Sometimes Medicare will decide that a particular treatment or service isn’t covered, and will deny your claim. The good news is that if you believe you should have been paid, you can appeal.

The federal government makes the general rules for Medicare, but the day-to-day administration is handled by private insurance companies that contract with the government. In addition, the government contracts with committees of physicians who decide the appropriateness of care received by most Medicare beneficiaries in hospitals.

Many of the decisions made by insurance companies and doctors’ committees are highly subjective. For instance, they might involve a judgment call as to whether a given treatment is medically necessary, or whether a service is “custodial care” as opposed to medical care.

If Medicare refuses to pay for a treatment or service, you’ll learn this when you receive your “Medicare Summary Notice” in the mail.

A good first step is to find out whether the denial of coverage is simply the result of a coding mistake. You can ask your doctor to confirm that the correct medical code was used on the Medicare paperwork. If it wasn’t, that might solve the problem right there.

If the code was correct and you still believe Medicare should have paid, you can appeal the decision through Medicare’s internal review process.

If that doesn’t work, you can go to court. This is allowed as long as the amount in dispute is at least $1,000 (or $2,000 for some types of claims). An attorney can represent you in the case.

According to the Medicare Rights Center, only about 2 percent of Medicare beneficiaries appeal denials of care. But 80 percent of those who appeal Part A denials – and 92 percent of those who appeal Part B denials – win more care as a result.

Even if Medicare was correct in denying coverage, beneficiaries can sometimes avoid having to pay for a treatment if they can show that they didn’t know and couldn’t have been expected to know that a particular treatment wouldn’t be covered.

Have you been officially asked to manage someone else’s money? For example, have you been named as an agent under a power of attorney, or a trustee of a trust?

As our society ages, more and more people are being asked to take on these roles, but they can be daunting.

In order to help, the U.S. Consumer Financial Protection Bureau has published four free guides, under the general titleManaging Someone Else’s Money. The guides are designed for (1) agents under a power of attorney, (2) court-appointed guardians and conservators, (3) trustees of a living trust, and (4) people appointed to manage someone else’s government benefit checks.

In general, someone in such a position is called a “fiduciary.” Fiduciaries are legally required to manage the other’s person’s assets carefully, keep them separate from their own property, act in the other person’s best interests (and not necessarily their own), and keep good records. The guides include detailed information about these four duties.

The guides also offer advice on how to protect the person in your care from financial exploitation, how to avoid problems with family and friends who question your decisions, how to coordinate with other agents who may be assigned to work with you, and how to deal with outside professionals such as lawyers, brokers, and financial planners.

Most of the time, the exact extent of a fiduciary’s role will be determined by a document, such as a court order or a power of attorney or trust document. The four guides can’t make specific decisions for you, and they aren’t a substitute for legal advice, but they may be helpful in getting you started.

The federal government has tightened the rules on reverse mortgages, making it harder for some seniors to get these types of loans and reducing the amount of a home’s value that can be tapped.

Reverse mortgages allow elders who are house-rich but cash-poor to use their housing equity.  Homeowners who are at least 62 years old may use the equity in their home to obtain a loan that doesn’t have to be repaid until the homeowner moves, sells, or dies. The homeowner receives a sum of money from the lender, usually a bank, based largely on the value of the house, the age of the borrower, and current interest rates.

Homeowners can get the money in one of three ways (or in any combination): in a lump sum, as a line of credit that can be drawn on at the borrower’s option, or in a series of regular payments, called a “reverse annuity mortgage.” Seniors sometimes use these loans to pay for home care while they remain in the home.

Almost all such loans are insured by the U.S. government. The government says that in recent years, default rates have been rising, and many seniors are losing their home when they are unable to continue paying for insurance and property taxes.

To address this problem, last year the government eliminated the most popular type of reverse mortgage, which was the “standard,” fixed-rate lump-sum mortgage.

This year the government is adding new restrictions, including:

• Who can borrow. Seniors are now required to undergo a financial assessment to make sure they can afford insurance and property taxes. If a lender determines that you’re at risk of defaulting on these payments, you might be required to set aside money for them.
• Amount you can borrow. Until last year, homeowners had a choice of two programs: the “standard,” which allowed for larger loans, and the “saver,” which offered smaller loans and smaller fees. The government has now merged the two programs. The new maximum loan amount is about 10-15 percent less than in the standard, but slightly higher than in the saver.
• Fees. Previously, the upfront fee to take out a standard loan was 2 percent of the property’s value, while the saver fee was a tiny .01 percent. The new fee is .5 percent. However, seniors who borrow more than 60 percent of a home’s value will instead pay a hefty 2.5 percent fee.
• First-year limit. During the first year of a loan, homeowners can no longer withdraw more than 60 percent of the total loan amount.

In general, proceeds from a reverse mortgage are not subject to income tax and generally won’t affect your ability to receive Social Security or Medicare. However, it’s possible that they could affect your eligibility for other government programs such as Medicaid.

A revocable or “living” trust can be a great way to avoid probate, manage your assets if you become impaired, and protect your family’s privacy. If you have one, it’s a good idea to review it every few years to make sure that it still meets your goals and is up-to-date with the law.

The most important questions involve which assets are in the trust and what will become of them if something should happen to you. But there are a lot of other factors to think about that can also be very important for your estate plan. Here are some common issues and problems with living trusts that you might want to consider:

1. Do you have the right successor trustees? Typically, you’ll be the trustee of your own living trust, and if you’re married, your spouse might be a co-trustee. But it’s good to name successor trustees in case you or your spouse pass away or become incapacitated. Have you done so? If so, are the people you named still the best people to manage your affairs? Do you want one of them to begin acting as a trustee now? If you and your spouse are co-trustees, do you want a successor to step in when the first of you becomes incapacitated, or not until neither of you can serve?
2. Can your heirs remove a trustee? Do you want your heirs to be able to remove a trustee after you pass away? This can potentially be helpful if there are communication problems or disagreements with a trustee. On the other hand, some heirs might take advantage of this provision by installing a “puppet” as trustee who will ignore your wishes and do whatever they want.
3. Can your spouse change the distribution of assets after your death? Many trusts give a surviving spouse the right to change the way that assets are distributed. This can be helpful to provide flexibility in responding to changes in family circumstances. However, in one recent Massachusetts case, a wife used this power to give everything to her children from her first marriage, and nothing at all to the trust’s original beneficiaries (her deceased husband’s own children).
   Of course, even if a spouse doesn’t have children from a previous marriage, there have certainly been cases where a surviving spouse has later remarried and become estranged from the rest of the family.
4. Does your trust protect children from lawsuits and divorce? You have the option of having your trust continue during your children’s lives, so the assets in the trust will be protected if your children are sued, incur large debts, or get divorced.
5. Have you funded the trust? It’s not uncommon for people to set up a trust and then forget to re-title their assets so they are included in the trust. But this mistake can destroy all the benefits of having the trust in the first place.
6. Have you reviewed your beneficiary designations? A trust should be coordinated with assets outside the trust that have beneficiary designations, such as bank and brokerage accounts, IRAs, 401(k)s, life insurance, etc. These designations should be reviewed every few years to make sure they’re current and coordinated with the trust as part of your estate plan.
7. When do children and grandchildren receive their inheritance? Most trusts provide that assets will remain in the trust until those inheriting them reach a certain age, such as 21. But it’s important to note that not all 21-year-olds are responsible enough to handle an inheritance. You can change this age if you want. You can also provide that assets will be distributed over time. For instance, a third of the assets might be distributed at age 25, another third at age 30, and the remainder at age 35.
8. Is the trust the beneficiary of a retirement plan? While you can choose to have your retirement plan assets go directly to your heirs – and this is often the simplest approach – there can be tax advantages in leaving these assets to a trust, where the tax deferral can be stretched out over many years. However, this requires some very technical provisions in the trust, and it’s important to make sure these provisions are current.
9. Is your trust up-to-date for estate tax purposes? Congress and many states have changed the estate tax laws several times in recent years. If your trust is more than a few years old, or if you lived in a different state when it was drafted, it should be reviewed by an attorney to make sure it’s still current and that you’re getting all the tax savings that are available.

One of the most common mistakes people make in estate planning is that they finally create a complete, thorough, highly advantageous estate plan – and then forget to follow through and put it all into effect.

It’s not uncommon for people to have detailed documents drawn up, and then not get around to signing them. Or they create a trust, but forget to transfer assets in order to fund it. Or they decide whom to name as beneficiaries of their IRA, 401(k), bank and brokerage accounts – and then don’t fill out the paperwork to make the change.

A recent case involved Allen Kagan, a Minnesota pharmacist who had a $415,000 life insurance policy through his employer. Allen died of a sudden heart attack, and was survived by his new wife Arlene and three children from a previous marriage.

The life insurance policy said that if Allen didn’t name a beneficiary, then by default the beneficiary would be his wife – Arlene.

The children claimed that Allen and Arlene “fought constantly” and had sought marriage counseling. After Allen’s death, the children found a form on which Allen had designated the children as the life insurance beneficiaries, and cut out Arlene. Allen had signed the form – but he hadn’t submitted it to the insurance company before he died.

The case went all the way to a federal appeals court, which sided with Arlene. Although the signed form suggested that Allen had intended to change his beneficiary, he never followed through, the court said. Because Allen never submitted the form, the court couldn’t assume that he had fully made up his mind to do so. Therefore, Arlene got the money.

The bottom line is that the best estate plan in the world isn’t worth the paper it’s printed on if you don’t follow up and take the necessary steps to make it a reality.

Bernard and Jeanne Adler donated $50,000 to an animal shelter in their hometown of Princeton, N.J. The gift was to finance a new structure for large dogs and older cats (whose prospects for adoption are limited), and the structure was to be named for the Adlers.

Before construction began, however, the shelter merged with another organization. After the merger, the new organization announced plans to build a smaller structure in another town, without specific facilities for large dogs and older cats and without naming anything for the Adlers.

The Adlers went to court and demanded that the shelter return their $50,000 gift.

The shelter argued that it had fulfilled the Adlers’ intent as well as it could under its changed circumstances. But an appeals court said that didn’t matter – the Adlers had made the gift with specific conditions, and if the conditions weren’t met, the charity had to return the funds.

The moral of the story is that if you’re making a charitable gift and you intend for the money to be used for a specific purpose, this needs to be very clearly spelled out in a contract or gift agreement, so that you have legal recourse if the charity takes your money and uses it for something else.

Some people never get around to writing a will or planning their estate until the last minute, when they have grown old and have a serious illness.

Other people write a simple will when they’re young, but never review or update it until something happens that makes them think that death is imminent.

While any estate planning is better than none, the vast majority of mistakes and problems occur when people procrastinate planning their estate and then try to do it in a hurry.

If you wait until the last minute, it might be very difficult to locate all the documents you need to properly execute an estate plan. And you might not have sufficient time to take advantage of all the techniques that are available to save taxes and properly take care of your heirs.

In addition, last-minute changes to your will can be very disturbing to family members. A great many will contests are the result of heirs whose expectations were upset by eleventh-hour amendments.

Estate planning is a critical part of your overall financial planning. Most people would never buy a stock or other investment and then completely ignore it for 20 years. In the same way, you should review and update your estate plan every few years, or whenever there’s a significant change in your circumstances.

If you don’t need all the money in an IRA after you retire, there can be big tax advantages in carefully leaving it to your children or other heirs. If it’s done right, the heirs can take out only the minimum required distribution each year, and the assets in the IRA can continue to grow tax-deferred for decades – and in some cases, for generations to come.

The problem with this planning technique is that it requires your heirs to be patient money managers. In the real world, many heirs withdraw the funds from an inherited IRA quickly, which destroys the tax advantages.

The traditional solution is to leave your IRA to a trust, in which a trustee can decide how to invest the IRA, when to make withdrawals from the IRA, and what distributions to make to your heirs.

Trusts have other advantages, such as that they can benefit a surviving spouse during his or her lifetime, and later benefit children from an earlier marriage. They can also shelter IRA assets from estate tax if your spouse is from another country and doesn’t have a large estate tax exemption.

Recently, though, some financial institutions have been pitching a new product called a “trusteed IRA.” The new product is similar to a trust, in that a trustee is appointed who will manage the IRA assets and limit future distributions to heirs.

The main advantage of a trusteed IRA is that the tax rates for trusts have risen recently, and at least for the near future, a trust might pay higher taxes than the beneficiary of a trusteed IRA.

However, trusteed IRAs also have a very big drawback, which is that you can’t pick the trustee and you don’t have any flexibility for special circumstances.

With a trusteed IRA, your assets will be managed by a money manager who works for the financial institution and likely has no familiarity with your family or your preferences. Plus, the trustee has no ability to bend the rules if the circumstances require. If your heirs ever need extra distributions to pay for education, health problems, starting a business, or any other contingency, they’ll be out of luck – whereas with a trust, you can pick a trustee who understands your heirs’ needs, and you can write the trust to give the trustee power to help them when appropriate.

Either way, it’s important to talk to an estate planner about how to choose the beneficiaries of an IRA. While the tax advantages can be huge, the rules are complex and technical and it’s very easy to make a mistake.

For decades, it was very common for trusts to be set up like this: “The trust income will go to the first beneficiary, and when the first beneficiary dies, the trust assets will go to a second beneficiary.”

Here are some common examples:

• A couple sets up a trust with the income going to a child, and when the child dies, the assets go to their grandchildren.
• A wife’s will creates a trust that pays income to her second husband, and when he dies, the assets go to her children by her first marriage.
• A man sets up a trust where the income goes to his wife, and when she dies, the assets go to a charity.

That’s all well and good when interest rates are healthy. But over the last few years, interest rates have plunged to historic lows, and stayed there.

The result in many cases is that the first beneficiary of a trust ends up getting a lot less income than he or she expected – or than the person who created the trust expected, for that matter.

This often puts trustees in a bind. Typically, trustees want to manage the funds fairly to help both the first beneficiary and the second beneficiary. They will invest some assets in bonds and other fixed-income instruments to produce income, and others in equities to create long-term appreciation. But recently, such an approach has had the effect of shortchanging the first beneficiary.

A trustee could shift all the investments to bonds to try to make up the difference. But doing so would harm the second beneficiary.

There’s no perfect solution, but a different type of trust called a “unitrust” could make things easier in this environment.

Rather than paying the first beneficiary the interest each year, a unitrust pays the first beneficiary a fixed percentage of the trust’s total assets. So for instance, a trustee could determine the total value of all the trust assets as of December 31 of each year, and then pay the first beneficiary 4 percent of that value.

This doesn’t solve every problem, but it does prevent a first beneficiary from being punished when interest rates drop and stay low for a long time. It also allows a trustee to manage funds for the best possible overall return without having to worry about shortchanging one of the beneficiaries. The better the trust’s investments do, the better off both the first and second beneficiary will be.

While a typical unitrust pays the first beneficiary a fixed percentage of the trust assets each year, a popular variation is to “average out” the value of the assets over a three-year period. For instance, a trust could pay first beneficiary 4 percent of the average value of the trust on December 31 of the past three years.

This is a way of smoothing out the payments, so the first beneficiary’s income doesn’t fluctuate wildly from year to year depending on the market.

If you’re setting up a new trust, or if you have an old trust that can be modified, it might be worth considering making it a unitrust.

In highly unusual circumstances, even a trust beneficiary may be able to make this change.

In one recent New York case, a trust created in 1983 was designed to pay income to a daughter, with the assets going to other children after the daughter died. After the 2008 crash, the daughter’s income from the trust dwindled considerably. The daughter went to court and asked a judge to convert the trust to a 4-percent-a-year unitrust, saying she needed the additional funds to pay for her health care.

The judge agreed and converted the trust. The judge said that doing so was in keeping with the intent of the trust, which was to adequately support the daughter. The judge also said that since the daughter was now elderly and the trust assets had grown over the years, there was little chance that upping the annual payout to 4 percent would dangerously deplete the trust assets for the other beneficiaries.

Javier Castro was in the hospital and wanted to write a will. Because there was no paper handy, he used a Samsung Galaxy tablet computer and signed the will using the tablet’s stylus. His brothers also signed as witnesses. After Javier’s death, his family printed out the will and submitted it to probate in Ohio. 

A judge accepted the will, finding that it met the requirements of Ohio law, which are that a will be in writing, signed by the testator, and witnessed. (If the will hadn’t been approved, Javier’s estate would have passed to his parents under state law, and not to the people and organizations he designated in the will.)

Although the judge approved the will, he noted that the legislature needs to update the law to address electronic wills.

Electronic wills may be convenient, but they raise serious concerns about authentication and forgery. Currently, Nevada is the only state that specifically provides guidelines for creating a valid electronic will. Some states, such as Arizona and North Carolina, refuse to accept wills that aren’t on paper. Most states simply have no rules yet, so whether a computer will is okay is up in the air.

The best way to make sure your will is considered valid is to consult with your attorney, who can explain all the legal requirements, and also provide advice on avoiding taxes and unnecessary hassles and expenses.