Two years after the passage of the Achieving a Better Life Experience (ABLE) Act, four states — Florida, Nebraska, Ohio and Tennessee — have ABLE plans up and running, and all but Florida allow out-of-state beneficiaries to open accounts.

States have been slow to create the appropriate regulations governing ABLE accounts, in part because the IRS and the Social Security Administration took a long time proposing regulations covering them. But now that the federal agencies have finalized their rules, it appears that more states will bring ABLE accounts online.

As you can see in this comparison chart, each state currently offering ABLE accounts differs slightly from the others when it comes to fees and funding minimums, although in most cases the charges are reasonable. All of the accounts have at least four different investment options to choose from, and Nebraska even offers a state tax deduction for contributions into an account.

We will try to keep you updated as more states begin offering plans, but for immediate updates and more information about ABLE’s rollout, you can visit the ABLE Resource Center’s website.

When people retire they often have more time to travel.  Although Medicare coverage is generally not available when beneficiaries are overseas, what about coverage for those exploring our own varied and scenic land?

If you have original Medicare, the answer is easy: you can travel anywhere in the U.S. or its territories and receive health services from any doctor or hospital that accepts Medicare.  (“Territories” includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.) The amount you will pay depends on whether the provider “accepts assignment.”  Those that take assignment agree to accept the approved Medicare amount as payment in full, although in the case of outpatient visits you or your Medigap insurer may be left with a 20 percent coinsurance, as would be the case for care at home.

Providers that don’t accept assignment may charge you up to 15 percent above the Medicare-approved amount, although this percentage may be lower in some states. In the case of providers that don’t accept Medicare at all, you will have to pay the entire cost of care.

If instead of original Medicare you are in a Medicare Advantage plan (a privately run managed care plan), the answer to the question of coverage is more complicated. Depending on your post-retirement goals, this could be a consideration in whether you choose original Medicare or an Advantage plan.

For enrollees traveling for less than six months outside their plan’s service area, Medicare Advantage plans must cover emergency and urgent care, and charges for such care that is out-of-network cannot exceed $65 or whatever you would have paid for an in-network provider.  Whether you will be covered for anything more than emergency or urgent care depends on the plan’s geographic service area, its rules about travel outside of that area, and what type of plan it is.

If your plan is of the PPO (Preferred Provider Organization) variety, it must cover care delivered by providers who aren’t in the plan’s network or service area, although you will usually pay more for out-of-network care.  Plans that follow the HMO (Health Maintenance Organization) model usually do not cover care from out-of-network providers.  If your HMO plan does cover out-of-network providers, be sure to follow the plan’s rules or you may find that you’re not covered, and you will likely pay more for the care in any case.

If you are outside your plan’s service area for six months or more, most plans must automatically disenroll you and you will be returned to original Medicare unless you choose another Medicare Advantage plan.  However, some plans will allow you to travel outside the service area for up to a year. Even if your plan has such a travel benefit, check what geographic areas and types of care are covered.  If you get care from providers not covered in the plan’s network, you may pay more or not be covered at all.

The Medicare Rights Center advises Medicare Advantage enrollees to “look at your plan benefits carefully to see what costs and rules apply when you travel within the United States or its territories.”  For more from the Medicare Rights Center on Medicare Advantage coverage if traveling within the U.S., click here.

If your plan denies you coverage, you can always appeal.  For more on Medicare Advantage appeals.

Passing down a Roth IRA can seem like a good idea, but it doesn’t always make the most sense. Before converting a traditional IRA into a Roth IRA to benefit your heirs, you should consider the tax consequences.

Earnings in a traditional IRA generally are not taxed until they are distributed to you. At age 70 1/2 you have to start taking distributions from a traditional IRA. Contributions to a Roth IRA are taxed, but the distributions are tax-free. You also do not have to take distributions on a Roth IRA.

Leaving your heirs a tax-free Roth IRA can be used as part of an estate plan.   However, in figuring out the best type of IRA to leave to your beneficiaries, you need to consider whether your beneficiary’s tax rate will be higher or lower than your tax rate when you fund the IRA. In general, if your beneficiary’s tax rate is higher than your tax rate, then you should leave your beneficiary a Roth IRA. Because the funds in a Roth IRA are taxed before they are put into the IRA, it makes sense to fund it when your tax rate is lower. On the other hand, if your beneficiary’s tax rate is lower than your tax rate, a traditional IRA might make more sense. That way, you won’t pay the taxes at your higher rate; instead, your beneficiary will pay at the lower tax rate.

Regardless of which IRA you pass on to your heirs, remember that your IRA is part of your taxable estate, so it can be subject to estate taxes if your estate is over the estate tax exemption ($5,450,000 in 2016).

Also bear in mind that the above is based on the tax rules as they now exist (August 2016).  Future tax rules regarding inherited IRAs may change, making certain strategies more or less advantageous.    

For information on what to do with an inherited IRA.

Seniors with pricier homes now have an increased ability to get a jumbo reverse mortgage in order to raise cash for retirement. As the housing market has improved, jumbo reverse mortgages are becoming more popular even though they carry some risk.

Reverse mortgages allow homeowners who are at least 62 years of age to borrow money on their house. The homeowner receives a sum of money from the lender, based largely on the value of the house, the age of the borrower, and current interest rates. The loan does not need to be paid back until the last surviving homeowner dies, sells the house, or permanently moves out. Homeowners can use money from a reverse mortgage to pay for improvements to their home, to allow them to delay taking Social Security, or to pay for home health care.

The most widely available reverse mortgage product is the Home Equity Conversion Mortgage (HECM), the only reverse mortgage program insured by the Federal Housing Administration (FHA). However, the FHA sets a ceiling on the amount that can be borrowed against a single-family house, which is determined on a county-by-county basis. The national limit on the amount a homeowner can borrow is $625,000.

High-end borrowers must look to the proprietary reverse mortgage market, which imposes no loan limits. Proprietary or jumbo reverse mortgages allow buyers to borrow millions of dollars. For example, American Advisors Group, a reverse mortgage lender, allows borrowers to obtain a reverse mortgage on properties valued up to $6 million. Qualified borrowers can borrow up to $3 million in loan proceeds. While HECM loans limit the amount a borrower can have access to in the first year, these jumbo mortgages may allow the borrower to access the entire loan right away.

The downside of a jumbo reverse mortgage is that because it is not insured, it doesn’t have to have the protections set by the federal government for HECM reverse mortgages. For example, loan counseling isn’t required and fees are not restricted. During the housing market collapse most lenders stopped offering jumbo reverse mortgages, but as the market has improved, the jumbo is returning.

A reverse mortgage is not the right step for everyone. For more information on whether to get a reverse mortgage.

For more information about the new jumbo reverse mortgages, click here.

As people approach age 65, they should be thinking about their Medicare enrollment choices, including whether to sign up for traditional Medicare or with a Medicare Advantage plan, and if so, which one. But it turns out that some Medicare-age people are having these important decisions made for them, often without their knowledge.

Before they become eligible for Medicare, many Americans are covered by a commercial or a Medicaid health care plan run by an insurance company. These insurers often also operate Medicare Advantage plans, which are the privately run managed-care alternative to traditional Medicare. Under a little-known process authorized by the federal government, insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan. It’s called “seamless conversion,” and all it requires is that the health plan obtain Medicare’s prior approval and send a letter to the beneficiary explaining the new coverage, which takes effect unless the member opts out within 60 days.

The idea is to preserve continuity for those who want to stay with the same company, but some seniors are unaware that they have been signed up, in part due to the flood of mail they get from insurers around age 65. In a recent Kaiser Health News expose, reporter Susan Jaffe related the stories of several new Medicare beneficiaries who were shocked to learn that they had been enrolled in a Medicare Advantage plan. One, Judy Hanttula of Carlsbad, New Mexico, signed up for traditional Medicare and then ignored the subsequent mail, which apparently included the notice from her insurer telling her that it had automatically enrolled her in its Medicare Advantage plan.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

Unfortunately for Ms. Hanttula, before she became aware of the automatic assignment to a Medicare Advantage plan, she had surgery that her new plan subsequently refused to cover, leaving her with a $16,622 bill. Eventually, with the help of David Lipschutz, a senior attorney at the Center for Medicare Advocacy in Washington, Medicare officials disenrolled Ms. Hanttula from her unwanted Medicare Advantage plan, restored her traditional Medicare coverage and agreed to cover her medical bills, reports Jaffe.

Medicare officials won’t say which insurance companies have sought or received approval to seamlessly convert their members to their own Medicare Advantage plans, but Jaffe reports that among the insurers that are already automatically enrolling members into Medicare plans in at least some parts of the country include Aetna and United Healthcare and that Humana, he nation’s second-largest Medicare Advantage provider, has asked for federal permission to also do auto-enrollment.

Medicare officials are developing procedures for seamless conversion requests and implementation, but in response to complaints from her constituents and health care advocates, Rep. Jan Schakowsky (D-Ill.) wants to build in stronger consumer protections.

In the meantime, those enrolled in a health plan offered by a Medicare Advantage organization when they become eligible for Medicare should “be attentive,” says attorney Lipschutz of the Center for Medicare Advocacy. “Be on the lookout for written notice regarding conversion and carefully consider whether to opt-out of the [Medicare Advantage] plan.”

For a Center for Medicare Advocacy case study on the seamless conversion issue, click here.

To read the Kaiser Health News article, click here.

While it is illegal for a nursing home to discriminate against a Medicaid recipient, it still happens. To prevent such discrimination, nursing home residents and their families need to know their rights.

The potential for discrimination arises because Medicaid pays nursing homes less than the facilities receive from residents who pay privately with their own funds and less than Medicare pays. Nursing homes are not required to accept any Medicaid patients, but Medicaid payments are a steady guaranteed payment, so many nursing homes agree to accept Medicaid recipients.

When a nursing home agrees to take Medicaid payments, it also agrees not to discriminate against residents based on how they are paying. Medicaid recipients are entitled to the same quality of care as other residents. A nursing home cannot evict residents solely because they qualified for Medicaid.

Unfortunately, discrimination against Medicaid patients does occur, and the discrimination can take different forms. The nursing home may refuse to accept a Medicaid recipient or may require that a resident pay privately for a certain period of time before applying for Medicaid. When a resident switches from Medicare or private-pay to Medicaid payments, the nursing home may transfer the resident to a less desirable room or claim that it doesn’t have any Medicaid beds.

There is at least one way that nursing homes can treat Medicaid recipients differently, however. Nursing homes are allowed to switch residents who were privately paying for a single room to a shared room once they qualify for Medicaid. In addition, the nursing home is not required to cover personal and comfort care items, such as a telephone or television. In some states families are allowed to pay the difference to get a private room or the care item. Other states do not allow any supplementation.

If you feel you have been discriminated against by a nursing home, contact your state’s long-term care ombudsman or your attorney.

For a guide to the 20 common nursing home problems, including discrimination against Medicaid recipients, click here.

Saying that there has been “undue influence” is often used as a reason to contest a will or estate plan, but what does it mean?

Undue influence occurs when someone exerts pressure on an individual, causing that individual to act contrary to his or her wishes and to the benefit of the influencer or the influencer’s friends. The pressure can take the form of deception, harassment, threats, or isolation. Often the influencer separates the individual from their loved ones in order to coerce. The elderly and infirm are usually more susceptible to undue influence.

To prove a loved one was subject to undue influence in drafting an estate plan, you have to show that the loved one disposed of his or her property in a way that was unexpected under the circumstances, that he or she is susceptible to undue influence (because of illness, age, frailty, or a special relationship with the influencer), and that the person who exerted the influence had the opportunity to do so. Generally, the burden of proving undue influence is on the person asserting undue influence. However, if the alleged influencer had a fiduciary relationship with your loved one, the burden may be on the influencer to prove that there was no undue influence. People who have a fiduciary relationship can include a child, a spouse, or an agent under a power of attorney. For more information on contesting a will, go here.

When drawing up a will or estate plan, it is important to avoid even the appearance of undue influence. For example, if you are planning on leaving everything to your daughter who is also your primary caregiver, your other children may argue that your daughter took advantage of her position to influence you. To avoid the appearance of undue influence, do not involve any family members who are inheriting under your will in drafting your will. Family members should not be present when you discuss the will with your attorney or when you sign it. To be totally safe, family members shouldn’t even drive or accompany you to the attorney’s office. You can also get a formal assessment of your mental capabilities done by a medical professional before you draft estate planning documents. For more information on preventing a will contest, go here.

In many states, seniors have the right to decline jury duty based on their age. But the age limits and rules vary by state and by type of court, so if you are summoned for jury duty, check with the court to determine if you are exempt.

The majority of states have a rule in place that allows individuals over a certain age to choose not to serve on a jury if called. How this works varies by state and by court. Some states allow anyone over a certain age to be permanently exempted; other states allow seniors to be excused from serving if they are called. Some states require notice in writing; other states have a box the senior can check on the jury summons form. The ages at which seniors can be exempted or excused are 65 (Mississippi and South Carolina), 70 (Alabama, Alaska, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, Nevada, Oklahoma, Oregon, Texas, Virginia, and West Virginia), 72 (North Carolina and Wyoming), 75 (Arizona, Indiana, New Jersey, New Mexico, New York, Ohio, and Pennsylvania), and 80 (Hawaii and South Dakota).

Some states have more complicated rules regarding seniors and jury duty. In Nevada, for example, everyone over age 65 who lives 65 miles or more away from the court is exempt from serving on a jury. Once you reach age 70 in Nevada, you are exempt from serving on a jury no matter where you live. In California, individuals with a permanent health problem can be exempted from jury duty, but if you are 70 years or older, you don’t need a doctor’s verification of the health problem.

Each of the federal district courts has its own rules about jury service. Many federal courts offer excuses from service, on individual request, to designated groups, including people over age 70.

Although voting is the hallmark of a democracy, it isn’t easy if you are in a long-term care facility. Nursing home residents face several challenges to voting, from registering to vote to actually casting a ballot.

When you move into a nursing home or assisted living facility, your address changes, which means you probably need to register to vote based on the new address. You can register in-person, by mail, or, in some states, online. To register in person, visit your local elections office or your local department of motor vehicles. To find out where to register in your state, go here: http://www.eac.gov/voter_resources/contact_your_state.aspx.  Alternatively, there is a national voter registration application that you can use to register by mail. The form includes state-specific instructions. Finally, more than 30 states have online registration.

Once you are registered, you still need to physically cast your ballot. This can be difficult if you have trouble leaving your facility. There are several methods that nursing home residents may be able to use to vote. All states allow absentee voting, but the requirements are different in each state. Some states require an excuse –- such as a physical disability — to vote absentee. In many states being at least aged 60 to 65 (depending on the state), is a reason to qualify for an absentee ballot.

Twenty-three states allow mobile polling, which is supervised absentee voting conducted in the residential facility. Mobile polling is often based on demand, so to get mobile polling in your facility, contact your local elections office.

If it is difficult for you to get to the polls on Election Day, 37 states offer early voting. Early voting allows voters to visit an election office and vote in person without providing an excuse. This can give you the flexibility to vote when it works for you.

For more information about your right to vote while in long-term care, the National Consumer Voice for Quality Long-Term Care has fact sheets on How to Register to Vote and How to Cast a Vote.