.

Why premiums rise. And how to plan for it.

Even on a community-rated or issue-age-rated plan, premiums rise. The drivers:

  • Medical inflation. Healthcare costs rise faster than general inflation. Medigap premiums rise with them.
  • Aging into a higher-cost state, if relevant. Plans aren’t portable; if your parent moves to a higher-cost state, premiums change.
  • Insurer rate filings. Insurers periodically file rate increases with state regulators. Even community-rated plans see increases.

A reasonable expectation is 3–8% annual premium increases for most Medigap policies, occasionally higher in high-utilization years. Over a 20-year retirement, the trajectory of premium increases compounds — which is why the choice of pricing method (community vs. issue-age vs. attained-age) matters more than it appears at the moment of enrollment.

How to shop Medigap well.

Six things that matter more than the marketing materials:

  1. Use Medicare’s Plan Finder — the official comparison tool at Medicare.gov. Lists all Medigap plans available in your zip code, all insurers, all premiums.
  2. Sit with a SHIP counselor. Free, unbiased, and they’ll walk through plan letters, pricing methods, and insurer histories with you. (Find your state SHIP.)
  3. Ask each insurer which pricing method they use. Community-rated, issue-age-rated, or attained-age-rated. Often not on the brochure.
  4. Ask about household discounts. 5–12% off if both spouses enroll. Often not mentioned proactively.
  5. Look at the insurer’s rate increase history, not just the current premium. State insurance departments publish this; ask your SHIP counselor for guidance.
  6. Buy during the Open Enrollment Period. The six months starting when your parent enrolls in Part B at 65 or older. Underwriting-free. Don’t skip this window.

“Identical coverage, different prices. Two 65-year-olds on the same Plan G in the same state can pay premiums that differ two or three times. That spread isn’t a quirk — it’s the central feature of how this market works.”

FROM WATCHING THE OPEN ENROLLMENT WINDOW MATTER:

Of all the Medicare-related things I learned across fifteen years of helping parents and stepparents through this system, the one I’d most want to put on a billboard is this: the Medigap Open Enrollment Period is a six-month window, and most adult children don’t know it exists until it’s already closed.

The version of this story that plays out in countless families is the same: parent turns 65, picks a Medicare Advantage plan because the premium looks lower, feels fine for a decade, then around 75 or 78 a serious diagnosis arrives, and suddenly they want the broader provider access of Original Medicare with Medigap. That’s the moment they discover that getting a Medigap policy in their state, with their now-existing health conditions, is either dramatically more expensive or simply not offered.

The choice they made at 65 — feeling young, feeling healthy, feeling like the cheaper plan made sense — locked them into the path they’re now stuck with.

What I wish more adult children knew, and what I’d want every family I work with to know going into Medicare eligibility: the Medigap Open Enrollment Period is a one-time gift from the system. Six months, no medical underwriting, every plan available on equal terms. Use it, even if your parent feels healthy. A modestly priced Plan G or Plan N during that window is insurance against the version of your parent’s life ten years from now, when health is more complicated and the underwriting door has closed.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes building the financial structure that gives them options when their needs change — not just the cheapest option at 65. The pricing-method choice (community-rated vs. attained-age-rated) and the open-enrollment timing are the two leverage points that determine whether your parent has Medigap at 80 — and whether they can afford it.

The version of this post if I had to pick.

If your parent is approaching 65 and choosing between Original Medicare + Medigap and Medicare Advantage, this is the version of the math that matters:

  • The premium difference between MA and Original Medicare + Medigap is real — but smaller than the brochure suggests once you add Part D and account for prior-authorization risks on the MA side.
  • The pricing-method decision (community-rated vs. attained-age-rated) is more consequential than most agents emphasize.
  • The Open Enrollment window is non-renewable. If your parent doesn’t enroll in Medigap during their first six months on Part B, in most states, they may never be able to get it on the same terms again.

Use the SHIP counselor. Use Medicare.gov’s Plan Finder. Ask the right questions. The Medigap market rewards the families who shop carefully — sometimes by thousands of dollars a year, every year, for the rest of their parent’s life.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through the Medicare enrollment timeline, the doctor-and-medication worksheet, and the annual review cadence — built so the Medigap decision is made well the first time and reviewed appropriately year over year.

See the toolkit →

Some additional articles that might be helpful:

Some additional notes:

Premium ranges ($120–$220/month for Plan G; spread of $90–$300 in same zip code) are illustrative.  The most current data should come from Medicare.gov Plan Finder.

The Part B deductible figure (~$257 in 2025) changes annually. Verify against the current year’s Medicare.gov costs page.

The state-specific Medigap protections list (CT, MA, ME, NY, plus a handful of others) is approximate and changes periodically as states pass legislation. Verify the current state-by-state landscape at the National Association of Insurance Commissioners or via your state SHIP.

The 3–8% annual premium increase range is a reasonable historical estimate but premium trends shift over time. This is not a guarantee, validate it before making any decisions.

The “Plan C and F no longer sold to new enrollees” rule is stable federal policy from MACRA (effective January 1, 2020). This may change so verify before making any decisions.

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Why Siblings Fight Over Inheritance and How to Avoid It

Here’s the part most articles about inheritance disputes miss: siblings don’t fight about money.

They fight about money. The fight is about money the way a family argument at Thanksgiving is about who set the table. The thing on the surface is real, but it’s standing in for something underneath that’s been there for forty years.

The thing underneath is usually some version of: who did Mom love most, who got more attention growing up, who stayed close, who moved away, who gave up parts of their life to help and who didn’t, who was acknowledged for it and who wasn’t. The will is the moment all of that becomes legible — written down, in dollars and houses and rings and accounts. The number on the page becomes the answer to a question the family never asked out loud.

This post is about that. The real reasons siblings fight about inheritance, the patterns that produce most of the conflict, and what families can do — both before and during the moment — to keep the legal moment from rewriting the relationships.

If you haven’t read it, the legal-mechanics companion: Probate Court Basics for Inheritance Disputes. This post is the human-dynamics version of the same problem.

What siblings actually fight about.

Five patterns surface in almost every contested estate I’ve watched or read about.

1. The caregiver-distance gap. One sibling did the heavy lifting — daily phone calls, hospital admissions, medication management, the cold rooms at 3 AM, the conversations with the discharge planner. The other siblings lived farther away, called less, helped less. When the will distributes equally, the caregiver feels punished. When the will distributes unequally, the distance siblings feel attacked. Both versions produce conflict. The version that doesn’t is the one where the family talked about it explicitly while the parent was alive — and the parent’s intent (and the recognition of the caregiver’s contribution) was clear before any document needed enforcing.

2. The “Mom always said” phenomenon. A specific item — the wedding ring, the dining room table, the cabin on the lake, the family photographs — that one sibling believes was promised to them. The other siblings remember either no such promise or a different one. None of those promises are in writing. When the will doesn’t address the item specifically, or addresses it differently than the verbal promise, the fight starts. Sometimes it’s the most expensive item. More often it’s the smallest sentimental thing.

3. Perceived favoritism, decades old. “You were always Dad’s favorite.” “Mom never forgave me for moving away.” “You got the wedding paid for; I didn’t.” The will becomes the venue for grievances that have nothing to do with the will. The distribution doesn’t have to actually be unequal — it just has to land in a family that already feels unequally loved.

4. Late-life relationships and step-family. A second marriage, a romantic partner late in life, step-children, half-siblings — any of these change the inheritance math in ways the original family didn’t expect. Children of a first marriage often feel that any assets going to a late-life spouse or step-children represent something taken from them. The fight tends to be more about identity (“who is the real family?”) than dollars.

5. The executor as proxy for the conflict. One sibling is named executor. The others now perceive every decision — sell the house or keep it, distribute the personal effects how, pay this debt or contest it — as biased. The executor, even when behaving cleanly, becomes the lightning rod for the underlying family conflict. Family-member executors face this scrutiny far more than professional executors do.

The thread connecting all five: the inheritance moment is the moment a lifetime of family dynamics becomes legible in a legal document. The will writes down what was previously only felt. The fight that follows is the fight the family has been having quietly for forty years, but couldn’t name.

What “fair” actually means.

A common assumption that produces most fights: that “fair” means “equal.” It often doesn’t.

Equal distribution divides the estate into identical shares for each beneficiary. It treats everyone as if they had identical relationships with the parent and contributed identically to the parent’s life. That’s almost never true. The caregiver who gave up career trajectory to help didn’t have the same relationship as the sibling who flew in twice a year. The sibling who borrowed $80,000 fifteen years ago and never paid it back didn’t have the same financial relationship as the sibling who didn’t.

Equitable distribution adjusts for those differences. The caregiver gets compensated for years of unpaid labor. The sibling who borrowed money has it deducted from their share. The disabled grandchild gets a Special Needs Trust. The college tuition the parent paid for one child counts against that child’s share if the parent intended it to.

Neither approach is right or wrong. What matters is that the parent decides which approach reflects their wishes, documents it specifically, and ideally talks to the family about it while alive. Equal distributions can be fair. Unequal distributions can be fair. Disputes happen when the family can’t tell which one the parent intended, or when the parent’s intent contradicts what the family expected.

Prevention. The conversations that work.

Most inheritance disputes are preventable. The patterns that prevent them, in order of leverage:

1. Talk while everyone’s alive. This is not a single conversation. It’s a series of conversations, over years, in low-stakes moments. “Mom, what’s most important to you about how things get distributed?” “Dad, do you want me to know what’s in the will so I can plan?” “Have you thought about how to handle the cabin?” The parents who answer these questions out loud, even imperfectly, produce families that don’t fight after they’re gone. The parents who keep everything private produce families that fight.

2. Address the caregiver-distance gap directly. If one sibling has done meaningfully more caregiving, the conversation about how that’s recognized — financially, in the will, or symbolically — should happen explicitly. Not by surprise in the document, but openly with all the siblings. The recognition can take many forms: an explicit additional bequest, a reimbursement clause, a written acknowledgment, a different distribution of personal effects. What matters is that everyone knew it was coming.

3. Document personal effects. Most fights I’ve watched about specific items would have been prevented by a one-page list with names next to objects. Mom’s ring → Sister. Dad’s watch → Brother. The dining room table → Local nephew. Most parents resist doing this, partly because it forces them to play favorites, and partly because the items don’t feel important enough to specify. They become important the moment the parent is gone. Write it down.

4. Consider a family meeting while the parent is alive. A facilitated conversation where the parent explains, in broad terms, what the plan is and why. Not a reading of the will. A statement of intent. “Here’s what I’m thinking. Here’s why. I want you all to hear it from me, not from the lawyer after I’m gone.” The mediator can be an elder law attorney, a family therapist, a financial planner, or a trusted friend. The version that works is one where the parent speaks; the version that doesn’t is one where the children speak for the parent in their absence.

5. Pick the executor for the relationships, not the resume. The right executor is responsive, even-handed, organized, and respected by all the siblings. Sometimes the most successful sibling is the wrong choice because of underlying family dynamics. Sometimes a professional executor (a bank trust department, an attorney) is the right call even though it costs more — because the neutrality is worth more than the savings. Talk to the parent about who they’re considering and why.

6. Update everything after life events. A new marriage, a divorce, a new child or grandchild, a death of a beneficiary, a major financial change — any of these calls for an estate review. A 25-year-old will that names an executor who has since passed away is worse than no will. So is a beneficiary designation that names a long-divorced spouse.

During the moment, if a dispute is starting.

If you’re already inside a dispute or feel one coming:

Slow down. Most disputes escalate because someone moves too fast — a sibling who clears the parent’s house in a weekend without consulting the others, an executor who sells assets before the family agrees, a beneficiary who threatens litigation in the first family conversation. The speed of the response usually makes the dispute worse. Most things can wait two weeks.

Name what’s actually happening. Often the surface dispute is about a specific item or decision. Underneath, it’s about something older. Saying the underlying thing out loud sometimes dissolves the surface dispute entirely. “I think we’re fighting about the house, but I think this is really about who Mom listened to.” Naming it doesn’t always fix it. But it changes the conversation.

Bring in a mediator before you bring in a lawyer. Family mediators specialize in exactly this. They’re cheaper than litigation, faster, and produce outcomes that preserve relationships. Most probate attorneys will recommend mediation before they recommend court. Take the recommendation. See Roles of Elder Law Attorneys in Caregiving for context on the legal side.

Consider what the parent would have wanted. The honest version, not the version that supports your position. If your parent could see the family fight you’re in right now, would they recognize the family they raised? That question is worth asking before any escalation.

Decide what you can live with. A pyrrhic victory in court that estranges siblings for thirty years is not a win, even if you get the larger share. Money you spend the rest of your life regretting isn’t money. Some battles aren’t worth fighting even when you’d win.

“Siblings don’t fight about money. They fight about money. The fight is about money the way a family argument at Thanksgiving is about who set the table.”

FROM A SISTER WHO MADE IT EASIER:

Across fifteen years of caregiving for parents and stepparents, I had one structural advantage that not every adult-child caregiver has: my sister and I worked together.

She was older, more familiar with the systems, and the one who walked me through the Medicaid eligibility math before my stepmother entered the skilled nursing facility. The reason our family didn’t have inheritance disputes wasn’t that we had simpler estate situations than other families. It was that we were aligned long before any documents needed enforcing. There were four of us but only two engaged in caring for our parents, the others were not capable or didn’t want to be involved. We accepted that and moved on.

What I’ve watched in other families — the families I’ve worked with through ElderHonor and the families I’ve watched as a friend or relative — is the version where siblings aren’t aligned. Where one is local and exhausted, the others are distant and unaware or not engaged. Where promises were made decades ago that nobody wrote down. Where a late-life remarriage rewrote the math without anyone in the family acknowledging it. The fights I’ve seen weren’t really about money. They were about the things underneath the money.

One pattern I keep seeing: the siblings who fight hardest after the parent is gone are usually the ones who never figured out how to talk to each other while the parent was alive. The families that talked — even imperfectly, even painfully — almost never end up in court. The conversations were uncomfortable. They were also cheap. Probate litigation is expensive and slow and public, and it rewrites family relationships in ways that don’t get repaired afterwards.

If I could put one piece of advice on a billboard for adult children right now, it would be this: the inheritance conversation isn’t the conversation about money. It’s the conversation about love, and recognition, and what your parent’s life meant. Have that conversation. Have it more than once. Have it before there’s a document to fight over.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes honoring the family we’ll have to live in after they’re gone. The siblings who fight over the will are usually the siblings who didn’t have the harder conversations earlier. The siblings who don’t fight are usually the ones who did.

The longer view.

Inheritance disputes have a half-life. The legal proceedings end. The financial outcomes settle. What lasts is the family relationship the dispute leaves behind.

The siblings I’ve seen reconcile after a contested estate were the ones who pulled back before the litigation got too far. The siblings I’ve seen permanently estranged were the ones who let the legal fight run its course. You usually can’t unwind years of court filings, depositions, and accusations. The damage you do during the dispute is the damage you live with afterwards.

That’s worth weighing against any specific outcome you might be fighting for.

Where to start today.

If your parent is alive and there’s no inheritance plan in place — or the plan in place is private and the family hasn’t discussed it:

  1. Have the conversation. Not all of it at once. A series of conversations over time. “Have you thought about how things get distributed?” in a low-stakes moment.
  2. Pull the existing documents — wills, trusts, beneficiary designations — and verify they reflect current intent.
  3. Consider a family meeting with all the adult children present, where the parent explains the plan in broad terms.
  4. Document the things the will doesn’t cover — personal effects, sentimental items, specific bequests.
  5. Update everything every five years and after any major life event.

If a dispute is already starting:

  1. Pause before escalating. Two weeks is rarely too long.
  2. Name what’s actually happening. Sometimes the surface dispute is downstream of something deeper.
  3. Find a mediator before a litigator. Most disputes resolve faster, cheaper, and more cleanly through mediation.
  4. Talk to a probate attorney about your standing before you commit to litigation. Strong-feeling and strong-position aren’t the same thing.

You’ve got this.

The toolkit’s Conversations and Documents modules walk through the conversation framework, the family-meeting prompts, and the document checklists that prevent most inheritance disputes from ever starting — built so the family that comes through the loss is still a family.

See the toolkit →

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Roles of Elder Law Attorneys in Caregiving

Most adult children find an elder law attorney the way most people find a plumber: in a panic, the day the floor floods.

The crisis is usually one of three: a parent’s hospital admission with a Medicaid clock starting; a sudden cognitive decline that exposes how little legal authority the family has; or an inheritance dispute that’s already in the air by the time anyone uses the word “lawyer.” In all three cases, the family hires the attorney to fix something that would have been faster, cheaper, and less painful to prevent.

This post is the version of the conversation you can have before the floor floods. What an elder law attorney is. What they actually do. When the call is worth it. How to find a good one. And the specific way an attorney earns their fee — sometimes many times over.

What an elder law attorney is.

Elder law attorneys specialize in the legal issues that affect older adults and their families. The specialty overlaps with estate planning but goes well beyond it.

A traditional estate planning attorney focuses on what happens after death — wills, trusts, beneficiary designations, probate avoidance. An elder law attorney handles those things, plus what happens during the long stretch of aging before death — Medicaid planning, capacity issues, advance directives, long-term care strategy, special needs planning, guardianship, and elder abuse.

For a family caregiving for an aging parent, the second cluster matters more than the first. The estate-planning side rarely changes how care actually unfolds. The elder-law side often makes the difference between a family that has options and a family that doesn’t.

If your parent already has a “regular” estate planning attorney, that’s a good start. It’s not the same as having an elder law attorney, and the difference can matter once your parent’s situation involves long-term care, Medicaid, capacity questions, or sibling disputes.

What an elder law attorney actually does.

Six core services that come up most often in caregiving situations:

1. Medicaid planning and asset protection. This is the highest-leverage service most families don’t realize is available. Properly structured irrevocable trusts, caregiver agreements, spousal asset transfers, and timing strategies can preserve significant family resources while still achieving Medicaid eligibility for long-term care. The 5-year look-back makes early planning dramatically more valuable than crisis planning. See 5 Steps to Combine Medicare and Medicaid for Long-Term Care for the broader sequence this fits into.

2. Powers of attorney and advance directives. A Durable Power of Attorney (DPOA) for finances and a Health Care Power of Attorney (HCPOA) for medical decisions are the foundation documents that let an adult child act on a parent’s behalf when the parent can’t. Without them, the family has no legal authority — even if everyone agrees on the right course of action. State-specific HIPAA releases, living wills, and POLST/MOLST forms (Physician Orders for Life-Sustaining Treatment / Medical Orders) round out the package. An elder law attorney drafts these to your parent’s specific situation, not from a generic online template.

3. Capacity evaluations and the framework around them. When cognitive decline is in question, families need a defensible answer to “is mom still capable of making this decision?” An elder law attorney coordinates capacity evaluations, knows which decisions require which level of capacity (signing a will requires less than executing a complex trust), and structures decision-making to preserve your parent’s autonomy as long as possible.

4. Guardianship and conservatorship. If a parent loses capacity without adequate POAs in place, a court-appointed guardianship may be the only path to making decisions on their behalf. Guardianship is heavy machinery — court oversight, annual filings, restrictions on the guardian’s authority. Done well by an attorney who handles them often, it works. Done poorly, it becomes a years-long expensive ordeal. Avoiding guardianship through proper POA setup is one of the highest-value legal moves an elder law attorney makes.

5. Special needs planning. If your parent has a disabled adult child, or if your parent is on government benefits that asset transfers could disrupt, a Special Needs Trust (SNT) preserves benefit eligibility while allowing supplemental support. The structures are technical and the consequences of getting them wrong are large.

6. Elder abuse and financial exploitation. Elder financial exploitation is a documented and growing problem (National Council on Aging, Elder Abuse Statistics). When a parent has been targeted by a scam, when a caregiver or family member is exploiting them financially, when a romantic partner late in life is rewriting beneficiary documents — an elder law attorney is the right professional to bring in. They know how to unwind transfers, how to document patterns, and how to coordinate with Adult Protective Services (APS) and law enforcement when needed.

When to hire one.

Six triggers that should send you to an elder law attorney within the next 30 days:

  • Your parent’s care needs are accelerating and you don’t yet have a long-term plan.
  • Your parent has meaningful assets and Medicaid may eventually be needed (the 5-year look-back rewards early planning).
  • Your parent doesn’t have a Durable Power of Attorney or Health Care Power of Attorney — or the documents they have are 15 years old and may not reflect their current wishes.
  • Your parent is showing signs of cognitive decline — even mild — and capacity questions may be on the horizon.
  • There’s family conflict about your parent’s care, finances, or future.
  • Your parent has been the target of financial exploitation, scams, or coercive influence.

If two or more of those apply, you’re already past due. Don’t wait for the call from the discharge planner or the bank.

How to find a good elder law attorney.

Three sources that produce good attorneys:

  • National Academy of Elder Law Attorneys (NAELA) — the professional association for elder law specialists. Their member directory is searchable by location.
  • Certified Elder Law Attorney (CELA) — a credential awarded by the National Elder Law Foundation. Fewer than 500 CELAs exist nationwide, but if you have one in your area, it’s a strong signal.
  • Area Agency on Aging (AAA) — most local AAA offices maintain referral lists of vetted elder law attorneys in the community.

The state bar association’s lawyer referral service is a backup if the above don’t yield options in your area, but the matches tend to be less specialized.

What to expect cost-wise.

Elder law fees vary widely by region and by complexity:

  • Initial consultation — many attorneys offer 30 to 60 minutes free or for a modest flat fee ($100–$250).
  • Estate plan package (will, POAs, advance directives, HIPAA release) — typically a flat fee of $1,500 to $4,000 for a couple, depending on complexity and region.
  • Medicaid planning — usually flat fees in the $5,000 to $15,000 range, sometimes higher for complex cases involving trusts, business interests, or significant assets.
  • Hourly work for ongoing matters — typical ranges run $300 to $500 per hour, higher in major metro markets.

For a family with meaningful assets, the cost is almost always small relative to what’s preserved. A $10,000 Medicaid planning engagement that preserves $200,000 in family assets has paid for itself 20 times over. The math is rarely close.

For a family with modest assets, the right move is usually the estate plan package and the AAA’s free Medicaid eligibility screening — full Medicaid planning may not pay back the engagement cost.

Ask for the fee structure in writing before any work begins. A good elder law attorney will provide it without resistance.

How to prepare for the first meeting.

Bring or have available:

  • A list of your parent’s assets — accounts, properties, investments, life insurance, retirement
  • A list of your parent’s income sources — Social Security, pension, retirement distributions
  • Existing estate planning documents — wills, POAs, advance directives, trusts
  • Your parent’s Medicare card and current health insurance information
  • A list of close family members and their roles in your parent’s life
  • A clear statement of what you’re trying to accomplish

The clearer you are about your goals, the more leverage you get from the attorney’s hourly rate. Coming in vague costs money. Coming in specific saves it.

Questions to ask.

Five questions worth asking on the first call or first visit:

  1. “How much of your practice is elder law?” Look for at least 50%. Some general estate-planning attorneys list elder law as a service but rarely handle complex Medicaid or guardianship matters.
  2. “Are you a NAELA member, and are you a CELA?” Strong signal of specialization. Many excellent attorneys are not CELAs, but a NAELA membership suggests engagement with the field.
  3. “Have you handled cases like ours before?” Listen for specific examples. Generic answers suggest less hands-on experience.
  4. “What’s the fee structure for what we’re describing?” A clean answer on this in the first meeting is itself a quality signal.
  5. “What would you do if you were in our shoes?” This question separates attorneys who think strategically about your situation from attorneys who answer narrow legal questions in isolation.

Red flags to watch for.

  • Pressure to act immediately without a clear explanation of why
  • Reluctance to commit to a fee structure in writing
  • Promises of guaranteed outcomes — Medicaid eligibility, asset protection, court rulings — outcomes are never guaranteed
  • Recommendations that benefit the attorney’s other business interests (e.g., financial products they sell)
  • Inability to explain the strategy in plain language — if you can’t follow what the attorney is recommending, it’s their job to make it followable

“A $5,000 Medicaid planning engagement that preserves $200,000 in family assets has paid for itself 20 times over. The math is rarely close.”

FROM THE FAMILIES THAT HIRED EARLY VS. LATE:

Across fifteen years of caregiving and the families I’ve worked with through ElderHonor, the most consistent pattern I’ve seen with elder law attorneys is the gap between families that hired one early and families that hired one in the middle of a crisis.

The early-hire families had time on their side. They could structure assets correctly. They could update Powers of Attorney before capacity questions surfaced. They could navigate the 5-year look-back as a feature, not a problem. The conversations were unhurried. The strategies were thoughtful. The bills were modest relative to what was preserved.

The crisis-hire families paid more, got fewer options, and lived with constraints that wouldn’t have existed if the same attorney had been hired three years earlier. An asset transfer that an early-hired attorney would have structured differently. A Power of Attorney that a court had to override because it was outdated. A guardianship proceeding that would have been unnecessary with the right document in place.

The lesson: the best time to hire an elder law attorney is before you need one. The second-best time is the moment you realize you do.

The pattern in my own family was the version that worked. The planning had been done early. By the time my stepmother needed Medicaid for the skilled nursing facility, the eligibility math wasn’t a scramble — it was a plan. By the time my dad followed her into the same facility, the same planning carried forward. It worked because somebody had hired the right attorney at the right time, well before anyone was sure they’d need one.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes building the legal scaffolding that gives them options when their needs change. The elder law attorney isn’t a luxury. For a family with meaningful assets or a complicated situation, the attorney’s fee is usually the smallest line in the budget compared to what they preserve.

You don’t have to be wealthy to need one.

A common reason families don’t hire elder law attorneys is the assumption that “we don’t have enough assets for this to matter.” Sometimes that’s true. Often it isn’t.

Even modest situations have legal complexity — a Power of Attorney that needs updating, a Special Needs Trust for a disabled grandchild, a beneficiary designation that’s in conflict with a will, a sibling who wants to challenge the parent’s care decisions. The estate plan package alone — wills, POAs, advance directives, HIPAA release — is worth its cost for almost any family. Full Medicaid planning is the additional service that pays back when assets warrant it.

If your parent doesn’t already have these documents in place, the estate plan package is the foundation everything else builds on. Get that done, then revisit Medicaid planning as the situation warrants.

Where to start today.

If you don’t already have an elder law attorney for your family:

  1. Search NAELA for members in your parent’s state and county.
  2. Call your local Area Agency on Aging (AAA) for referrals. (Find your local AAA via Eldercare Locator.)
  3. Schedule the initial consultation. Most are free or low-cost.
  4. Bring the materials list above and the goals list above.

The first conversation will tell you more than any blog post ever can. Most adult children leave that first meeting with a clearer picture than they walked in with. Sometimes the meeting reveals the family doesn’t need full elder law engagement — that’s a win too.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through what to gather before the attorney meeting, what questions to ask, and what to do after the engagement is in place — built so the attorney’s time is used well and the family’s plan stays current as situations change.

See the toolkit →

Some additional articles that might be helpful:

Some additional notes:

The cost ranges (estate plan packages $1,500–$4,000; Medicaid planning $5,000–$15,000; hourly $300–$500) are illustrative national ranges. They vary substantially by region and complexity. The actual range depends on your market.

The “fewer than 500 CELAs nationwide” figure should be verified against the National Elder Law Foundation before publishing — the count changes as attorneys earn or recertify.

The 5-year (60-month) Medicaid look-back is federal and stable, but the penalty calculation varies by state. Verify your state’s requirement before making any decisions.

The NCOA elder abuse statistics linked are stable annual references, but the specific numbers update periodically.

The POLST/MOLST naming varies by state — some states use POLST, some MOLST, some have proprietary versions (e.g., MOST in West Virginia). Check with your state’s requirements first.

The “50% of practice in elder law” benchmark for screening attorneys is a rule of thumb, not a regulatory standard.

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Medicare vs Medicaid: Understanding Dual Eligibility

Most adult children learn the difference between Medicare and Medicaid the hard way.

It usually goes like this. Your parent has a stroke, or a fall, or a sudden Alzheimer’s diagnosis. Medicare pays for the hospital stay and the rehab. You exhale. Then about four weeks in, the discharge planner sits you down and says, “Medicare’s coverage ends at 100 days. After that, the family is responsible for long-term care costs unless your parent qualifies for Medicaid.”

That’s the moment most families start trying to learn a system they should have been learning a year earlier.

This post is the version of that conversation you can have before the crisis. What Medicare is. What Medicaid is. Why they’re different. Why your parent might qualify for both. And what “dual eligibility” actually unlocks for the family doing the work.

The one-sentence version of each program.

Medicare is federal health insurance for people 65 and older (and for some younger people with disabilities or specific conditions). It covers doctor visits, hospital stays, prescription drugs, and a limited amount of skilled nursing or rehab care. It does not cover long-term custodial care.

Medicaid is a joint federal-state program that covers low-income individuals of all ages. For older adults, it’s the program that does cover long-term care — nursing homes, memory care, in-home aides — if your parent meets the income and asset limits.

If you remember nothing else from this post, remember the line that catches most families off guard:

Medicare pays for getting better. Medicaid pays for getting cared for.

Medicare in plain language.

Medicare has four parts. You’ll hear them as letters; here’s what each one actually does.

  • Part A covers inpatient hospital stays, some skilled nursing facility care (up to 100 days, after a qualifying hospital stay, and only while your parent is improving), hospice, and limited home health. Most people don’t pay a premium for Part A.
  • Part B covers outpatient care — doctor visits, lab work, preventive care, durable medical equipment. Most people pay a monthly premium for Part B (around $185 in 2025, higher for high earners).
  • Part C (Medicare Advantage) is a private-insurer alternative to original Medicare. Bundles A, B, and usually D, and may include extras like dental, vision, hearing, and gym memberships. We cover the tradeoffs in Pros and Cons of Medicare Advantage vs. Original Medicare.
  • Part D covers prescription drugs. Available as a standalone plan with original Medicare, or bundled into Medicare Advantage.

The single most important thing about Medicare for adult-child caregivers: Medicare’s skilled nursing benefit is not long-term care. It’s rehab. It pays for the time after a hospital stay where your parent is making measurable progress. The day they stop improving, the benefit ends. Period. This is the surprise that catches most families flat-footed.

Medicaid in plain language.

Medicaid is a means-tested program — your parent has to meet income and asset limits to qualify. The rules are set by each state within a federal framework, so the specifics vary, but the structure is similar everywhere:

  • Income limit — typically around $2,901/month for an individual in 2025, varies by state and category (Medicaid.gov / Long-Term Services and Supports).
  • Asset limit — most states cap countable assets at around $2,000 for an individual applying for long-term care Medicaid. The primary residence, one vehicle, and a small burial fund are usually exempt.
  • 5-year look-back period — Medicaid reviews asset transfers from the previous five years. Gifts, transfers below market value, or large withdrawals can trigger a penalty period during which Medicaid won’t pay for care.
  • Spousal protections — if one spouse needs long-term care and the other doesn’t, the “community spouse” can keep a portion of assets and income (the federal floors and ceilings change annually).

Medicaid covers the things Medicare doesn’t: nursing home care, memory care, in-home personal care, adult day services. For most families navigating dementia, frailty, or end-of-life care at scale, Medicaid is the program that ultimately pays the bill.

What “dual eligibility” actually means.

About 12 million Americans qualify for both Medicare and Medicaid simultaneously (Medicare-Medicaid Coordination Office, CMS). They’re called “dual eligibles,” or sometimes “duals.” If your parent is over 65 and low-income — or if their assets have been depleted by years of caregiving costs — they may be dual eligible without you realizing it.

Dual eligibility unlocks several practical benefits:

  • Medicaid pays the Medicare premiums and most cost-sharing. Part B premiums, deductibles, and coinsurance get covered. For a parent on a fixed income, this is meaningful.
  • Access to Dual Special Needs Plans (D-SNPs). These are Medicare Advantage plans designed specifically for dual eligibles. They coordinate Medicare and Medicaid benefits, offer extra services, and usually have $0 premiums. Not every region has D-SNPs available; check what’s available in your parent’s zip code.
  • Long-term care coverage. Medicare doesn’t pay for nursing homes or memory care; Medicaid does. Dual eligible patients in long-term care are typically covered through Medicaid for the residential portion and Medicare for the medical portion.
  • Lower out-of-pocket costs across the board. Most of the financial barriers to receiving care evaporate once both programs are coordinating.

Dual eligibility is the financial scaffolding that keeps a lot of older Americans cared for. Most adult children don’t know it exists until someone tells them.

The 5-year look-back trap.

If your parent has assets and you’re starting to think about Medicaid eligibility, this is the section you can’t skip.

Medicaid reviews all asset transfers in the 60 months before the application date. Gifts to family, large unexplained withdrawals, transfers below fair market value, “I’ll just put the house in my daughter’s name” — every one of those can trigger a penalty period during which Medicaid will refuse to pay for care.

The penalty is calculated by dividing the value of the transfer by the average monthly cost of nursing home care in your state. If your parent gave you $60,000 three years ago and the state’s average nursing home cost is $10,000/month, that’s six months of ineligibility — which the family pays out of pocket.

This is the area where a few hundred dollars in elder law attorney fees often saves families hundreds of thousands. The strategies that work — irrevocable trusts, properly structured caregiver agreements, spousal transfers, certain annuity arrangements — exist, but they have to be set up correctly and before the look-back window starts running. See Roles of Elder Law Attorneys in Caregiving for when to bring one in.

If you’re already inside the look-back period and your parent is going to need Medicaid soon, don’t make it worse. Don’t transfer assets in panic. Don’t move money. Talk to an elder law attorney first.

When to apply. The timing problem.

Medicaid applications take time. In most states, the processing window is 45 to 90 days for standard applications, sometimes longer for long-term care Medicaid because the asset documentation requirements are heavier.

Practical implications:

  • If your parent is on Medicare in a skilled nursing facility, start the Medicaid conversation by week three. The 100-day Medicare benefit will run out before you know it. If Medicaid isn’t already approved, the family pays out of pocket during the gap — which can run thousands of dollars per week.
  • If your parent is still at home but assets are depleting, don’t wait until they’re gone. A planned application is cleaner than a crisis application.
  • Documentation is brutal. Medicaid applications require five years of bank statements, tax returns, life insurance policies, deed records, every account your parent has, and explanations for large transactions. Start gathering documents now. The toolkit’s Documents module covers what to keep and how.

The state-by-state reality.

Federal Medicaid rules set the floor; states set the rest. Significant variations include:

  • Income limits and asset limits — most states follow the federal numbers, but a few are more or less generous.
  • HCBS (home and community-based services) waivers — these allow Medicaid to pay for in-home care instead of just nursing home care. Every state has them, but waiting lists and rules vary dramatically.
  • Spousal allowances — the amount the community spouse can keep varies between the federal floor and ceiling.
  • Estate recovery — after a Medicaid recipient dies, states are required to attempt to recover costs from the estate. The aggressiveness of recovery and the protections vary by state.

If you’re researching for your parent, start at your state’s Medicaid agency website. The toolkit’s Resource Library points to state-specific resources. National generalizations only get you so far.

What this means for the family doing the work.

If you’re an adult child caring for an aging parent, here’s the practical lens:

  • If your parent has significant assets, plan early. Elder law attorney, irrevocable trust if appropriate, asset protection strategies set up well before any 5-year look-back window matters.
  • If your parent has modest or depleted assets, dual eligibility is probably in your future — and the sooner you understand the path, the less crisis-driven the application becomes.
  • If your parent is already in care and you’re scrambling, prioritize the Medicaid application above almost everything else. The Medicare clock is short. Medicaid is the bridge to sustainability.
  • If your parent is healthy now, the right move is learning the system before the crisis. Read the basics. Know what Medicare covers. Know what Medicaid covers. Know what dual eligibility unlocks. The day you’ll need this knowledge is not the day you’ll have the bandwidth to learn it.

“Medicare pays for getting better. Medicaid pays for getting cared for.”

FROM LEARNING THE HARD WAY:

The first time I really understood the difference between Medicare and Medicaid was when my sister and I were getting paperwork ready for moving my stepmother into a skilled nursing facility. My sister explained to me, her younger brother, the difference and why certain assets counted and others didn’t. The administrator made several corrections as the calculations change every year and you need to keep up to date with them.

My understanding before that conversation was the understanding most adult children have: “Mom has Medicare. Medicare covers her medical care. We’re fine.” The thing nobody had explained — that nobody explains until you’re already inside the situation — is that Medicare’s nursing benefit is rehab, not care. It pays for getting better. It doesn’t pay for being unable to live alone.

Across five parents and stepparents, I lived through different versions of this conversation. Some had assets that meant Medicaid wasn’t coming into the picture. Others got there over time as care costs ground down what was saved. In every version, the families who had learned the system in advance did better — financially, emotionally, and in terms of how much choice the parent actually had about where they lived.

The families who learned it in the hallway didn’t do as well. Not because they cared less, but because they were making decisions in 48-hour windows about a system that rewards 5-year planning.

The single best gift you can give yourself as an adult-child caregiver is to learn this stuff while your parent is still healthy. Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes building the financial scaffolding that keeps them in good care without bankrupting the family doing the caring. That scaffolding is built out of knowledge, not heroics.

You don’t have to figure this out alone.

The Medicare-Medicaid system is genuinely complicated, and it’s set up in a way that rewards expertise. Three free or low-cost resources every adult-child caregiver should know:

  • State Health Insurance Assistance Program (SHIP) — every state has one. Free counseling on Medicare. They will sit with you and walk through the options. (Find your state SHIP.)
  • Area Agency on Aging — local nonprofit network that helps with Medicaid applications, benefits screening, and connecting families to services. (Find your local AAA via Eldercare Locator.)
  • Elder law attorney — for asset protection, Medicaid planning, and complex trust work. Costs more upfront. Saves more in the long run when your parent’s situation involves real assets.

You don’t need to become an expert. You need to know enough to ask the right questions and to bring in the right experts at the right time. That’s what this whole topic cluster is built to help you do.

The system isn’t going to get simpler. But your understanding can. Start now. Your future self — and your parent — will thank you.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through exactly what to gather and when, so the day a Medicaid conversation lands in your lap, you’re not starting from zero. Built so the system’s complexity doesn’t have to be yours.

See the toolkit →

Some additional articles that might help:

Some additonal notes:

The Part B premium ($185/month in 2025) and Medicaid income limit (~$2,901/month for an individual) are accurate as of mid-2025 but change annually. Verify against Medicare.gov and Medicaid.gov to get up-to-date numbers.

The “12 million dual eligibles” figure is from the CMS Medicare-Medicaid Coordination Office. The most current figures are at CMS dual eligibles page.

The 5-year look-back period is federal and stable, but the state-specific penalty calculation (average monthly nursing home cost) varies and changes. Check your state’s’ numbers before relying on any calculations.

The state-by-state Medicaid variation note is intentionally generic — every state’s specific rules require state-specific reference. Check your state’s’ numbers before relying on any calculations.

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Pros and Cons of Medicare Advantage vs Original Medicare

This is one of the higher-stakes decisions your parent will make in retirement. Most families treat it like picking a cell phone plan.

The choice between Original Medicare and Medicare Advantage shapes how your parent gets care, what it costs, which doctors they can see, how easily they can travel, and — when health declines — whether the system will say yes or no to the next thing they need. It’s reversible in theory and surprisingly sticky in practice. And most adult children only get involved in the decision after their parent has been on whatever plan they’re on for years.

This post is the version of the conversation you can have now, before the next Annual Enrollment Period, when the choice is most fluid. What Original Medicare is. What Medicare Advantage is. The tradeoffs that actually matter for caregivers. And the trap that catches families when they try to switch back.

Original Medicare in plain language.

Original Medicare is the federal program. It comes in two parts:

  • Part A covers inpatient hospital care, limited skilled nursing, hospice, and some home health.
  • Part B covers outpatient care — doctor visits, lab work, preventive care, durable medical equipment.

To turn Original Medicare into something close to comprehensive coverage, most people add two more pieces:

  • Part D — a standalone prescription drug plan.
  • Medigap (Medicare Supplement) — private insurance that fills the cost gaps Original Medicare leaves behind (Part A and B deductibles, coinsurance, and so on).

The result: a multi-policy structure that covers most things, has predictable costs, and lets your parent see almost any provider in the United States that accepts Medicare — which is the vast majority of them.

Tradeoff: higher monthly premiums (Part B + Medigap + Part D), but lower out-of-pocket costs when care is needed and almost no network restrictions.

Medicare Advantage in plain language.

Medicare Advantage (Part C) is private insurance that takes over the federal Medicare benefit. Your parent still has Medicare, but the plan is administered by a private insurer — Humana, UnitedHealthcare, Aetna, Cigna, a regional Blue plan, or one of dozens of others.

Most Medicare Advantage plans bundle:

  • Parts A and B (the federal Medicare benefit)
  • Part D (prescription drugs, usually included)
  • Extra benefits the insurer adds — dental, vision, hearing aids, gym memberships, transportation, sometimes meal benefits or over-the-counter allowances

In exchange for those extras, the plan adds:

  • A network. Most are HMOs (you must use in-network providers except for emergencies) or PPOs (in-network is cheaper, out-of-network is allowed at higher cost).
  • Prior authorizations. The insurer can require approval before procedures, specialist visits, durable medical equipment, and skilled nursing or home health.
  • An annual out-of-pocket maximum. This is one of the structural advantages of MA — Original Medicare alone has no out-of-pocket cap.

About 54% of Medicare-eligible adults are enrolled in Medicare Advantage as of 2024 (KFF, Medicare Advantage in 2024: Enrollment Update and Key Trends). It’s now the majority pathway, and the share has been climbing for over a decade.

Tradeoff: lower premiums and extra benefits, but networks, prior authorizations, and a structurally different relationship with the federal program.

The four tradeoffs that actually matter.

Pages of comparison content get written about this choice. Most of it noise. Here are the four tradeoffs that actually determine which path is better for a given person.

1. Provider choice. With Original Medicare, your parent can see virtually any provider, anywhere in the country, who accepts Medicare. That’s most of them. With Medicare Advantage, your parent is limited to the plan’s network — which can be excellent in dense urban areas and thin in rural areas. If your parent has established specialists they want to keep, check whether those specialists are in the MA plan’s network before enrolling.

2. Travel and out-of-state care. Original Medicare follows your parent anywhere in the U.S. Medicare Advantage networks are usually regional. If your parent splits time between two states, has a vacation home, or might move closer to family later, Original Medicare’s portability matters more than the brochure suggests. Snowbirds in particular hit network problems with MA plans built around their primary residence.

3. Cost predictability. Both paths have monthly premiums and out-of-pocket costs, but the structures are different. Original Medicare + Medigap is a higher monthly cost with very predictable usage costs. Medicare Advantage is a lower monthly cost but a wider variance in actual usage costs depending on what your parent uses and how the insurer adjudicates claims. For a healthy 65-year-old, MA usually looks cheaper. For an 82-year-old with multiple chronic conditions, the math often flips.

4. Prior authorizations. This is the tradeoff that gets mentioned least and matters most as health declines. Medicare Advantage plans require prior authorization for many procedures, specialty consults, durable medical equipment, skilled nursing facility stays, and home health services. Denials and delays are real. A 2023 OIG report found that 13% of MA prior authorization denials would have been approved under Original Medicare rules (Office of Inspector General, Some Medicare Advantage Organization Denials of Prior Authorization Requests). The denials disproportionately affect post-acute care — exactly the moment a frail parent needs the system to say yes quickly.

The trap: switching back is harder than switching to.

The single most important thing most adult children don’t know about this choice: moving from Original Medicare to Medicare Advantage is easy. Moving the other direction is sometimes very hard.

When your parent first enrolls in Medicare, they have a one-time guaranteed-issue right to buy a Medigap policy without medical underwriting. That window is six months long. After it closes, in most states, insurers can use medical underwriting to decide whether to sell your parent a Medigap policy — and they can decline.

The implication: a 67-year-old who picks Medicare Advantage feeling young and healthy may find, at 78 with diabetes and atrial fibrillation, that switching back to Original Medicare + Medigap is no longer affordable, or no longer available. They’ve inherited the network they signed up for years earlier.

A few states (Connecticut, Massachusetts, Maine, New York, and a handful of others) have stronger Medigap protections that allow easier switching, sometimes year-round. Check your parent’s state. In most states, the choice gets more locked-in over time, in a way the brochure doesn’t emphasize.

D-SNPs: when dual eligibility changes the math.

If your parent is dual eligible — qualifying for both Medicare and Medicaid — there’s a third option that’s worth understanding: Dual Special Needs Plans (D-SNPs). These are Medicare Advantage plans designed specifically for dual eligibles. They:

  • Coordinate Medicare and Medicaid benefits
  • Usually have $0 premiums
  • Often include extras tailored to the population (transportation to medical appointments, OTC allowances, meal benefits)
  • Have care coordinators who help navigate the dual-program complexity

D-SNPs aren’t available everywhere, and the quality varies. But for a family caregiver navigating a dual-eligible parent, a D-SNP can simplify what would otherwise be a two-program juggling act. See Medicare vs Medicaid: Understanding Dual Eligibility for the dual-eligibility framing.

What to evaluate when helping a parent choose.

Six questions that matter more than the marketing materials:

  1. Are your parent’s current doctors in the plan’s network? Specialists especially.
  2. Are the medications your parent takes on the plan’s formulary, and at what tier? Drug costs vary widely between plans.
  3. What’s the maximum out-of-pocket exposure? Both paths have it; the structures differ.
  4. What happens if your parent travels or moves? Network coverage outside the home region.
  5. What’s the prior authorization burden for the kinds of care your parent might realistically need? Specialty consults, post-hospital rehab, durable medical equipment, home health.
  6. Is your parent likely to want to switch back to Original Medicare in the future, and what would that path look like in your state? Underwriting rules, state-specific Medigap protections.

These are the questions a SHIP (State Health Insurance Assistance Program) counselor will walk through with your parent, free of charge. For a decision this consequential, an hour with a SHIP counselor is worth more than a month of comparing plans online. (Find your state SHIP.)

“Moving from Original Medicare to Medicare Advantage is easy. Moving the other direction is sometimes very hard. The choice gets more locked-in over time.”

FROM WATCHING THE CHOICE PLAY OUT:

Across my parents and stepparents, I watched the Medicare Advantage vs. Original Medicare choice show up in different ways at different times.

The pattern that stayed with me: the right plan at 65 isn’t always the right plan at 80. Health changes. Networks change. The benefits that looked best on enrollment day aren’t always the ones that matter most a decade later. The families I’ve seen do best with this decision are the ones who treat it as a choice to revisit, not a setting to lock in once.

The thing I’d tell any adult child whose parent is approaching Medicare eligibility — or already on it — is this: review the plan every year during the Annual Enrollment Period. Medicare’s open enrollment runs October 15 through December 7. Plans change benefits, networks, formularies, and prior authorization rules every year, sometimes substantially. The plan your parent picked three years ago may not be the same plan it was when they picked it.

An hour with a SHIP counselor every fall, looking at your parent’s medications, doctors, and likely care needs against the current year’s plan options, is one of the highest-leverage uses of your time as an adult-child caregiver. It costs nothing. It often saves thousands.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes making sure the financial structure under their care is the right one for who they are now — not who they were when they signed up. The Medicare decision isn’t one decision. It’s a yearly conversation. The families that treat it that way come out ahead.

The version of this post if I had to pick.

If your parent is healthy, has assets, doesn’t travel much, and lives in a region with a strong MA network they like, Medicare Advantage often makes sense. The lower premiums, extras, and out-of-pocket maximum are real benefits.

If your parent has significant chronic conditions, sees specialists outside what would be a typical MA network, travels, splits time between states, or values predictability and provider choice over premium savings, Original Medicare with Medigap and Part D is usually the better long-term path — and the easier path to maintain into the years where health complications make underwriting difficult.

There’s no universal right answer. But the questions above — provider network, drug formulary, out-of-pocket exposure, travel, prior authorization burden, switching difficulty — are the ones that produce the right answer for a specific family.

Use the SHIP counselor. Review the plan annually. Don’t assume the choice your parent made years ago is still the right one. You’ve got this.

The toolkit’s Documents and Roadmap modules walk through the Medicare review checklist, the doctors and medications worksheet, and the annual-enrollment cadence — built so the choice can be revisited every year without restarting from scratch.

See the toolkit →

Additional articles that might be helpful:

Some additional notes:

The 54% Medicare Advantage enrollment figure is from KFF’s 2024 enrollment update. Enrollment shifts annually so this number changes frequently, verify for yourself before relying on any numbers.

The OIG report on prior authorization denials (13% of MA denials would have been approved under Original Medicare rules) is from the 2022 report published in 2022 and most recently referenced in 2023 follow-up work.

The Annual Enrollment Period dates (October 15 through December 7) are stable but Medicare also has a Medicare Advantage Open Enrollment Period (January 1 through March 31) that allows MA-to-MA or MA-to-Original switching.

The state-by-state Medigap protection variation note is intentionally generic. Verify the current rules in your state before relying on any numbers.

Medigap underwriting rules also vary by state. The general statement that “in most states, insurers can use medical underwriting” is accurate, but a few states have stronger protections that should not be overgeneralized. Verify the current rules in your state before relying on any numbers.

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Living Wills: A Guide for Caregivers

A living will is the document that tells the rest of us what your parent wants when your parent can’t say it themselves.

It is one of the most consequential pieces of paper a family can have, and one of the most frequently absent. Adult children who would never let their parent leave for a road trip without insurance regularly let their parent walk into a stage of life that has higher stakes — a stage in which decisions about ventilators, feeding tubes, resuscitation, and palliative care will be made by somebody — without ever having the conversation about who decides, and what should be decided.

This post is the version of the conversation you can have now, while everyone is healthy. What a living will is. What it isn’t. How it works alongside the Health Care Power of Attorney (HCPOA). The conversation that turns a blank form into a real plan. And the realities every caregiver should understand before the moment arrives.

If you haven’t read it, the foundational read: Estate Planning Checklist for Adult Children.

What a living will is.

A living will is a written legal document that states a person’s wishes about life-sustaining medical treatment in situations where they can no longer communicate those wishes themselves. Most living wills cover:

  • Resuscitation — whether your parent wants cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing.
  • Mechanical ventilation — whether your parent wants to be placed on a breathing machine, and under what conditions.
  • Artificial nutrition and hydration — feeding tubes and IV fluids when natural eating and drinking are no longer possible.
  • Dialysis — kidney support when the kidneys fail.
  • Antibiotics and aggressive medical treatments in advanced disease states.
  • Pain management and comfort care preferences, including how aggressive palliative care should be.
  • Organ and tissue donation preferences.

It is a statement of wishes, not a person. The person who carries those wishes into the room with the doctor is the Health Care Power of Attorney (HCPOA, sometimes called a healthcare proxy or surrogate). You need both documents. The living will tells the proxy what to advocate for; the proxy makes sure those wishes are heard and followed.

What a living will isn’t.

Three confusions worth clearing up before you sit down with your parent:

A living will is not a will. A regular will distributes assets at death. A living will speaks during life — about medical care when the patient can’t speak for themselves. They’re entirely separate documents.

A living will is not a Do Not Resuscitate (DNR) order. A DNR is a medical order signed by a physician based on the patient’s wishes. The living will may guide the DNR conversation, but the DNR itself is a clinical order written into the medical record. Some states use POLST or MOLST forms — Physician Orders for Life-Sustaining Treatment / Medical Orders for Life-Sustaining Treatment — to translate the living will’s wishes into actionable physician orders. Ask the doctor whether your parent’s state uses these.

A living will is not a permission slip. It doesn’t give your parent’s HCPOA authority to make decisions outside what’s documented. The HCPOA fills the gaps the living will can’t anticipate, guided by the living will’s wishes — but the legal authority to act flows from the HCPOA document, not the living will.

How the living will and the HCPOA work together.

If you remember nothing else about end-of-life documents, remember this pairing.

The Living Will documents what your parent wants. Specific scenarios, specific treatments, specific yes-or-no preferences.

The HCPOA names who speaks for your parent. The person who walks into the hospital, sits with the doctor, asks the questions, and makes the call when the document doesn’t anticipate the exact situation.

In every real-world end-of-life situation, both documents work together. The HCPOA reads the living will, considers the current medical reality (which is rarely identical to anything the document explicitly addressed), and makes the closest decision to what your parent would have wanted. The living will gives the HCPOA the standing to say “This is what Mom wanted” with paper to back it up. The HCPOA gives the living will a voice that can adapt to the actual room.

Without the living will, the HCPOA is making decisions in a vacuum.
Without the HCPOA, the living will is a document nobody is empowered to enforce.
You need both.

The conversation behind the document.

The biggest mistake families make with living wills is treating them as paperwork. A living will signed without a conversation is a document that fails the moment it’s needed.

The conversation matters more than the form. Some questions worth asking your parent, when the time is right:

  • “If you had advanced dementia and stopped eating, would you want a feeding tube?”
  • “If a stroke left you unable to speak or move, but breathing on your own, what would matter to you?”
  • “If you were on a ventilator and the doctors said the chances of recovery were very low, how should we think about when to stop?”
  • “What does ‘quality of life’ mean to you? What’s the line between living and just being kept alive?”
  • “What kinds of pain or limitations would be unacceptable to you?”
  • “Where do you want to be when you die — at home, in a hospital, in hospice?”
  • “What are you most afraid of, when you think about end-of-life care?”

These are not easy questions. They’re easier than the same questions in an ICU at 3 AM. Have them on the back porch, on a road trip, after dinner. Have them more than once over the years; preferences change with age and life experience.

Then translate the answers into the document, with an elder law attorney if the situation warrants it, or with the standard state-issued forms if the wishes are straightforward.

What the document should actually say.

A few drafting realities the families I’ve worked with consistently report:

Be specific where you can be. “No life-prolonging treatment if I’m in a permanent vegetative state with no reasonable chance of recovery” is more actionable than “I don’t want to be a vegetable.” Specific is enforceable. Vague is interpretable.

Address dementia explicitly. Most boilerplate living wills focus on the ICU patient on a ventilator. Dementia is a much more common end-of-life trajectory than most families plan for — and the document needs to address feeding, hydration, antibiotics, and hospitalizations in late-stage dementia specifically, or the HCPOA is left guessing.

Name comfort care preferences. Pain management can be aggressive (focused on relief, even if it shortens life slightly) or conservative. State your parent’s preference. Most families regret not having had this conversation.

Address organ and tissue donation. Even if it doesn’t feel like a major decision now, the documentation matters when the moment arrives.

Date the document and revisit it. A living will signed at 60 may not reflect what your parent wants at 80. Review every five years, and after any major medical event or diagnosis.

Where to keep it.

Three places, minimum:

  • The original in your parent’s binder of estate documents, alongside the HCPOA, will, and other key paperwork. (See the Estate Planning Checklist post for the full binder.)
  • A copy with the HCPOA so they have it in their own hands when needed.
  • A copy with the primary care physician, included in the medical record. Most physicians will scan it into the chart on request.

If your parent has a hospital they typically use, send a copy to that hospital’s medical records department and ask them to scan it into the system. Hospitals that have it on file follow it; hospitals that have to guess usually don’t.

For traveling parents or those who split time between locations, carry a copy in a clearly labeled folder in the car or a wallet card noting where the document is and who the HCPOA is.

What can go wrong without one.

A few of the patterns families face when there’s no living will in place:

  • The hospital follows default state hierarchy. In the absence of a clear directive and an HCPOA, decisions fall to the next-of-kin order specified by state law — which may be a spouse, then children, then siblings. Disagreements among kin are common; the hospital often defaults to the most aggressive treatment in the absence of consensus, because that’s the safest legal position for the institution.
  • The aggressive default kicks in. Without documented wishes, the medical default is to do everything — full resuscitation, intubation, ICU admission, prolonged life support — because the legal liability for under-treating is much greater than for over-treating. Many parents would not have wanted what the default produces.
  • The family fragments. End-of-life decisions made under pressure, by a family that hasn’t had the conversation, are a leading source of post-death sibling estrangement. The living will doesn’t just protect your parent. It protects the family.

The conversations behind specific scenarios.

Three scenarios worth thinking through with your parent before they’re hypothetical:

Advanced dementia where eating becomes difficult. Late-stage dementia patients often stop eating naturally. Feeding tubes can extend life but are well-documented to not improve quality of life and to introduce additional complications (American Geriatrics Society position on feeding tubes in advanced dementia). Your parent should have a documented preference here. Most don’t.

Stroke that leaves the patient unable to speak or move but conscious. This is a wide range of outcomes. Document what level of disability your parent would consider acceptable, and what level would not.

A terminal diagnosis with treatment options that would extend life but not cure. Chemotherapy that buys six months. Surgery with a 30% chance of working and a 70% chance of leaving them weaker. Document the framework your parent uses to think about these tradeoffs.

“A living will signed without a conversation is a document that fails the moment it’s needed. The conversation matters more than the form.”

FROM THE CONVERSATIONS WE DIDN’T HAVE EARLY ENOUGH:

Across my parents and stepparents, the moments where the living will and HCPOA mattered most were never the moments anyone expected.

What I learned: the families I’ve watched do well at end of life are the families that had the conversation early, more than once, when nothing was on the line. The families that struggled were the ones where the conversation kept getting deferred — “we’ll talk about it at the holidays,” “let’s not bring it up while she’s recovering,” “we have time” — until the moment arrived and there was no time, and everyone was making decisions in a hospital corridor about a parent who couldn’t tell us what they wanted.

The form itself is the easy part. Most states have free advance directive templates downloadable from the department of health. The hard part is having the conversation honestly, while there’s still time to have it.

A piece of advice that’s stayed with me from a hospice nurse I worked with: “The patients who die well are the ones whose families had the conversation. Not the patients with the longest documents — the patients with the clearest conversations behind their documents.” That has been true in every end-of-life situation I’ve watched. The paper is the formality. The conversation is the gift.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes making sure their voices are in the room when they can no longer speak — through documents that reflect their actual wishes, and through the people they trust to interpret those wishes when situations don’t fit the form. Living wills aren’t morbid. They’re the most practical love letter you’ll ever help your parent write.

Where to start today.

If your parent has no advance directive in place:

  1. Download your state’s standard advance directive form. Free from the state department of health website, or from CaringInfo (a program of the National Hospice and Palliative Care Organization). Your State might also have specific forms for this purpose.
  2. Have the conversation. Use the questions above as a starting point. Don’t try to cover everything in one sitting.
  3. Translate the conversation into the document. Specific, dated, signed in front of witnesses (and notarized if your state requires it).
  4. Distribute copies — original to the binder, copies to the HCPOA, primary doctor, and frequent hospital.
  5. Revisit every five years and after any major life or health event.

If your parent has an advance directive that’s more than ten years old:

  1. Pull the existing document and read it together. Does it still reflect what your parent wants?
  2. Update the conversation with current preferences.
  3. Refresh the document if anything has changed.
  4. Replace all distributed copies with the updated version.

You don’t need an attorney to execute a basic living will and HCPOA in most states — the standard state forms are free and adequate for most situations. You do need the conversation, the witnesses, and the distribution. The form is the easy part.

You’ve got this.

The toolkit’s Documents and End of Life modules walk through the conversation prompts, the document templates, and the distribution checklist that turns a blank advance directive into a real plan — built so the conversation happens early, not under pressure.

See the toolkit →

Some additional links that might be helpful:

Some additional notes:

Document names vary by state. “Living Will” is the most common term but several states use “Health Care Directive,” “Medical Directive,” or “Advance Health Care Directive.” The post uses “Living Will” throughout for consistency.

POLST/MOLST naming varies by state. Some states use POLST, others MOLST, others use proprietary names (e.g., MOST in West Virginia, POST in some states). Verify your state-specific name before using it in any documents.

Witness and notarization requirements for advance directives are state-specific. Refer to your state for specific guidance.

The “next-of-kin order” hierarchy in absence of HCPOA is state-specific. Refer to your state for specific guidance.

The “default to aggressive treatment” framing reflects general legal/practice patterns but may not be uniformly true across all hospitals. Verify with you healthcare provider for information specific to your situation.

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7 Common Beneficiary Mistakes to Avoid

There is no document in your parent’s estate plan that does more damage when it’s wrong than a beneficiary designation.

The will gets all the attention. People talk about it, plan around it, contest it in court. Meanwhile, sitting quietly inside every retirement account, life insurance policy, annuity, and certain bank accounts is a separate document that passes outside the will entirely and pays directly to whoever is named on the form. The beneficiary designation overrides everything. A 30-year-old form will pay an ex-spouse $300,000 the day after your parent dies, and no will, no court ruling, and no family meeting can stop it.

This post is the practical companion to Estate Planning Checklist for Adult Children and Probate Court Basics for Inheritance Disputes. Seven specific beneficiary mistakes that show up over and over in adult-child caregiving situations, what each one actually causes, and how to fix it before it costs the family.

Mistake 1 — Letting designations go decades without review.

This is the most common beneficiary mistake by a wide margin. A retirement account opened in 1985 still names the spouse from a 1990 marriage that ended in 2003. A life insurance policy from a first job names a parent who’s been dead for fifteen years. A 401(k) rollover never updated the beneficiary from the previous employer’s form.

The designation in force the day your parent dies is the designation that pays. Outdated forms produce most of the worst inheritance surprises.

The fix: Walk through every account with your parent. Pull up each beneficiary form. Verify the named beneficiaries match current intent. Update any that don’t.

Most financial institutions will let you do this online or by mailing a single form. For an adult-child caregiver helping a parent get organized, this is one of the highest-leverage afternoons you’ll ever spend.

Mistake 2 — Naming no contingent beneficiary.

A primary beneficiary is the first person who receives the asset. A contingent (or “secondary”) beneficiary receives it if the primary beneficiary has predeceased the account holder, declines the inheritance, or can’t be located.

Many families name a primary but not a contingent. When the primary has died — and your parent forgot to update the form — the asset typically reverts to the estate, which means it goes through probate, which means it pays in months, not weeks, often after legal fees.

The fix: Every account should have at least one contingent beneficiary. Many accounts allow multiple contingents at percentages that add to 100%. A married parent with adult children might name the spouse as primary and the children equally as contingent. A widowed parent might name the children as primary and grandchildren as contingent.

Mistake 3 — Naming a minor child or grandchild directly.

When a beneficiary is a minor (typically under 18, sometimes 21 depending on state), the inheritance can’t go directly to them. The court appoints a guardian or conservator to manage the funds until the child reaches majority. This adds delay, court fees, ongoing oversight, and reduces the family’s flexibility.

The fix: Name a Uniform Transfers to Minors Act (UTMA) custodian for the minor, or — better — name a trust that benefits the minor. A Revocable Living Trust (RLT) or a separate trust for the minor can hold the assets, distribute them at appropriate ages (some at 25, some at 30, some held for education), and provide much more flexibility than a single distribution at age 18.

For families with grandchildren as beneficiaries, trusts are usually the right structure. An elder law or estate planning attorney can advise on the right trust type and structure. See Roles of Elder Law Attorneys in Caregiving.

Mistake 4 — Naming a person with a disability directly.

This is one of the most expensive beneficiary mistakes for families with a disabled adult child or grandchild — and one of the most preventable.

A direct inheritance to a person on means-tested government benefits — Medicaid, Supplemental Security Income (SSI), or other needs-based programs — typically disqualifies them. Suddenly receiving $50,000 from a parent’s life insurance can make the disabled person ineligible for the benefits that pay for their housing, healthcare, and daily care. The inheritance, intended to help, ends up costing far more than it provides.

The fix: Name a Special Needs Trust (SNT) as the beneficiary, with the disabled person as the trust beneficiary. The trust can supplement (not replace) the government benefits, preserve eligibility, and provide for quality-of-life expenses the benefits don’t cover.

This is technical work that requires an attorney with special-needs experience. Get one before any beneficiary form is updated. The wrong structure can do as much damage as no structure.

Mistake 5 — Naming “my estate” as the beneficiary.

Some account holders, perhaps wanting flexibility, name “my estate” as the beneficiary of a retirement account or insurance policy.

This forces the asset through probate, which it would otherwise have bypassed. It adds time (months), cost (often 3–7% of the asset’s value in probate fees), and public exposure (probate is public record). It also can produce unfavorable tax outcomes for retirement accounts — distributions to an estate may not qualify for the longer payout periods available to a named individual or qualifying trust.

The fix: Name actual people (or properly structured trusts) as beneficiaries, not “the estate.” If the goal is to give the executor flexibility, the right structure is a properly drafted trust as beneficiary, not the estate itself.

Mistake 6 — Not coordinating designations with the will.

The will says one thing. The beneficiary designations say another. The beneficiary designations win.

This produces the most common version of the inheritance surprise: the will leaves the estate equally to all the children, but a $400,000 retirement account names only one child as beneficiary. That account doesn’t go through the estate. It pays to the named child directly. The other siblings’ “equal” share is calculated only on what’s left after the retirement account paid out — which is much less than they expected.

Sometimes this is the parent’s deliberate intent. Sometimes it’s an oversight from a long-ago beneficiary form that nobody revisited. Either way, the family doesn’t find out until after the parent has died.

The fix: Walk through every account, then read the will, then check that the two are aligned with current intent. If the parent wants something different from what the documents show, update the documents — together, with the help of an attorney for anything complex.

For families that want truly equal distribution, the cleanest path is naming a trust (or the estate, with the tradeoffs noted above) as the retirement account beneficiary, with the trust then distributing equally. A direct beneficiary designation to one child is rarely the right tool for “equal” intent.

Mistake 7 — Not updating after life events.

Marriages end. Divorces happen. Children are born. Spouses die. People become estranged. Tax law changes.

Every major life event is a trigger to revisit beneficiary designations. The most common updates needed:

  • After a divorce: the ex-spouse is often still named on retirement accounts, life insurance, and bank accounts. Some states automatically void designations to ex-spouses on death; many don’t, and federal law (ERISA, which governs many retirement plans) sometimes overrides state automatic-revocation rules.
  • After a remarriage: beneficiary intent often shifts; the new spouse may need to be added or the structure may need adjustment to balance new spouse vs. children from a previous marriage.
  • After a child’s birth or adoption: new beneficiaries to add as primary or contingent.
  • After a beneficiary’s death: the deceased beneficiary should be removed and a contingent advanced or new primary designated.
  • After major financial changes: the relative weight of accounts may have shifted in ways that affect equal-or-equitable intent.
  • After tax law changes: rules around inherited retirement accounts have changed substantially in recent years (the SECURE Act of 2019 and SECURE 2.0 of 2022 changed inherited IRA distribution rules); designation strategies that were optimal under prior law may not be now.

The fix: Set a calendar reminder every 5 years to review designations. Set a separate trigger to review immediately after any of the life events above.

A note on Transfer-on-Death and Payable-on-Death.

Two related designations that aren’t always thought of as “beneficiary designations” but function the same way:

  • Transfer-on-Death (TOD) — used on brokerage accounts, sometimes vehicles, and in some states real estate. Designates who receives the asset at the account holder’s death.
  • Payable-on-Death (POD) — used on bank accounts, savings bonds, and certain other accounts. Same mechanism.

Both pay outside probate, both override the will, both should be reviewed and updated with the same discipline as retirement and insurance beneficiary designations.

What to actually do this weekend.

If you’re an adult child helping a parent get organized:

  1. List every account. Bank, brokerage, retirement (401(k), IRA, 403(b)), life insurance, annuity, pension, employer-provided life or disability, savings bonds, vehicle titles where TOD is used.
  2. For each account, locate the beneficiary form. Most are accessible online, by phone, or by mail request.
  3. Verify primary and contingent beneficiaries. Note any that are outdated, missing contingents, or contradict the will.
  4. Identify the high-stakes ones. Largest accounts, accounts with named ex-spouses, accounts naming minors directly, accounts naming someone on government benefits.
  5. Schedule an attorney consultation for any accounts with structural issues — especially Special Needs Trust situations or large retirement accounts where current SECURE Act rules may have changed optimal designation strategy.
  6. Update the documents. Most updates are a single form, often online.

This is one afternoon of work. It can prevent the worst inheritance disputes I’ve seen, and it almost always pays for itself many times over in avoided probate, taxes, and legal fees.

“There is no document in your parent’s estate plan that does more damage when it’s wrong than a beneficiary designation. The form on file the day your parent dies is the form that pays.”

FROM THE FIFTEEN-YEAR-OLD FORM THAT REWROTE A FAMILY:

The clearest illustration I’ve ever seen of how beneficiary designations override everything else came from inside my own family.

My mom’s second husband had been married to her for fifteen years when he passed during a nap one afternoon. Full life. Full marriage. What the family didn’t know — what we found out only after the funeral — was that his life insurance still named his ex-wife as the beneficiary. The form had never been updated when he remarried.

Hundreds of thousands of dollars went to the ex-wife. The current family — my mom, the woman he’d been married to for fifteen years — had no recourse. The will didn’t matter. The marriage didn’t matter. The intent everyone in the family understood didn’t matter. The form that was on file the day he died was the form that paid.

Mom’s response, fifteen years later, was characteristic of her generation: “Too bad.” She moved on. But the lesson sat with me, and it sits with me every time I sit with a family who’s organizing their parent’s documents: a fifteen-year-old beneficiary form, never updated, can rewrite a family’s financial future in a way no probate court, no will, and no marriage can fix.

The mistakes above are not abstract. Each one of them has happened in a real family, with real money, in ways nobody saw coming. The afternoon spent walking through every beneficiary form is one of the most consequential afternoons an adult child can spend with their parent. No drama. No conflict. Just a quiet review of paperwork that, ten or twenty years later, will determine where hundreds of thousands of dollars go and whether the family stays a family.

Honor is in the name of our company for a reason: ElderHonor. Honoring our parents includes the unglamorous, important work of making sure their wishes can actually be honored when the moment arrives — through forms that are current, designations that match the will, and conversations that prevent the surprises that drive most disputes.

Where to start today.

If you’re an adult child who hasn’t done the beneficiary review yet:

  1. This weekend, sit with your parent and pull up one or two of their accounts. Just to start. The momentum builds.
  2. Make a list of all accounts you can think of. Add to it as the parent remembers more.
  3. Schedule a follow-up session to systematically work through each form.
  4. Engage an attorney if anything looks structurally complex (large retirement accounts, special needs situations, second marriages with children from a prior).
  5. Set the 5-year review as a standing calendar item.

If your parent has already passed and you’re discovering surprises:

  1. Get the actual beneficiary forms from each financial institution before assuming anything.
  2. Consult a probate attorney if a designation appears to violate the parent’s stated intent — challenges to designations are possible in some circumstances (capacity at signing, undue influence, fraud) but require proof and timely action.
  3. Don’t move money or take action without legal counsel.

You’ve got this.

The toolkit’s Documents and Roadmap modules walk through the full account inventory, the form-tracking templates, and the review cadence that catches most beneficiary mistakes before they become inheritance surprises — built so the documents stay current as the parent’s life changes.

See the toolkit →

Some additional links that might be helpful:

Some additional notes:

The SECURE Act (2019) and SECURE 2.0 Act (2022) substantially changed inherited retirement account rules — most non-spouse beneficiaries now must distribute inherited IRA balances within 10 years, with exceptions for “eligible designated beneficiaries.” These rules are evolving — the IRS has issued multiple sets of guidance and the rules have been clarified periodically. Verify current rules before making any decisions.

Probate cost estimates (3–7% of estate value) are national averages. State-specific costs vary widely, contact your state for up-to-date rates.

State-specific automatic-revocation-on-divorce rules vary. The post’s note that “many states don’t” is generally accurate, but the specific list changes. Verify with your state for specific guidance.

ERISA-governed retirement plans (most 401(k)s, some pensions) operate under federal rules that override state law in many cases — particularly the requirement that a married participant’s spouse must consent in writing to any non-spouse beneficiary. Verify with your state before making any decisions.

The “$50,000 disqualifies SSI/Medicaid” framing is the general pattern but specific eligibility math varies by program and state. Verify with your state before making any decisions.

The “court fees / probate fees” framing assumes traditional probate — small-estate procedures may bypass much of this and are available in most states for estates under a state-specific threshold. Verify with your state before making any decisions.

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