Dear Penny, My spouse suffered from a stroke three years ago. He is unable to work and is receiving Social Security and is very noncompliant about his health. I am currently and have been the breadwinner for this family. ...

Dear T.,

Watching your spouse jeopardize his health and risk your future in the process has got to be agonizing. Unfortunately, the threat of unmanageable medical bills is far too common since Medicare only covers the first 100 days of skilled nursing care.

Paying for a nursing home can quickly erase a lifetime’s worth of savings. The average cost of a semi-private room in a skilled nursing facility is over $7,700 per month, according to Genworth’s 2020 Cost of Care survey. Eventually, Medicaid will kick in — but only after someone has depleted almost all of what’s called countable assets, which include things like retirement accounts and other investments, cash, bank accounts and homes that aren’t used as a primary residence.

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When one spouse needs Medicaid but the other doesn’t, the non-applicant spouse can typically keep no more than $137,400 of countable assets. That’s not much if you’re expecting a long retirement.

But you do have options for preserving the money you’ve worked hard for over the years. It’s essential that you consult with an elder care attorney. Medicaid planning is extraordinarily complex, and the laws vary significantly by state. You can use the National Academy of Elder Law Attorneys database to search for an attorney near you.

You’re correct in that if you divorced, your husband would probably be entitled to part of your retirement. But most attorneys don’t recommend getting divorced solely to qualify one spouse for Medicaid for a host of reasons that are too complicated to delve into here.

One option you should discuss with an attorney is a Medicaid-compliant annuity. In a nutshell, Medicaid considers the income of the spouse who’s applying for coverage, but the other spouse’s income is off-limits. A Medicaid-compliant annuity takes part of your assets and converts it into a fixed income stream. The payments are based on your life expectancy, calculated according to Social Security’s life expectancy table.

For simplicity’s sake, let’s say you have $257,400 in countable assets, which would put you $120,000 above Medicaid’s threshold. You use that $120,000 to buy an annuity. If your life expectancy is 10 years, you’d immediately start to get payments of $1,000 a month, or $12,000 annually, for the next 10 years.

The insurance company makes its money by investing your principal. It’s a good tool for married couples when only one spouse needs care because, remember, the income of the other spouse isn’t used for Medicaid eligibility.

There are many rules an annuity has to follow to be considered Medicaid compliant. For example, it has to be a single premium immediate annuity, meaning you buy it in a lump sum and the payments start right away. If you’d opt to go this route, it’s important to look specifically for a Medicaid compliant annuity. Annuities advertised as “Medicaid-friendly” often don’t meet all the rules.

If you have debt, you could also use part of your assets to pay it off so you can keep your expenses minimal in retirement. Paying off a mortgage balance, a personal car loan or a credit card balance generally won’t violate Medicaid’s rules. If the two of you own your home, there’s no limit on your home equity as long as you continue to reside there.

You could have other options depending on your state. For instance, if you live in Florida or New York, you may be able to use a spousal refusal strategy, where you essentially sign a written statement refusing to contribute to the cost of your husband’s care.

These are just a few strategies that may be possible in the event that your husband needs long-term care. However, I can’t stress how important it is to consult with an experienced attorney about how to protect your assets. You may not need to take any action right away. But just knowing what options you have will set your mind at ease.

Robin Hartill is a certified financial planner and a senior writer at The Penny Hoarder. Send your tricky money questions to AskPenny@thepennyhoarder.com.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.

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