Immediate irrevocable annuity converts spend-down assets into an income stream for the community spouse.
The Deficit Reduction Act allows a Medicaid-compliant annuity (immediate, irrevocable, non-assignable, actuarially sound, state as remainder beneficiary) purchased by/for the community spouse to convert countable assets into an income stream for the well spouse. Institutionalized spouse qualifies for Medicaid immediately; community spouse retains income for life expectancy. Especially powerful in 'income cap' states with expanded CSRA.
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Irrevocable income-only trust funded 5+ years before Medicaid application shelters home and assets from spend-down.
Transfer the primary residence to an adult child who lived there caregiving for 2+ years — no Medicaid transfer penalty.
In select states, the well spouse refuses to contribute — Medicaid must cover institutionalized spouse, may sue later.
Wartime-era veterans (or surviving spouses) needing help with ADLs get up to $2,795/mo tax-free — stacks with Medicaid.
Written contract paying an adult child market rate for caregiving spends down assets without Medicaid transfer penalty.
Ladybird deed transfers home at death with §1014 step-up, avoids probate, and doesn't trigger Medicaid transfer.
Post-65, HSA funds pay Medicare Part B/D/Advantage premiums + LTC insurance premiums tax-free.
Combo policies give LTC benefits if needed, death benefit if not — no 'use it or lose it' like standalone LTC.