As the year winds down and the holiday season approaches, it is easy to push administrative tasks to the back burner. However, the fourth quarter is the most critical time of the year to audit an estate plan. Life changes, laws evolve, and tax deadlines are absolute.

Here is the essential end-of-year checklist to share with clients to ensure their legacy remains secure into 2027.

1. The Beneficiary Audit: Updating After Life Events
A Last Will and Testament does not control everything. Assets like 401(k)s, IRAs, life insurance policies, and payable-on-death (POD) bank accounts are distributed based entirely on their specific beneficiary designations superseding whatever is written in the Will.

• Marriages and Divorces: Ensure ex-spouses are legally removed from policies and current spouses are fully protected.
• New Additions: If the family welcomed new children or grandchildren this year, contingent beneficiaries must be updated so the newest generation is not unintentionally excluded.
• Passing of Loved Ones: If a named beneficiary has passed away, their share might default back to the estate, unnecessarily subjecting those assets to the costly and public probate process.

2. Status Check: Healthcare Directives and POAs
Medical emergencies do not make appointments. A comprehensive plan requires up-to-date advance directives and Powers of Attorney (POA) that reflect the client's current wishes and relationships.

• Financial Power of Attorney: Confirm that the appointed agent still has the capability and legal authority to manage finances if the client becomes incapacitated.
• Healthcare Surrogate / Proxy: Ensure the designated proxy is still the right person to make critical medical decisions.
• Accessibility: Having the documents is only half the battle. Ensure family members and primary care physicians have active copies on file before a crisis hits.

3. Leverage 2026 Tax Exemption Thresholds
The end of the year is the final deadline to execute strategic wealth transfers under the current tax code.

• Annual Gift Tax Exclusion: For 2026, the IRS allows individuals to gift up to $19,000 per recipient without triggering the gift tax or dipping into the lifetime exemption. For married couples, this doubles to $38,000 per recipient. These gifts must be completed by December 31 to count for the current tax year.
• Federal Estate Tax Exemption: The federal estate and lifetime gift tax exemption for 2026 sits at $15 million per individual, or $30 million for married couples. High-net-worth clients should review their trust structures to ensure they are fully capitalizing on these historically high thresholds before any future legislative changes.

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Don't let the calendar turn before ensuring your family's future is protected. Reach out to our office today to schedule a Q4 estate plan review and secure your peace of mind for the new year.

If you have Medicare Advantage and have recently been hospitalized, a doctor may say you need more care after leaving the hospital, whether at an inpatient rehabilitation facility or rehabilitation center, skilled nursing facility, or long-term care hospital. But what if your Medicare Advantage plan says no?

Federal investigators have been examining how often Medicare Advantage plans deny this kind of post-acute care. What they’ve found raises real concerns for the more than half of Medicare-eligible beneficiaries now enrolled in these private plans.

In June 2026, the Department of Health and Human Services’ Office of Inspector General (OIG) published two reports examining prior authorization requests, the advance approval many Medicare Advantage plans require before they’ll pay for care.

Among the 19 Medicare Advantage organizations reviewed, nearly two-thirds of prior authorization requests for long-term care hospital stays were denied. Over half of requests for inpatient rehabilitation facility stays were also denied. Requests for skilled nursing care were denied about 12 percent of the time. These denial rates are well above the roughly 8 percent overall Medicare Advantage prior authorization denial rates for all types of care combined.

A denial is not necessarily final. When patients appealed, Medicare Advantage organizations overturned 36 percent of long-term care hospital denials, 43 percent of inpatient rehabilitation denials, and 95 percent of skilled nursing facility denials. 

These findings suggest that some people may have been denied medically necessary care initially, but relatively few denials were ever appealed.

Why Medicare Advantage Plans Deny This Kind of Care
Post-acute care is health care you need after a hospital stay. It may include physical therapy, wound care, rehabilitation services, or skilled nursing, and it tends to be expensive. It’s also an area where prior authorization can create an additional review step before care is approved.

A few factors help explain the pattern investigators found:

• How Medicare Advantage plans get paid. Because Medicare Advantage plans receive fixed monthly payment for each enrollee, denying or limiting covered care can reduce the plan’s spending on that enrollee. This payment structure, on its own, doesn’t prove wrongdoing, but investigators have flagged it as a potential financial incentive to deny expensive services like extended rehab or long-term hospital stays.
• Reliance on outside contractors. Some of the highest denial rates were traced to outside contractors that review requests on a plan’s behalf, sometimes using automated tools to help make decisions quickly. OIG found that a meaningful share of those contractor-driven denials were later overturned by the plan on appeal, raising questions about whether the contractors were adequately trained or supervised.
• Wide variation between insurers. Denial rates varied enormously depending on which company administered a patient’s plan. That variation suggests the differences are more about a given insurer’s internal policies and review practices than about any objective difference in how sick their members are.
• Low appeal rates create little pushback. Because relatively few denied patients file an appeal, plans may face limited pressure to correct a pattern of overly strict initial reviews, even when a large share of appealed cases are ultimately reversed.

Insurers have pushed back on some of these findings, arguing that prior authorization is a legitimate tool to ensure care is medically necessary and to guard against unnecessary costs that could raise premiums for everyone. Federal regulators and members of Congress from both parties, however, have said the scale and inconsistency of these denials warrant closer scrutiny.

What to Do If Your Care Is Denied
A denial is not necessarily the final word. Medicare Advantage enrollees have the right to challenge denials, and appeals succeed often enough that it’s worth trying. Here’s how to respond if you’re facing a denial for post-acute care.

Get the Denial in Writing 
Ask for the written denial notice if you haven’t received it. It should explain the reason for the denial and how to appeal. Keep copies of the denial notice, any letters from the facility, and notes from phone calls, including dates, names of the people you spoke with, and what was said.

Ask Your Doctor or Facility for Help Building Your Case
Your hospital discharge planner, doctor, or a staff member at the receiving facility can be a valuable ally. They often have experience navigating these denials and can help identify what documentation the plan says is insufficient or missing. Ask them directly:

• What specific medical criteria did the plan say I didn’t meet?
• What additional records, test results, or physician notes could address that gap?
• Can you write a letter of medical necessity explaining why this level of care is required?
• Is there a case manager or patient advocate at this facility who handles insurance appeals?

File an Appeal
Every Medicare Advantage plan must have an appeals process. The first level is called reconsideration. 
Some key things to know:

• Deadlines matter. You typically have 65 days from the date of the plan’s initial denial notice to request reconsideration, but follow the deadline and instructions on your notice. A standard service appeal generally must be decided within 30 days.
• If waiting could jeopardize your health, ask for an expedited appeal. It generally must be decided within 72 hours.
• If the plan upholds its denial, it must forward your case to an independent outside reviewer for a second look. You don’t have to request this separately.
• Your doctor can request an appeal on your behalf, which can carry weight since the reviewer will be evaluating medical necessity.

Get Free, Expert Help
Every state has a State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling on Medicare appeals. You can also contact Medicare at 1-800-MEDICARE or reach out to a local aging or disability advocacy organization, many of which have staff who specialize in Medicare Advantage appeals and denials.

Keep a Record of the Effects of Any Delay
If the denial is delaying your discharge or forcing you to leave a facility before you or your family feel it’s safe, document that too. Notes on your condition, mobility, and complications may support your appeal.

A Medicare Advantage Denial Is Not Necessarily Final
Federal data suggest that a substantial share of Medicare Advantage denials for post-acute care may not hold up to scrutiny. That doesn’t mean every denial is wrong. However, it does mean patients and families have real reason to push back. Getting the denial in writing, asking your care team for documentation, and filing a timely appeal are the best paths to getting a second look and, quite possibly, a different outcome.

Ask most people with Medicare whether they understand their coverage and the answer is usually yes. However, a new survey suggests that people’s knowledge of Medicare may fall short of their confidence.

In August, eHealth, an online health insurance marketplace, published results from a survey of more than 1,000 U.S. adults. Nearly nine in ten current Medicare beneficiaries (89 percent) said they felt confident about their coverage options. Yet only 13 percent could correctly define the four main types of Medicare coverage: Original Medicare, Medicare Advantage, Medigap, and Medicare Part D.

What the eHealth Survey Found

• Eighty-eight percent did not know that Original Medicare has no yearly limit on out-of-pocket costs.
• Forty-two percent weren’t aware that Original Medicare has a 20 percent coinsurance — or believed that number to be lower.
• Twenty-four percent of adults ages 55 to 64 not yet on Medicare felt confident about their coverage options.
• In the same age group, 88 percent did not know about the Part B late enrollment penalty. Eighty percent were not aware of potential Part D penalties. Seventy-one percent did not know they could be rejected or charged more for Medigap if they applied late.

Failing to understand your Medicare coverage can lead to unexpected bills or missed deadlines.

Medicare Terms People Often Misunderstand
The path to understanding Medicare begins with getting familiar with some of the basic terms that are often misunderstood.

• Original or Traditional Medicare. Consists of Part A (hospital care) and Part B (doctor visits and outpatient care). It does not include prescription drug coverage and generally does not cover routine dental, vision, or hearing care, or long-term custodial care.
• Coinsurance. This is the percentage of a bill you pay after the deductible is met ($283 in 2026). Typically, you pay 20 percent of the Medicare-approved amount for covered services. Many preventive services are an exception and do not carry a 20 percent charge.
• Out-of-pocket limit. This is the cap, or maximum, you have to pay each year for medical services. Original Medicare does not have an out-of-pocket limit, so 20 percent of medical bills can add up quickly. Medicare Advantage plans, by contrast, must set a yearly limit on what you pay for covered services.
• Part D. This is prescription drug coverage, bought as a separate plan alongside Original Medicare. Conversely, many Medicare Advantage plans include drug coverage.
• Late enrollment penalty. Signing up for Medicare late incurs extra costs, unless you had alternate, qualifying coverage. For Part B, 10 percent is added to your premium for each 12-month period you could have enrolled. Part D has its own penalty, as well. Each penalty lasts the duration of your coverage.
• Initial Enrollment Period. The seven-month window around your 65th birthday is your Initial Enrollment Period. It includes the three months before, the month of, and the three months after your 65th birthday. Missing it can lead to the penalties above.

Medicare Advantage and Medigap Are Not the Same Thing
These two are among the most confused Medicare terms. Although both are sold by private insurance companies and involve Medicare, they work differently. Put simply, Medicare Advantage replaces the way you get Original Medicare, while Medigap adds to it.
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What it is
Medicare Advantage (Part C): A private-plan alternative to Original Medicare.

Medigap (Medicare Supplement): Extra insurance sold by private companies that works alongside Original Medicare.

How it works with Original Medicare
Medicare Advantage (Part C): The plan takes the place of Original Medicare for your Part A and Part B coverage. You still have Medicare and still pay the Part B premium.

Medigap (Medicare Supplement): You keep Original Medicare. Medigap helps pay costs Original Medicare leaves behind, such as deductibles, copayments, and coinsurance.

Choice of doctors and hospitals
Medicare Advantage (Part C): Usually network-based (such as an HMO or PPO). Some plans require referrals or prior approval.

Medigap (Medicare Supplement): Works with any provider that accepts Original Medicare.

Cost protection
Medicare Advantage (Part C): Required to have a yearly limit on what you pay for covered services.

Medigap (Medicare Supplement): Depending on the plan, covers some or most of the 20 percent coinsurance and other cost-sharing.

Prescription drugs
Medicare Advantage (Part C): Most plans include Part D drug coverage.

Medigap (Medicare Supplement): Not included. A separate Part D plan is required.

Dental, vision, and hearing
Medicare Advantage (Part C): Many plans offer some coverage.

Medigap (Medicare Supplement): Typically not included.

How plans differ
Medicare Advantage (Part C): Benefits, costs, and networks vary by company and location.

Medigap (Medicare Supplement): In most states, plans are labeled by letter. Each offers the same basic benefits regardless of the company selling them. Prices can differ.
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When to sign up
Your Initial Enrollment Period or set enrollment windows, such as the Annual Enrollment Period (October 15 to December 7).

The one-time, six-month Medigap Open Enrollment Period beginning the first month you are enrolled in Part B. After that, insurers in most states can decline you or charge more based on your health.

You cannot combine both plans. Medigap only works with Original Medicare, you cannot buy a Medigap policy if you have a Medicare Advantage plan.

Choosing the best option depends on your medical needs and budget. Medicare Advantage plans often have lower monthly premiums and extra benefits but come with network rules and possible approval requirements. Medigap policies tend to cost more each month, but they offer more predictable costs and a wider choice of providers.

Because there is only one Medigap enrollment window, you should fully understand both options before choosing.

Where to Get Help
Plans can change their costs, coverage, and networks every year, so it pays to review your plan each fall.  Medicare’s Annual Enrollment Period, when people can change their coverage for 2027, opens October 15.

Free, unbiased help is available from your State Health Insurance Assistance Program (SHIP). You can also contact Medicare directly by calling 1-800-MEDICARE (1-800-633-4227).

If your child is navigating their teenage years or heading off to college, you may already feel like you are losing a bit of control over their daily life. Legally speaking, this becomes a reality the moment your child turns 18. In the eyes of the state, they are now an adult with the exclusive legal right to govern their own life.

Up until their 18th birthday, you are legally entitled to access your child’s medical records, make decisions regarding their healthcare, and manage their finances. Once they turn 18, that access abruptly ends. Your now-adult child is legally entitled to absolute privacy, meaning you no longer have automatic authority over their medical, educational, or financial information.

While everything is fine as long as they are healthy and safe, it is crucial to plan for the unexpected. Before your child heads out into the adult world, ensure they have a basic estate plan in place that includes these three vital components:

1. Health Care Proxy with HIPAA Release

Under the Health Insurance Portability and Accountability Act (HIPAA), an 18-year-old’s health records are strictly between them and their healthcare provider. This privacy wall prevents doctors from even giving you medical updates if your child is incapacitated and unable to grant permission. Without a HIPAA release, you could face immense obstacles just trying to find out if your child has been admitted to a specific hospital.

If your child suffers a medical emergency and cannot communicate, medical professionals may legally refuse to speak with you or let you direct their care. To intervene, you could be forced to hire an attorney and petition a court to be appointed as your child’s legal guardian. In a medical crisis, your only concern should be your child’s recovery, not navigating expensive and stressful court proceedings.

A Health Care Proxy with a HIPAA Release enables your child to designate you (or another trusted adult) to receive medical information and make critical healthcare decisions on their behalf if they cannot do so themselves.

2. Durable Power of Attorney

Just like medical information, an 18-year-old’s finances are entirely private. If your child becomes incapacitated, a Durable Power of Attorney is the only way you can access their bank accounts, pay their bills, or manage their credit cards without petitioning a court for a conservatorship.

Even outside of an emergency, this document is incredibly practical when a child is away at college or traveling abroad. If an issue arises—like a locked bank account or a stolen debit card while traveling—a Durable Power of Attorney gives you the legal authority to step in and resolve the issue for them.

(Note: Some parents try to circumvent this by opening joint bank accounts with their adult children. This is rarely recommended, as it can cause unintended consequences regarding taxes, financial aid applications, and creditor liabilities.)

3. Will

Your 18-year-old legally owns any funds they have earned or that were given to them as a minor. In the catastrophic event that your child passes away before you, their assets will go through probate and pass to their heirs (which, in most states, are the parents).

If you have carefully structured your own estate plan to minimize taxes or protect assets, unexpectedly inheriting your child's assets could frustrate those larger planning goals. Furthermore, writing a Will gives your young adult the agency to leave their personal property, a beloved pet, or financial assets to siblings, friends, or a favorite charity.

​While a Will might seem less urgently necessary than a Health Care Proxy or Power of Attorney, having all three documents in place prevents parents from having to go to court just to secure the legal authority to help their own child.If you have a child or grandchild approaching adulthood, talk to your elder law and estate planning attorney about getting these three crucial documents executed.
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Berger Estate & Elder Law P.A. has been serving Kansas City for over 30 years providing Trusted Council with Proactive Solutions. Call us today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.

When an individual passes away without a funeral plan, the responsibility of arranging the service often falls on grieving family members, such as a surviving spouse or children. Taking the time to plan your own funeral arrangements not only ensures your final wishes are respected, but it also protects your loved ones from carrying a heavy emotional and financial burden during an incredibly difficult time.

The True Cost of a Funeral​
Without a clear plan, surviving family members often find themselves unsure of their loved one's wishes. This uncertainty can lead to expensive choices, as families sometimes feel pressured to overspend as a demonstration of their love.

Funeral costs can add up quickly. According to the most recent data from the National Funeral Directors Association (NFDA), the national median cost of a traditional funeral with a viewing and burial is $8,300. For those who prefer cremation, the median cost of a funeral with a viewing and cremation is $6,280. 

You can shield your family from these costs by prearranging your funeral and, if it makes sense for your situation, prepaying for the arrangements. (Note: Always do thorough research and consult a financial or legal professional before prepaying.)

The Gift of Time and Clarity
Without a plan in place, grieving families are forced to make rapid decisions under immense time constraints. They rarely have the time or emotional energy to visit multiple funeral homes or compare pricing. As a result, they often choose the first facility they contact, missing out on the opportunity to find the best fit and value.

When you prearrange your funeral, you have the luxury of time. You can research your options, carefully decide the details of your end-of-life arrangements, and ensure everything aligns with your budget and values.

Beyond selecting a funeral home, preplanning allows you to make important decisions, such as:

• Disposition of remains: Choosing between burial, cremation, or alternative options.
• Final resting place: Determining a burial location (like a family plot) or providing instructions on where to scatter or keep ashes.
• Medical directives: Deciding whether you wish to donate your organs or body to scientific research.
• Service details: Selecting the specific type of funeral, memorial service, or celebration of life you prefer.

How to Formalize Your Funeral Arrangements
Planning your arrangements starts with writing down your wishes in detail and providing copies to trusted family members.

If you have a clear idea of where you will reside long-term, you might consider prepaying a local funeral home to guarantee the services and remove the financial burden from your family completely.

When documenting your plans, keep the following in mind:

• Advance Directives: These documents outline your desires regarding end-of-life care and allow you to appoint a healthcare agent. While your agent’s formal authority usually ends upon your death, you can provide them with your written funeral wishes and the power to oversee the arrangements.
• Prepaid Contracts vs. Wills: While many people include their funeral wishes in their will, a will is often not read until after the funeral has taken place. Instead, it is better to outline your end-of-life wishes in a separate, dedicated document—like a prepaid burial contract or a letter of instruction, kept in an accessible location.

By deciding your funeral arrangements in advance and clearly communicating those instructions to your loved ones, you prevent family disagreements, eliminate guesswork, and offer your family the ultimate gift of peace of mind.

Telehealth allows you to connect with your healthcare provider virtually, bringing the doctor's office directly to you. Through telemedicine, you can share health concerns, receive professional medical opinions, and manage your care from the comfort of your home using a computer, smartphone, or tablet.

Types of Care Available Through Telemedicine
While some medical services will always require an in-person visit, an impressive array of care is now fully optimized for telehealth. Telemedicine encompasses a wide variety of services, including:

• Assistance with recurring conditions
• Dermatology appointments
• Managing viral and bacterial infections
• Lab test results
• Physical therapy
• Prescription management
• Post-surgery care
• Mental health services

From Pandemic Necessity to Everyday Convenience
Before 2020, telemedicine was relatively uncommon and used primarily for psychotherapy or monitoring niche chronic conditions. When the pandemic hit, the U.S. Department of Health and Human Services and the CDC advised patients to consult physicians online to prevent the spread of the virus. This sparked a massive shift in how we seek care, with the CDC reporting a 154% increase in telehealth use in just one year.
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Today, the landscape has permanently changed. What began as a temporary safety measure has evolved into a preferred, standard option for millions of patients who value the convenience and efficiency of virtual care.

How to Use Telehealth
A telehealth appointment operates much like a standard visit, just through a phone call or secure video chat. The ecosystem also goes beyond the live appointment:

• Remote Monitoring: You can send your doctor real-time data about your vital signs, weight, or blood pressure.
• Secure Messaging: Outside of scheduled appointments, you can use patient portals to exchange secure messages, send medical records, and upload images of wounds or skin conditions.
• Actionable Care: Your provider can issue prescriptions, give instructions for at-home management, and provide specialized steps to improve your daily quality of life.

The Lasting Benefits of Telehealth
While severe medical emergencies still require a trip to the ER or a traditional doctor's office, telehealth offers undeniable everyday benefits:

• Dodging the Waiting Room: Telehealth reduces your exposure to common infectious diseases like the flu, RSV, or the common cold. High-risk individuals can get the care they need without sitting in a room full of sick patients.
• Ultimate Convenience: Visiting the doctor virtually saves hours of your day. You can skip the commute, the parking hassle, and the time spent away from work or family.
• Expanded Accessibility: For individuals who live in rural areas, have mobility challenges, or simply lack reliable transportation, telemedicine makes healthcare vastly more reachable.
• Faster Communication: Patients who are self-isolating or have difficulty traveling can get online triage quickly. A fast virtual consult can alert doctors to severe concerns and help them determine if an immediate, in-person ER visit is actually necessary.

As a powerful supplement to in-person care, telehealth helps patients communicate with their providers more efficiently, making high-quality healthcare more accessible than ever before.​

Second marriages are increasingly common in the lives of seniors today. Many seniors who remarry enjoyed a lifetime of love with a spouse who has passed away, only to happily discover love with someone new. While remarrying in your later years is an exhilarating chapter, the excitement of newfound love shouldn't overshadow some of life’s most serious decisions.

Unfortunately, many seniors choose not to update their estate plans when remarrying, which can cause unforeseen challenges, strain close relationships, and even spark infighting among family members.

Longer lifespans are largely responsible for the growing number of senior remarriages. As this trend continues, couples are blending families and finances in increasingly complex ways. Questions about what to do with a lifetime of accumulated assets are ones that couples rarely consider in their twenties, but they are essential for seniors. With 50% of seniors remarrying, elder law attorneys are hearing these questions more and more. Meeting with an experienced attorney can help you and your new spouse explore your options.

Prenuptial Agreements 
The biggest consideration for seniors remarrying is a prenuptial agreement. While Hollywood often portrays prenups as worst-case scenarios, they are actually the norm for senior remarriages and often provide the best protection for both spouses.

Open communication is the most important factor when drafting a prenuptial agreement. Typically, both spouses have children or family members they wish to maintain as beneficiaries on bank accounts, stocks, and other assets. A prenup ensures that the first spouse to pass away doesn’t unknowingly disinherit their children.

Managing a Lifetime of Assets
Pooling assets together and putting a new spouse's name on a title might seem intuitive when remarrying, but these decisions often have hidden pitfalls. Relying on blended families to simply “work it out” after you pass away is a risky strategy.

Assets often have strict limitations on how many beneficiaries can be designated, and property titling has legal complexities that vary by state. Newlyweds need a plan that protects their children and their new spouse simultaneously and there is rarely a way to do this effectively without creating a trust.

Taxes, Medicaid & Pension Considerations
Dying intestate (without a will) or even with a standard will that guarantees a trip through probate, adds unnecessary complexity to an already emotional time. When remarrying as a senior, you also have to weigh the financial impacts of combining incomes. Depending on your situation, remarrying could:

• Bump you into a higher tax bracket
• Alter your Social Security benefits
• Disqualify you from a former spouse's pension
• Impact your eligibility for Medicaid

Elder law attorneys with financial planning experience are vital for understanding your full range of options. Proper planning ensures you are prepared when the IRS comes collecting or when an institution changes its terms of service.

Trusts
Trusts give trustors (you and your spouse) the most flexibility and control. Trying to evenly divide assets by constantly amending wills, life insurance policies, investments, and property deeds can be incredibly cumbersome.

Creating a trust allows you to dictate exactly how, when, and to whom your assets are distributed. This is the most reliable way to ensure a new spouse is well cared for, while still preserving an inheritance for your children.

Conclusion
Falling in love with someone new always impacts the other people we love. Sometimes blended families grow closer; sometimes they don't. Remaining loyal to a new spouse can sometimes make it difficult to navigate older family dynamics. While this isn't strictly an estate planning issue, it is a common reality of remarrying later in life.

It is crucial to plan for these changes proactively so you don't make knee-jerk decisions during highly emotional times. Finding love as a senior brings exuberance and joy, don’t let a lack of planning result in unintended consequences. Make sure your most heartfelt desires are carried out for both you and the people you love.
 
If you want to ensure that you make the right decisions for your own family when considering life and estate planning decisions, feel free to sit down and talk with us for a free consultation by calling (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located office at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.​ Berger Estate & Elder Law P.A. has been providing our clients with Trusted Counsel and Proactive Solutions for over 30 years, and we look forward to many more! ​

​Elder fraud has become a common form of financial exploitation across the country. Federal officials have estimated losses to be in the billions of dollars each year among older Americans, with government-impersonation schemes among the most reported types of fraud. For example, fraudsters may contact older adults and claim to be with the Social Security Administration (SSA) or the Department of Health and Human Services (HHS) while trying to extract information or money from them.

Scammers do not target older adults because they are less capable. They target this population because they may assume they have savings, established credit, and less familiarity with newer digital tactics. Awareness and preparation can make it harder for scammers to succeed.

How These Scams Work
Most impersonation and fraud schemes follow a consistent pattern, regardless of the specific story a scammer uses. It generally unfolds in four stages:

• Pretend. The scammer claims to represent a trusted source, such as the SSA, the HHS’s Office of the Inspector General (HHS-OIG), a bank, or a well-known company. They may already have some of the potential victim’s personal information, which makes the approach feel legitimate.
• Prize or problem. The scammer either offers something appealing, such as a benefit increase or a prize, or creates fear by claiming there is a serious problem, such as  a suspended Social Security number or a fraud alert on an account.
• Pressure. They tell the person to act immediately, often to “avoid arrest” or “protect” their benefits or accounts, leaving little time to verify the claim.
• Payment. The scammer requests payment or personal data through unusual channels, such as gift cards, wire transfers, cryptocurrency, cash delivered in person, or a Social Security or Medicare number provided “to confirm eligibility.”

A genuine call from the SSA or HHS-OIG will never ask a beneficiary to wire money, purchase gift cards, send cash, or disclose a Social Security number. That single rule can help older adults avoid most government-impersonation scams.

Practical Steps for Protecting Personal Data
Protecting personal information is often more effective than trying to recognize every new scam. Scammers’ tactics change constantly, but their goal remains the same: getting access to personal information or money.

Safeguard Your Most Personal Information
Personal information can be pieced together from public records, social media, data breaches, and previous contacts. Protecting key details makes it harder for scammers to create convincing requests.

• Do not share sensitive information. Never provide a Social Security number, Medicare number, bank account information, or online-account password to an unsolicited caller, texter, or email sender. Caller ID can be spoofed, so a government agency’s name or number does not prove that the contact is legitimate.
• Protect important documents. Store Social Security and Medicare cards securely at home rather than carrying them daily. Shred documents containing account or benefit numbers before disposing of them.

Check With the Official Source
Always verify unexpected requests through contact information you find yourself, not through a phone number, link, or website supplied by the person who contacted you.

• End the conversation. Hang up on unexpected calls claiming to be from the SSA, HHS-OIG, or the Medicare program. Then call the agency back using a number found independently on their government website.
• Monitor your accounts. Create an official my Social Security account to track benefit statements and catch unauthorized changes.

Pause and Talk With Someone You Trust
Scammers use urgency, isolation, and secrecy to prevent people from evaluating a request or seeking advice.

• Treat pressure as a warning sign. Legitimate agencies do not demand immediate action or ask beneficiaries to keep a conversation confidential from family members.
• Ask for help without fear or blame. Talk with a trusted family member, friend, or caregiver before sending money or sharing information in response to an unexpected request.

Create a Family or Caregiver Fraud-Prevention Plan
Families can reduce the risk of government-impersonation scams by agreeing in advance on how to handle unexpected calls, texts, and requests involving benefits or personal information.

• Choose a trusted contact. Agree on whom the older adult will call before sending money, sharing personal information, or responding to an urgent matter. This could be a family member, friend, caregiver, attorney, or other trusted advisor.
• Create a family code word. A code word can help relatives confirm that an urgent call or text is genuine, especially when a scammer pretends to be a grandchild or another family member.
• Set up account alerts. With the account holder’s permission, consider enabling notifications for large withdrawals, unusual purchases, password changes, or transfers to new recipients.
• Review important information together. Make sure contact information is current with banks, credit card companies, insurers, and government agencies. Knowing how to reach these organizations through official channels can make it easier to verify a suspicious request.

Open, respectful conversations can reassure older adults that they can seek help without fear of blame or embarrassment.

Limit Digital Exposure
Scammers can use information posted online to make impersonation attempts seem more personal and believable. Basic digital precautions can reduce the amount of information available to them.

• Handle messages carefully. Avoid clicking links or downloading attachments in unsolicited messages, even if they appear to come from a government agency or familiar company.
• Review privacy settings on social media accounts. Scammers often mine public posts for details, birthdays, family names, and routines that they can use to make impersonation attempts more convincing.

If You Encounter a Scam
Report suspected scams promptly, even if you recognized the fraud before sharing information or sending money. Reports can help investigators identify patterns, warn the public, and shut down schemes.

• Social Security-related scams. Report online or call the SSA OIG Fraud Hotline at 1-800-269-0271.
• Medicare, Medicaid, or other HHS program fraud. Report fraud attempts through the HHS-OIG Hotline.
• General fraud reports. File with the Federal Trade Commission.

If you believe you have already shared sensitive information or sent money to a scammer, contact your bank or credit card company immediately to limit further loss. Consider placing a fraud alert or credit freeze with the major credit bureaus.

The Rule That Can Prevent Most Impersonation Scams
No legitimate government agency will ever ask someone to move money to “protect” it, demand payment in gift cards or cryptocurrency, or ask for a Social Security number to determine benefit eligibility. Older adults and their families can help prevent fraud by verifying unexpected contacts and seeking advice before acting.

Every family that places a loved one in a nursing home, assisted living community, or other long-term care setting does so trusting that their loved one will be safe and treated with dignity. Most of the time, that trust is well placed. But abuse and neglect in long-term care can be difficult to detect, especially when a resident has cognitive decline or communication difficulties, or fears retaliation.

You do not need to determine whether conduct legally qualifies as abuse before asking for help. If something seems wrong, describe what happened, when it happened, and why you believe the resident may be at risk.

What Should Be Reported?
Report concerns that may threaten a resident’s safety, health, dignity, or financial well-being. Common examples include:

• Physical abuse. Hitting, rough handling, unnecessary physical restraint, unexplained injuries, or overmedication.
• Neglect. Leaving a resident in soiled clothing or bedding, failing to reposition someone at risk of pressure sores, skipping meals or medications, or ignoring calls for help.
• Emotional or verbal abuse. Yelling, humiliating, threatening, or deliberately isolating a resident from family, friends, or other residents as a form of control.
• Sexual abuse. Any nonconsensual sexual contact or behavior, including with residents who have cognitive impairment and cannot legally consent.
• Financial exploitation. Misuse of a resident’s money, bank card, benefits, identity, or legal authority by a caregiver, employee, representative, or other trusted person.
• Unsafe conditions or care-related fraud. Repeated staffing failures, medication errors, untreated injuries, dangerous conditions, or billing Medicare or Medicaid for services or equipment that were never provided or were unnecessary.
• Resident-to-resident violence. Physical, verbal, or sexual harm caused by another resident when the facility fails to respond appropriately or protect residents.

Who Should You Contact?
The right contact depends on the urgency and nature of the concern. In some situations, more than one report may be appropriate.

911 or Law Enforcement
Call 911 if a resident is in immediate danger, has a serious injury, or needs urgent medical attention. Law enforcement may also be appropriate when the concern involves assault, sexual abuse, theft, or another possible crime. Do not wait for the facility to complete an internal review when the resident may be in immediate danger.

Long-Term Care Ombudsman
Every state has a federally mandated long-term care ombudsman program for residents of nursing homes, assisted living communities, and similar facilities. Ombudsmen advocate for residents and help identify, investigate, and resolve complaints about care quality, resident rights, discharge disputes, and abuse, free of charge. Their role is to represent the resident’s interest and work toward a resolution.

Family members, friends, or facility staff can file a complaint whether or not the resident can do so themselves. A directory of links to each state’s program is available online.

Adult Protective Services (APS)
State and local APS agencies investigate reports of abuse, neglect, self-neglect, and financial exploitation of older adults and adults with disabilities. They can intervene to protect someone at risk in both facility and home settings. Consider contacting APS when:

• a resident may be unable to protect themselves;
• a caregiver or other trusted person may be exploiting the resident; or
• the resident needs protective intervention beyond the facility’s internal process.

State Survey Agency
A state survey agency generally investigates complaints about nursing homes that participate in Medicare or Medicaid. Complaints may involve abuse, neglect, poor care, inadequate staffing, unsafe or unsanitary conditions, and other mistreatment. An online directory of State Survey Agencies provides state-by-state contact information.

These agencies may be appropriate when a facility repeatedly fails to follow a care plan, provide medication or treatments, or respond to complaints.

Eldercare Locator
This service connects callers with their local ombudsman program, Area Agency on Aging, and APS office. Contact the Eldercare Locator online or call or text 1-800-677-1116. This can be a useful starting point when you know something is wrong but do not know which agency should receive the report.

National Elder Fraud Hotline
For suspected financial exploitation and scams targeting an older adult, contact the National Elder Fraud Hotline online at 1-833-372-8311.

What Victims and Families Can Do
If you believe a resident is in immediate danger, call 911 first.
Beyond emergencies, advocates who work with families regularly offer the same practical advice:

• keep a record of the resident’s name, facility, room, and primary contacts;
• as soon as you have a concern, write down specific dates, times, details, and locations of incidents as well as what the resident said happened and the names and job titles of involved staff or witnesses;
• list injuries, behavior changes, worsening personal conditions, or missed medications, meals, treatments, or care-plan services;
• hold on to relevant photographs, messages, voicemails, bills, and financial records;
• keep copies of care plans, discharge notices, and other paperwork;
• talk with your loved one first, if possible, about what outcome they want; and
• follow up any phone conversation with a brief written summary.

You do not need proof of wrongdoing to contact an ombudsman or adult protective service. Raising a concern early is itself part of how these systems catch problems.

Do not confront a suspected abuser or notify the facility first if doing so could increase the resident’s risk. In that situation, contact an outside agency or law enforcement for guidance.

Why This Infrastructure Matters
No single hotline or agency can eliminate abuse and neglect in long-term care. But the layered system now in place reflects decades of federal policy created specifically to make sure a resident’s voice does not go unheard simply because they cannot advocate for themselves. For families navigating a difficult situation, knowing these resources exist, and that they are free and available in every state, is often the first step toward getting help.

Assisted living is playing a growing role in dementia care. According to a recent report from AARP, more people 85 and older now reside in assisted living than in nursing homes. Of assisted living residents, 44 percent live with Alzheimer’s disease or another dementia, and many communities are responding by adding or expanding memory care units.

For families navigating this landscape, the expansion of memory care is both an opportunity and a challenge. On one hand, assisted living can feel less institutional than a nursing home and may support quality of life for older adults who are still physically capable. On the other hand, assisted living and memory care are regulated mostly at the state level, and the name on the brochure doesn’t always tell you what level of care a facility can truly provide.

What Is Assisted Living?
Today, 1 million Americans live in assisted living communities. Assisted living is often described as a middle ground between independent living and a nursing home. It typically combines:

• Housing (a private or semi-private apartment or room)
• Meals and housekeeping
• Supervision and help with activities of daily living (ADLs), like bathing, dressing, and eating
• Some health-related services, which may include help with medication administration

Assisted living is not the same as a nursing home, which provides a higher level of medical oversight and skilled nursing care. Also, note that services offered by assisted living facility may vary by facility and by state.

If your loved one needs round-the-clock medical care, you may need to look beyond assisted living.

How Do Assisted Living Facilities Serve Residents With Dementia?
Assisted living facilities primarily serve people with dementia by offering help with ADLs, which can become increasingly challenging as people age and dementia progresses. Some assisted living facilities provide dementia training to staff, but it is more common in specialized memory care facilities.

Not all assisted living is memory care, but many facilities offer it as a distinct, more specialized option within the same community.

Memory care facilities specifically serve people with dementia. Many states have developed a special licensure for assisted living facilities marketed as “memory care.” In those states, memory care facilities generally, but not always, have greater oversight of resident safety and staff receive dementia training.

What Role Do Family Caregivers Play?
While assisted living offers some support for people with dementia, family caregivers typically continue to provide support. Assisted living facilities typically offer limited hours a day of personal care services. When a resident’s needs exceed this, family caregivers often step in.

This caregiving can involve out-of-pocket costs. Family caregivers of assisted living residents with dementia report spending just shy of $9,000 annually on caregiving related costs, including things like personal supplies, transportation, and gaps in facility coverage.

What Questions Should Families Ask a Facility Before a Loved One Moves In?
Before a loved one with dementia moves into an assisted living facility, families should consider what services the facility provides and whether it can meet the needs of their loved one. As dementia progresses, the resident’s needs may increase over time, and a good facility should be able to adapt to changes in those needs.

Cost is also a major consideration. In 2024, the median annual cost of assisted living was $70,800, while the median income for adults 75 and older was $47,790. Facilities may charge additional fees for certain services, which can add up.

Keep in mind that Medicare does not pay for long-term custodial care, so most assisted living residents pay out of pocket. If funds run low, families often look to Medicaid. However, Medicaid rules vary by state, and Medicaid generally does not pay for assisted living room and board (although some states may cover certain care services for eligible residents).

The following questions can help families consider whether an assisted living facility is a good fit for a loved one with dementia.

1. How many hours a day of help with daily tasks are provided?
   
2. Who provides hands-on care and who administers medication?
   
3. Are staff members trained in dementia care? How many residents does each staff member typically care for?
   
4. Is there a nurse on site? If so, when?
   
5. Is this a memory care facility?
   
6. Is the memory care area secured? What happens if a resident is wandering and tries to leave?
   
7. What supports are provided for residents with dementia?
   
8. As dementia progresses, how does care adapt to meet a resident’s needs? How often is the care plan reassessed?
   
9. What are the monthly and yearly fees? Are services such as help with medication billed à la carte?
   
10. How do you respond to agitation, refusal of care, or sundowning?

What Should Families Understand in a Contract Before Signing?
A contract is more than a financial document. It governs key rights and expectations.

Because assisted living is largely regulated at the state level and residents’ rights can depend on state rules and contract terms, have a licensed attorney review the facility’s contract before you sign it.

Elder law attorneys can help families understand:

• the costs of services listed in the contract,
• when fees can increase and how increases are communicated,
• what happens if the resident needs to move out of the facility, and
• how disputes are handled.

Finding the right fit takes time, but asking the right questions about care, costs, and contracts is how families advocate for their loved one and find a place where they can truly thrive.