Government, Financial & Legal

An Area Agency on Aging (AAA) is a public or private non-profit agency, designated by the state to address the needs and concerns of all older persons at the regional and local levels. “Area Agency on Aging” is a generic term—specific names of local AAAs may vary.

AAAs coordinate and offer services that help older adults remain in their homes— if that is their preference. By making a range of options available, AAAs make it possible for older individuals to choose the services and living arrangements that suit them best.

• Medicaid, Medicaid Waiver – food and financial assistance eligibility.
• Long-Term Care Ombudsman – education, consultation, referral, and advocacy for those living in a long-term care facility.
• Developmental Disability Services – service coordination for those with disabilities.
• Social Services Block Grant Program – assistance for persons who are aged 60 and older or disabled so they may remain in their own home or in other safe surroundings as long as possible.
• Adult Protective Services (APS) – investigates and helps remedy abusive situations.

APS assists vulnerable and elder adults to stop and prevent abuse, neglect, or exploitation. Anyone can make a report about suspected abuse to the Hotline.
Nebraska Elder Abuse/Neglect
800-652-1999 Hotline
Iowa Elder Abuse/Neglect
800-362-2178 Hotline

Social Security is a retirement program for Americans who paid for coverage through payroll deductions or self-employment.

Some services may be extended to the spouse or dependent of an eligible veteran.

Hospitals and Hospice Programs often have foundations established to help those in need. Many pharmaceutical companies offer discounted prescription programs.

Many banks offer trust and wealth management services.

A reverse mortgage is a type of home loan that lets individuals aged 62 and older convert a portion of the equity in their home into cash. The Home Equity Conversion Mortgage (HECM) is FHA’s reverse mortgage program. You must meet with an HECM counselor first to discuss eligibility and requirements. Call HUD at the number below to find an FHA reverse mortgage lender as well as a counselor, or search online on their website.

Consult an online directory for further listings.

Long-Term Care Insurance (LTCI) was developed to cover long-term services and supports, including personal and custodial care in a nursing facility, an assisted living facility, or in an individual’s home. Long-Term Care Insurance reimburses policyholders a daily amount (up to a preselected limit) for services to assist with activities of daily living such as dressing and eating. The policyholder can generally select from a range of care options and benefits that allow them to get the services they need, where they need them. Without LTCI, many people pay privately for their long-term care needs, and this can become very costly. Medicaid only becomes effective when a person has spent down most of their personal resources. Medicare only covers certain medical expenses and for a limited time.

If the individual is in poor health or already receiving long-term care services, they may not qualify for LTCI. In some cases, they may be able to buy a limited amount of coverage or buy coverage at a higher “non-standard” rate. Since there is no national policy for LTCI, it is wise to research the topic and talk to several companies before deciding whether the insurance is needed and which policy is best for you. Many personal considerations will come into play during this process.

These include:

What is your personal financial situation, and do you in fact need LTCI for yourself and/or your spouse?

When should you purchase such a policy?

• It is often beneficial to begin consideration and research into LTCI between the ages of 45 and 60.

When you do start shopping for a policy, we suggest you consider the following:

• What services are covered? Does the policy provide for home health care and assisted living facilities as well as for nursing homes?
• What are the daily benefit amounts available? What amount will be needed to meet your particular needs?
• What is the waiting period before benefits begin?
• Are you required to have an assessment of activities of daily living, a physician’s certification of need, or a prior hospital stay before benefits can be redeemed?
• What is the benefit payout period: 2 years, 4 years, or lifetime?
• Is there an inflation clause built in, and what is that percent factor?
• Is there a maximum lifetime benefit?
• Have any complaints been filed with the Department of Insurance against the company?

It is helpful to research current prices of senior living options along with home health care companies to determine the level of policy one would need in order to be able to afford the type of care desired.

Very important: Be sure to understand the criteria required by the insurance company to be eligible for benefits.

These are by no means all the things to consider when making this decision, but they can make for a good start.

For more information on Long-Term Care Insurance, contact:

Consult an online directory for further listings.

Medicare is federal health insurance for people aged 65 and over, people under 65 with certain disabilities, and people with end-stage renal disease.

Medicare is divided into four parts:

• Part A is hospital insurance.
• Part B is medical insurance.
• Part C, known as Medicare Advantage, provides the option to choose from different health care plans.
• Part D provides the option to choose from different prescription drug plans.

Medicare does not cover everything, nor does it always cover the full amount.

There are 2 main ways to get your Medicare coverage – Original Medicare or a Medicare Advantage Plan.

• If you decide to go with Original Medicare, you decide if you need prescription drug coverage (Part D) and/or a Medicare Supplemental Insurance (Medigap) policy.
• If you decide to use a Medicare Advantage Plan (Part C), that plan combines Part A and Part B, and most cover Part D, or give you the option to add prescription drug coverage.

“Medicare & You” is a booklet with information on Medicare benefits, rights and protections, lists of available health and drug plans, and answers to the most frequently asked questions. This handbook, as well as other available publications, are revised yearly and available in both English and Spanish. You may obtain a copy by calling the Medicare office or read them online at Medicare.gov.

With questions or for information, contact:

Part A helps pay for care in hospitals and nursing facilities, hospice care and some home health. Premium-free for most people because of Medicare taxes paid while working.

Part B helps pay for medically necessary doctor’s services, outpatient care, home health, durable medical equipment and some preventive services. Standard 2026 premium: $202.90/month. Annual deductible: $283 (2026). After deductible, you typically pay 20% of approved amounts.

Medicare Advantage plans are offered by private, Medicare-approved insurance companies. They cover all Part A and Part B services and often add vision, hearing, dental and wellness. Most include Part D prescription drug coverage. Compare plans at Medicare.gov/find-a-plan. You may change plans October 15–December 7 each year. Call SHIP at 877-564-7323 (Nebraska) or 800-351-4664 (Iowa) for help.

Voluntary prescription drug insurance through private companies. Enrollment window: 3 months before through 3 months after your 65th birthday. Change plans October 15–December 7 each year. Compare at Medicare.gov/find-a-plan.

Medigap policies are sold by private companies to fill the gaps in Part A and Part B coverage — copayments, coinsurance and deductibles. Ten standardized plans to choose from. You must have both Part A & B; cannot use Medigap with Medicare Advantage. Enroll starting when you enroll in Part B (6-month open enrollment window). Compare at Medicare.gov/find-a-plan or call SHIP.

Medicaid is financed by individual states and the federal government to pay some health care costs for people with limited incomes and resources. Available to low-income persons 65+, blind, disabled, children 18 or younger, and others who meet eligibility requirements.

Medicaid generally pays Medicare copayments and deductibles. It may also cover hospital care, doctor visits, dental, eye care, speech/hearing/physical therapy, lab and x-ray services, nursing home care, home health, prescriptions, medical equipment, health aids, transportation and institutional care.

• Single person: Less than $1,799/month income. May retain up to $4,000 in resources. Home, one car, business property, up to $1,500 life insurance face value, and up to $6,122 irrevocable burial trust are exempt.
• Married couple: Less than $1,305/month income. May retain up to $8,000 ($4,000/spouse) in resources. Same exemptions per spouse.
• Couple with one spouse in nursing home: Spousal impoverishment rules apply. Combined resources split 50/50 if between $31,584–$157,920. Community spouse keeps all income; nursing home spouse keeps $60/month personal allowance.

Income and resource guidelines adjust yearly. Numbers above based on 2023 figures. Contact DHHS or AccessNebraska.NE.gov for current eligibility.

Navigating Medicaid eligibility and long-term care costs can be overwhelming. Medicaid planning professionals help families understand spend-down requirements, prepare Medicaid-compliant financial strategies, and complete the application process — guidance that doesn’t require an attorney.

PACE is a Medicare and Medicaid program for people who need support services to remain in their home. Services provided through PACE are determined by an interdisciplinary team of professionals. PACE provides primary and hospital care as well as prescription drugs, adult day services, transportation, and other services provided in the home, at the PACE center, and in the community.

Individuals may be eligible for PACE if they (a) are 55 years old or older, (b) live in the service area of a PACE organization, (c) meet the need for nursing home level of care, and (d) are able to live safely in the community with the help of PACE services.

Once enrolled in PACE, the amount you pay each month will not change no matter what care or services you might need. There is never a copay, deductible, or coverage gap. If you are eligible for Medicaid, you never pay a premium. If you are eligible for Medicare only, you are charged a monthly premium for the program and a premium for Medicare Part D coverage. If you are not eligible for Medicare or Medicaid, you pay a private pay rate. Because PACE provides and is responsible for all of your care, you may be held financially responsible for any care you receive outside the program that is not approved by the PACE interdisciplinary team.

Enrollment and disenrollment usually occur at the beginning of each month and must be done directly through PACE. You can leave a PACE program at any time. For more information, visit Pace4you.org or contact your local PACE provider:

Advance Medical Directives are written guidelines directing future care in the case an individual cannot make or communicate a medical decision. The primary emphasis is usually on end-of-life care. The most common types of advance directives are Living Wills & Powers of Attorney, but others have become more prominent in recent years. In Nebraska and Iowa, you must fill out a Living Will and a Healthcare Power of Attorney for a complete Advance Directive.

Living Will is a legal document that indicates the individual’s wishes regarding end-of-life decisions, i.e. CPR, ventilators, and feeding tubes. They can be specific or more general and only become active after the individual has been determined to be unable to make or communicate a medical decision. A Living Will supplements the Healthcare Power of Attorney by providing a means to understand and honor your personal wishes.

Five Wishes is a Living Will document that lets your family and doctor know your healthcare decisions and wishes and that meets legal requirements in Nebraska and Iowa. The “Five Wishes” include: (1) the person you would like to make healthcare decisions on your behalf, (2) the kind of medical treatment you would want, (3) how comfortable you want to be, (4) how you want people to treat you, and (5) what you want your loved ones to know. You can call 888-5-WISHES (594-7437) for information, or an online version can be found at AgingWithDignity.org.

Code/No Code – Do Not Resuscitate (DNR) Order is a medical order that states whether an individual wishes to have attempts made to restart his or her heart and lungs in the event that they stop working. It is also known as a DNR Order. Hospitals and care facilities often ask terminally ill patients or their agent to write a Code/No Code order for their medical record.

Powers of Attorney (POAs) are legal documents that appoint trusted persons to assist with medical or financial management on an individual’s behalf. If a Power of Attorney is durable, it will continue to be in effect after the individual is deemed incapable of making decisions on their own. It does still allow the individual to make decisions as long as they are capable. If a Power of Attorney is springing, it becomes effective upon the individual’s incapacity.

Healthcare Power of Attorney (HCPOA), or Medical Power of Attorney, appoints a trusted agent (the principal) to make medical decisions for an individual who cannot make or communicate a needed medical decision. The principal has the same rights as the individual to accept or reject treatments, provide instructions for desired end-of-life care, authorize access to medical records, admit the individual to hospitals or facilities, and relay feelings regarding hospice care, specific medical procedures, organ donation, or funeral instructions. There must be documentation from a physician regarding the incapacitation of the individual to become effective.

A Healthcare Power of Attorney must be written as well as signed and either witnessed by two adults or notarized. You may revoke your HCPOA at any time by notifying your healthcare provider or attorney or by making a new Healthcare Power of Attorney. An HCPOA prepared in another state is honored in Nebraska and Iowa.

Financial Power of Attorney (FPOA) appoints a trusted agent to manage finances and property for an individual. These may include checking accounts, savings accounts, safety deposit boxes, securities, investments, and more. An FPOA can be granted to a spouse so they may manage or access another spouse’s individually owned assets, or the agent may be another competent adult.

A Financial Power of Attorney must be written as well as signed and either witnessed by two adults or notarized. You may revoke your FPOA at any time.

The HCPOA and FPOA may be the same person or two different people. If they are different, they must be able to work closely together. An attorney can assist in preparing a power of attorney. Contact an elder law attorney or visit the Nebraska or Iowa State Bar Association for more information.
Guardianship & Conservatorship
If an incapacitated individual does not have powers of attorney in place or will not cooperate with their POA, the local court may appoint a Guardian or Conservator to assist and protect the individual.

Guardianship
An interested party may petition the court to appoint a Guardian to assist an individual whom doctors find unable to manage their health or daily needs if no durable Healthcare Power of Attorney is in place. Family, friends, or community volunteers may serve as the Guardian. The Guardian must work within the individual’s resources to provide food, clothing, shelter, and healthcare. A Guardian must report annually to the court on the individual’s condition and progress.

Conservatorship
An interested party may petition the local court to appoint a Conservator to assist an individual whom doctors find unable to manage their property and finances. Family, friends, or community volunteers may serve as a Conservator. The Conservator will use the individual’s assets to pay for medical care and support and may also apply for government benefits to assist with these costs. The Conservator must file a detailed annual accounting report for review by the court.

The Guardian and Conservator may be the same person or two different people. If they are different, they must be able to work closely together. Call the Office of Public Guardian at 402-889-3272 or contact an elder law attorney for more information.
Representative & Protective Payee
Representative Payee
A person appointed by the Social Security Administration to handle all of an individual’s Social Security affairs. That person must file an application with the Social Security office and have medical verification that the person is incapacitated.

Protective Payee
A person appointed by the Nebraska or Iowa Department of Social Services to handle the protected person’s state benefits.
Probate, Wills and Trusts
Powers of Attorney, Guardianships, and Conservatorships lose their authority to act when the individual dies. After death, the estate will often go into probate, and the assets of the deceased individual are controlled primarily by his or her Will or Trust.

Probate
A legal process that takes place after an individual’s death. Probate courts admit Wills, appoint personal representatives, oversee the accounting and distribution of the estate, and preside over any Will contests that may be filed. The probate process can be short and informal or longer and overseen by the court, depending on the size of the estate.

Will
A legal document that appoints someone to administer their estate, a personal representative, and says to whom assets should go. If an individual dies without a Will, state statutes determine the distribution of assets. Someone must still administer the estate. A Will must be written, signed, and witnessed by at least two individuals as required by state law.

Trust
A legal entity created by the individual to hold title to his or her assets. All assets are transferred to the Trust. A trustee may manage assets during the individual’s lifetime in case of illness. When the individual dies, the Trust continues to own the assets, and the beneficiaries bypass the probate process in obtaining assets. If an individual creates a Trust, he or she typically will still create a brief accompanying Will. An attorney can provide advice as to when a Will alone is adequate and when a Trust might have advantages.

Many law firms offer mediation services.

Many firms have attorneys with experience in probate, wills, and estate planning.