Page 10 THE SAUGUS ADVOCATE – FriDAy, SEpTEmbEr 11, 2026 Sa Sa a Sa you help me? --Caregiving Connie Dear Connie, Taking care of a parent after a stroke is hard enough without having to fi gure out Medicare too. The good news is that understanding the program can make life a lot easier. Knowing what’s covered – and what isn’t – can help you plan ahead, avoid costly surprises and make sure your father gets the care he needs. Here’s a practical guide to get you started. Medicare basics One of the best places to start is the offi cial “Medicare & You” handbook. It explains benefi ts and services in plain language. Medicare mails an updated copy every fall, but you can also view it online at medicare.gov/medicare-and-you. For questions, call Medicare at 800-633-4227 to speak with a representative. They can clarify coverage for doctor visits, hospital stays, home health care, and more. Your state’s State Health Insurance Assistance Program (SHIP) is another great resource. SHIP counselors provide free, one-onone counseling to help you understand your coverage, identify cost-saving programs, and answer questions about Medicare. Find a counselor near you at shiphelp.org or 877-839-2675. Caregivers should also create a secure Medicare account at medicare.gov/account/login. Once your father’s account is set up, you can review his coverage, track claims, check the status of medical services and prescriptions, and see which preventive benefi ts he’s eligible for. It’s an easy way to stay organized and keep all of your father’s Medicare information in one place. Choosing providers Medicare also lets you compare providers online at medicare.gov/ care-compare. You can search for doctors, hospitals, rehab centers, nursing homes, hospice providers, and medical equipment suppliers in your area. This is especially useful after a stroke, when your father may need rehabilitation or specialized care at home. y Senior enior Sen by Jim Miller A Caregiver’s Guide to Medicare Dear Savvy Senior, I’m taking care of my elderly father who recently had a stroke and have a lot of questions about how Medicare works and what it covers. He’s enrolled in original Medicare. Can Covered services Original Medicare covers many services your father may need, including hospital care, doctor visits, lab tests, and outpatient treatments. It also covers home health care if your father is homebound, under a doctor’s care, and needs part-time skilled nursing or rehabilitation therapy, such as physical, occupational or speech therapy. Medicare also covers medically necessary durable medical equipment and supplies prescribed by a doctor, including oxygen, wheelchairs, walkers and catheters. Short-term skilled nursing care in a facility may also be covered for up to 100 days after a qualifying hospital stay. Prescription medications are generally covered through a separate Medicare Part D plan, which helps pay for many outpatient drugs your father may need. Hospice care is covered for patients with a terminal illness and a life expectancy of six months or less, as certifi ed by a doctor. It includes nursing care, medications for comfort and short-term respite care to give caregivers a break. However, Medicare generally doesn’t pay for long-term custodial care at home, in an assisted living facility or in a nursing home. That means it generally won’t cover ongoing help with daily activities like bathing, dressing, eating, using the bathroom or supervision for someone with dementia. Routine dental care, dentures, eye exams for glasses and hearing aids are also not covered. Cost help If your father has limited income and resources, check programs that help reduce Medicare costs. Extra Help assists with prescription drug expenses, and Medicare Savings Programs can help pay premiums, deductibles, and coinsurance. Visit medicare.gov/basics/costs/ help or call 800-633-4227 to learn more or check eligibility. Taking time to understand Medicare can make caregiving a little less stressful. It helps you stay on top of appointments, treatments and equipment needs, while giving you greater confi dence that your father is receiving the care and benefi ts he’s entitled to. Send your questions or comments to questions@ savvysenior.org, or to Savvy Senior, P.O. Box 5443, Norman, OK 73070. nr ior TRUSTEE COMPENSATION PROVISION IN IRREVOCABLE TRUST M assHealth has in the past made the argument that if the Settlor of an irrevocable Trust, who is also serving as Trustee, has the right, pursuant to the terms of the Trust, to receive compensation, that this somehow results in the Settlor having the right to receive principal distributions thereby rendering all of the assets housed in the irrevocable Trust a “countable” resource for MassHealth eligibility purposes. I suppose even if one of the children of the Settlor were to serve as Trustee, MassHealth could try to argue that the child’s compensation could include principal and the Settlor could ask the child to hand over principal to the Settlor. If the child does not, the Settlor could remove and replace the child Trustee with someone else that would be more cooperative. So, the power to replace and remove the Trustee virtually for any reason arguably provides the Settlor with as much power over the Trust as if he or she were serving as Trustee. Pursuant to well-settled Trust law, the Trustee of a Trust is only entitled to fair and reasonable compensation for actual services rendered. The Trustee would be required to submit an invoice. No court of law would allow a Trustee to drain the principal of the Trust in order to pay himself or herself unreasonable Trustee compensation. Since the Settlor/Trustee would now be in a nursing home, how could he or she, as Trustee, render services to the Trust in order to be entitled to compensation in the fi rst place? Trustee compensation would result in taxable earned income and would fall under 130 CMR 520.009(c), a Massachusetts regulation that essentially states that such compensation for services rendered to the Trust is not equivalent to the Settlor/Trustee being “benefi tted” from the Trust as a beneficiary is so benefitted. The Trustee earned the income as a result of services rendered, which is a far cry from receiving income or principal merely because of the fact that he or she might also be a benefi ciary of the Trust. As an example, if the Settlor/ Trustee happened to be a carpenter and performed carpentry services related to real estate held in the Trust, and invoiced the Trust for such services, wouldn’t that represent payment for services rendered and not a distribution of principal from the Trust? It would represent earned income and would be taxable to the Settlor/ Trustee. The federal Medicaid law is clear in stating that state Trust law is to govern provisions found within Trust documents. The federal government relies on the body of law with respect to Trusts as it has evolved over the past 200 years within each state in the union. There is no Federal law which does not recognize state laws governing Trusts when determining ownership rights, property rights and other legal interests. One way to avoid ever having to defend such a possible attack on the part of MassHealth is to simply limit the Trustee compensation to the income generated by the Trust. In other words, Trustee compensation can only be paid out of income. That being said, by deduction, Trustee compensation cannot be paid from the principal. Therefore, with respect to the Trustee compensation issue, MassHealth cannot argue that the principal of the irrevocable Trust is somehow a countable asset. Pursuant to the Massachusetts Supreme Judicial Court case Fournier, decided in July of 2021, the Trust document must be read as a whole and there can be no circumstances in which the Settlor of the Trust could receive principal distributions. This case forced MassHealth to significantly reduce its attacks on irrevocable Trusts when no sound legal basis under well-settled Trust law for the attacks exists. Joseph D. Cataldo is an estate planning/elder law attorney, Certifi ed Public Accountant, Certifi ed Financial Planner, AICPA Personal Financial Specialist and holds a masters degree in taxation.
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