Comprehensive Guide to Medicaid Planning in Norris
Medicaid planning helps families in Norris prepare for the costs of long-term care while protecting assets and maintaining eligibility for public benefits. This page explains how careful planning can affect eligibility, what the Medicaid look-back period means, and how lifetime transfers, trusts, and other strategies may be used to achieve goals. If you are facing the prospect of nursing home care or need to plan for a loved one’s future, understanding the rules in Tennessee and the practical steps available will help you make informed decisions that align with your family’s needs and financial realities.
Effective Medicaid planning is about understanding timing, value transfers, and legal tools that can influence benefit eligibility without compromising care quality. Many families need clear explanations about estate impacts, spend-down approaches, and options for protecting a spouse’s income and savings. Planning may also involve coordinating with Veterans benefits, trusts, and asset reorganization to achieve necessary outcomes within state rules. The goal is to balance immediate care needs with long-term financial security for the applicant and surviving family members, while following Tennessee Medicaid regulations.
Why Medicaid Planning Matters for Families in Norris
Medicaid planning can protect a family’s savings from high long-term care costs, help ensure access to needed medical and nursing services, and reduce stress during a difficult time. Careful planning helps preserve resources for a surviving spouse or other dependents, while addressing eligibility rules like the look-back period and allowable transfers. In Tennessee, understanding state-specific rules and timing makes a significant difference in outcomes. Good planning can also streamline interactions with care facilities and government agencies so families can focus on care and recovery instead of unexpected financial surprises.
About Jay Johnson Law Firm’s Medicaid Planning Services
Jay Johnson Law Firm assists individuals and families in Norris and Anderson County with Medicaid planning as part of broader estate planning and probate practice. The firm helps clients understand the legal and financial implications of long-term care decisions, prepares necessary documents such as trusts and powers of attorney, and advises on timing and transfer strategies under Tennessee law. Communication is focused on clear explanations and practical steps so clients can make timely decisions that address both care needs and preservation of family assets.
Understanding Medicaid Planning Basics in Tennessee
At its core, Medicaid planning involves arranging finances and legal documents to help a person qualify for Medicaid coverage of long-term care while protecting as much of the family’s resources as permissible under law. In Tennessee, this includes attention to the state’s look-back period, allowed transfers, and income rules for applicants and spouses. Planning may involve applying spend-downs, establishing certain types of irrevocable or pooled trusts, or using other trust and gifting strategies. Properly documented plans also rely on clear medical and financial records to support applications.
Medicaid planning is not a one-size-fits-all solution; each family’s financial profile, health needs, and goals shape the best approach. Factors such as the applicant’s anticipated level of care, current assets, income streams, and family who may rely on those assets are all considered. Timing is often critical because transactions within the look-back period can create penalties or affect eligibility. Working through options early and documenting intentions reduces the risk of penalties and helps ensure smoother approval when long-term care becomes necessary.
What Medicaid Planning Entails
Medicaid planning refers to legal and financial planning techniques designed to help individuals meet Medicaid eligibility requirements for long-term care benefits while limiting out-of-pocket costs. The process typically involves reviewing assets and income, advising on transfers and trusts, and preparing documentation required for the Medicaid application. The planning may also include counsel on protecting a community spouse’s resources, structuring annuities in compliant ways, and ensuring income flows meet program rules. The result is a tailored plan that complies with Tennessee regulations and addresses each family’s priorities.
Core Elements of a Medicaid Planning Strategy
A Medicaid planning strategy commonly includes a comprehensive asset inventory, review of income sources, assessment of care needs, and evaluation of transfer options within the state’s law. Key processes include establishing appropriate trusts, documenting medical necessity for care, preparing and filing the Medicaid application, and responding to agency requests. The plan may also coordinate other governmental benefits and evaluate available long-term care insurance or Veterans benefits. Coordination with financial advisors and medical providers ensures the legal approach fits the family’s practical care arrangements and financial timeline.
Key Terms to Know for Medicaid Planning
Medicaid planning uses terms and rules that affect eligibility and outcomes. Familiarity with terms such as look-back period, community spouse resource allowance, irrevocable trust, spend-down, and transfer penalty will help families navigate decisions and conversations with agencies. Knowing these definitions supports better planning and prevents unintended consequences from well-intended transfers or gifts. This glossary section explains those terms in plain language and offers context for how they apply under Tennessee Medicaid rules so families can make more informed choices about long-term care funding.
Look-Back Period
The look-back period is the timeframe during which Medicaid reviews prior transfers and transactions to determine whether they affect eligibility. In Tennessee, transfers of assets for less than fair market value within the look-back can create a period of ineligibility known as a penalty period. Understanding which transfers are reviewed and how penalties are calculated helps families plan appropriately and avoid unintended gaps in coverage. Proper documentation and timing are important to mitigate the effect of any transfers that occurred during that period.
Irrevocable Trust
An irrevocable trust is a legal arrangement where assets are transferred out of the grantor’s ownership and into a trust that generally cannot be altered or revoked. Certain irrevocable trusts may be used in Medicaid planning to remove assets from countable resources, provided the transfer is completed outside of the relevant look-back period and complies with program rules. Using irrevocable trusts requires careful planning, clear documentation, and an understanding of how Tennessee treats trust assets for Medicaid purposes, including potential exceptions and limitations.
Community Spouse Resource Allowance
The community spouse resource allowance protects a portion of a married couple’s assets when one spouse applies for Medicaid long-term care. Tennessee rules allow the community spouse to retain certain resources to maintain a reasonable standard of living. Determining the correct allowance requires evaluating all countable assets and may involve reallocating resources to comply with limits. Proper planning ensures the healthy spouse retains necessary support while the applicant seeks benefits for long-term care, and documentation is prepared to demonstrate eligibility and need.
Spend-Down
A spend-down refers to using assets or income to pay for medical or care expenses until a person’s resources fall within Medicaid eligibility limits. This approach is often used when immediate care is required and other planning tools are not feasible because of timing or the look-back period. Spending down may involve paying for medical bills, home improvements related to care, or purchasing allowable exempt items. It is important to track spend-down payments carefully and keep receipts, because accurate records support the Medicaid application and demonstrate that funds were spent on allowable needs.
Comparing Limited and Comprehensive Medicaid Planning Approaches
Choosing between a limited or comprehensive Medicaid planning approach depends on timing, asset levels, family goals, and the urgency of care needs. A limited approach might focus on immediate eligibility steps, simple spend-downs, or short-term arrangements, while a comprehensive approach considers longer-term asset protection, trusts, and coordinated estate planning. Evaluating both options involves weighing potential penalties, the look-back period, and the financial impact on surviving family members. The right choice balances eligibility objectives with preservation of resources and the family’s broader estate planning priorities.
When a Limited Medicaid Planning Approach Works Best:
Immediate Care Needs with Short Timeline
A limited Medicaid planning approach often makes sense when care is immediately required and there is insufficient time to implement longer-term strategies that must clear the look-back period. In these cases, focusing on preparing a Medicaid application, documenting medical necessity, and identifying allowable spend-downs can secure coverage in the near term. Families might prioritize ensuring the applicant receives prompt care rather than pursuing asset transfers that carry penalties. Clear documentation and organized records remain important to support any application and subsequent appeals.
Low Asset Levels or Simple Financial Situations
When the applicant’s resources are already near Medicaid eligibility limits or the financial picture is straightforward, a limited approach may be sufficient and cost-effective. Simple measures such as reallocating certain noncountable assets, documenting allowable medical expenses, or adjusting income streams could be enough to qualify. In these scenarios, complex trust arrangements or transfers may offer little additional benefit and could add unnecessary paperwork and expense. The focus is on practical steps to secure benefits while minimizing disruption for the family.
Why Some Families Choose a Comprehensive Medicaid Planning Strategy:
Protecting Assets for Surviving Family Members
A comprehensive Medicaid planning strategy aims to protect family assets over the long term, often to preserve an inheritance or support a community spouse. These plans may involve establishing certain types of trusts, coordinating with retirement accounts, or restructuring ownership to comply with Tennessee rules. Such measures are most useful when the family has significant resources that could be depleted by long-term care costs, and when time allows for arrangements to be completed outside of the look-back period. Thoughtful planning helps balance care needs with legacy goals.
Coordinating Medicaid with Estate and Tax Planning
Comprehensive planning often includes integration with estate planning and tax considerations to create a cohesive strategy that addresses care, legacy, and legal obligations. This can include reviewing wills, powers of attorney, advance directives, and trust structures so that Medicaid planning fits within the family’s overall objectives. Coordination with financial professionals helps evaluate tax consequences and ensure decisions made today do not unintentionally complicate estate settlement later. This integrated approach reduces the likelihood of conflicting plans or unintended negative outcomes for heirs.
Benefits of a Comprehensive Medicaid Planning Plan
A comprehensive Medicaid planning plan can protect assets, preserve family wealth, and reduce the financial burden of long-term care while maintaining appropriate care standards. By reviewing all aspects of a client’s finances and legal documents, it is possible to craft a tailored approach that reduces the risk of ineligibility and helps ensure the community spouse retains necessary resources. This approach also anticipates future needs and puts documentation in place so that applications and appeals proceed more smoothly, saving time and lowering stress for family caregivers.
Long-term planning can also minimize disputes during probate by aligning Medicaid strategies with estate documents, which helps families avoid costly conflicts. Comprehensive plans provide clarity about asset distribution and care funding, which benefits both applicants and their heirs. By addressing income streams, trust arrangements, and potential benefits from other programs, families can make informed decisions that serve care needs now and protect financial interests in the future. The result is greater predictability and a clearer path to meet both care and legacy goals.
Asset Protection and Financial Stability
A primary advantage of comprehensive planning is protecting assets from excessive long-term care costs while maintaining financial stability for the family. That protection can include preserving a portion of savings for the community spouse, setting aside funds for future needs, and reducing the risk that care costs will consume the family inheritance. Planning also ensures that spending and transfer decisions align with Tennessee Medicaid rules, which reduces the likelihood of penalties or unexpected denials. This helps families face care needs with greater confidence about long-term financial impacts.
Greater Peace of Mind Through Coordination
Comprehensive planning offers peace of mind by coordinating legal, financial, and care considerations into a single cohesive plan that anticipates future developments. Families receive clear documentation and instructions for how assets will be handled, what benefits to expect, and how care decisions interact with legal arrangements. Knowing that plans are coordinated reduces confusion among family members and eases transitions when care needs change. This clarity helps reduce disputes and supports smoother administration of benefits and estate matters during emotionally difficult times.
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Practical Tips for Medicaid Planning
Start planning early
Beginning Medicaid planning early allows families to consider a wider range of legal tools and avoid transfers that could trigger penalties during the look-back period. Early planning also creates time to establish trusts, restructure assets, and coordinate other benefits to reduce long-term costs while protecting resources for a community spouse or heirs. Waiting until care is imminent often limits options and can force decisions that are less favorable. Proactive planning reduces stress and improves the chances of achieving both care and legacy objectives under Tennessee rules.
Keep clear records
Coordinate with family and advisors
Discuss planning goals with family members and coordinate with financial or tax advisors so everyone understands the implications of chosen strategies. Open communication reduces the chance of surprises and helps ensure that plans reflect realistic goals for care and inheritance. Advisors can help evaluate tax consequences and suggest adjustments to financial arrangements that complement Medicaid planning. Transparent conversations also reduce the likelihood of disputes later, and ensure caregivers know where documents are kept and who to contact when decisions are needed.
Why Consider Medicaid Planning in Norris
Families consider Medicaid planning to protect savings from the high costs of long-term nursing care, preserve resources for surviving spouses and heirs, and secure access to necessary medical services. Planning helps families understand the timing and consequences of transactions, including the state’s look-back rules and potential penalties. When changes in health status or finances make long-term care likely, a plan tailored to Tennessee law can reduce uncertainty, avoid unnecessary expenses, and ensure care needs are met without sacrificing important family resources.
Another reason to pursue Medicaid planning is to coordinate care funding with broader estate plans so that one set of decisions does not undermine another. Thoughtful planning provides clarity about which assets are protected and how benefits will be applied, reducing the administrative burdens of later probate and benefit disputes. Whether a family faces immediate care needs or is planning for the future, taking steps now can preserve options and increase the likelihood that both care and legacy objectives will be achieved under Tennessee rules.
Common Situations That Lead Families to Seek Medicaid Planning
Typical circumstances include a diagnosis requiring long-term care, sudden decline in health requiring nursing home placement, significant asset exposure to care costs, or concerns about preserving a spouse’s standard of living. Families also seek planning when they inherit property that could affect eligibility, or when they want to explore trust-based approaches to protect resources. In each case, a careful review of finances and timing helps determine whether immediate actions or longer-term strategies are most appropriate under Tennessee Medicaid rules.
Need for nursing home or long-term care
When an individual requires nursing home care or prolonged in-home care, Medicaid planning becomes a priority to help meet the costs that Medicare and personal insurance may not cover. Families often face urgent decisions about eligibility and how to use available resources to fund care without depleting savings. Practical steps include documenting medical necessity, identifying allowable spend-down expenses, and preparing Medicaid applications. Early organization and clear records support a smoother approval process and reduce delays in receiving benefits.
Protecting a community spouse
A married couple facing one spouse’s need for long-term care must consider protections for the community spouse to maintain a reasonable standard of living. Medicaid rules provide allowances and mechanisms to preserve resources for the healthy spouse, but these require careful calculation and documentation. Planning may involve reallocating certain assets or ensuring income is structured to maximize permitted retention for the community spouse. Proper steps help prevent financial hardship while the applicant seeks coverage for care needs.
Recent large transfers or gifts
If recent transfers or gifts have occurred, families may need planning to address potential penalties created by the look-back period. Understanding how such transfers affect eligibility and whether remedies or exceptions apply is important. In some cases, alternative strategies like using remaining allowable assets or negotiating with care providers can bridge gaps during any penalty period. Timely review of the transfer history and clear documentation supports assessing options and preparing an application that accurately reflects the applicant’s situation.
Medicaid Planning Services Available to Norris and Anderson County
Jay Johnson Law Firm serves clients in Norris, Anderson County, and surrounding areas with Medicaid planning as part of estate planning and probate services. The firm assists with eligibility assessments, asset review, trust formation, Medicaid applications, and coordination with other benefits programs. Clients receive practical guidance about state rules, timelines, and documentation required to support applications. The goal is to help families secure necessary care funding while protecting resources and preserving important family goals in accordance with Tennessee laws and procedures.
Why Families Choose Jay Johnson Law Firm for Medicaid Planning
Families seek Jay Johnson Law Firm for Medicaid planning because the firm focuses on clear, practical advice tailored to Tennessee rules and local procedures. The attorneys review each family’s financial and medical situation, explain available options, and develop a plan designed to meet care needs and protect assets where possible. Communication emphasizes understandable explanations of the look-back period, trust alternatives, and immediate steps to apply for benefits, helping families take timely and informed action when care decisions are required.
The firm assists with preparing and filing Medicaid applications, documenting medical necessity, and coordinating with long-term care providers and benefit agencies as needed. Counsel includes reviewing estate planning documents to align Medicaid strategies with wills, powers of attorney, and advance directives. This integrated approach helps families avoid conflicting decisions and ensures that Medicaid planning complements broader estate objectives. Accessibility and responsiveness to client questions are key parts of the service provided throughout the planning and application process.
Clients benefit from practical, local knowledge of Tennessee Medicaid procedures and the attention given to organizing records and meeting deadlines. The firm helps anticipate documentation requests and prepares clear explanations to support eligibility determinations. Whether a family needs immediate assistance or is planning for future care, the firm aims to reduce administrative burdens and offer straightforward guidance about the best available options within state rules. Contact information and local availability help families connect when they need help navigating this process.
Contact Jay Johnson Law Firm for Medicaid Planning Assistance
How Medicaid Planning Works at Our Firm
The firm’s Medicaid planning process begins with a thorough intake to understand the applicant’s health needs, financial situation, and family goals. Next, attorneys review asset and income details, identify Medicaid eligibility barriers, and propose practical options that comply with Tennessee law. If appropriate, the plan includes trust drafting, document updates, and preparation of the Medicaid application. The firm also assists with follow-up correspondence and appeals, providing a steady point of contact to shepherd the application through to a resolution while keeping family members informed.
Step One: Case Assessment and Documentation
During the initial assessment, the firm gathers detailed information about finances, health status, and family circumstances to identify eligibility options and timing concerns. Collecting medical records, financial statements, and documentation of recent transfers helps form a complete picture. This stage establishes priorities, whether immediate application is needed or if long-term strategies are available, and determines what evidence will be required by Medicaid. Clear records and early organization shorten processing times and reduce the risk of denials.
Financial Review and Asset Inventory
A full financial review lists countable and noncountable assets, income streams, and recent transactions that could affect Medicaid eligibility. The inventory includes bank accounts, investments, property, and retirement accounts, with attention to ownership and transfer history. Identifying exemptions and allowable resources helps clarify options. This review also considers potential benefits coordination, such as Veterans programs, to maximize available assistance while protecting family resources in accordance with Tennessee rules and timelines.
Medical Documentation and Care Assessment
Collecting medical records, physician statements, and assessments of care needs helps establish medical necessity for long-term services. Supporting documentation is essential when applying for Medicaid and when justifying early or ongoing placement in care facilities. The firm assists in identifying which records are most relevant and how to present them effectively to state agencies. Clear medical documentation reduces delays and supports the eligibility determination process.
Step Two: Strategy Development and Document Preparation
Once the assessment is complete, the firm develops a tailored strategy that addresses both immediate eligibility and longer-term asset protection goals as appropriate. This may include drafting trusts, updating estate documents, preparing powers of attorney and advance directives, and recommending allowable spend-down options. The plan is explained in plain language so clients understand trade-offs and potential timelines, ensuring decisions are aligned with family priorities and Tennessee Medicaid requirements.
Drafting Trusts and Other Legal Instruments
When appropriate, the firm prepares trust documents, transfer instruments, and other legal paperwork needed to implement the Medicaid plan. The drafting process focuses on compliance with state law and clarity of terms so the documents perform as intended over time. Trusts are drafted to reflect the family’s goals while considering the look-back period, permissible transfers, and the applicant’s need for eligibility. The firm also updates related estate documents to align all planning elements.
Preparing and Filing the Medicaid Application
The firm assists in completing the Medicaid application accurately and thoroughly, compiling required financial and medical documentation to support eligibility. Proper preparation helps avoid common errors and omissions that can delay approval. Attorneys file the application and monitor its progress, responding to agency requests and managing appeals if necessary. Timely follow-up and clear explanations of the applicant’s situation increase the likelihood of prompt consideration and approval by state caseworkers.
Step Three: Follow-Up, Appeals, and Ongoing Review
After filing an application, the firm continues to assist with follow-up communications, responding to agency inquiries, and, if needed, filing appeals to challenge adverse determinations. Ongoing review ensures that any changes in financial or medical status are addressed and that the plan remains effective. For clients with long-term needs, periodic reviews help adapt the strategy to evolving circumstances and maintain compliance with Tennessee Medicaid rules while preserving family resources when possible.
Responding to Agency Requests and Documentation
Medicaid caseworkers often request additional documentation or clarification during review. The firm helps gather and present the requested materials promptly and accurately, reducing the chance of delays. Clear responses include organized financial records, medical supporting documents, and explanations of any transfers or arrangements. Timely and comprehensive replies can prevent application denials and smooth the eligibility process for long-term care funding.
Managing Appeals and Ongoing Adjustments
If an application is denied or a penalty period is assessed, the firm assists in evaluating appeal options and pursuing the necessary administrative processes. Appeals often require additional evidence or legal argumentation about eligibility rules and exceptions. The firm also monitors changes in the client’s circumstances that may affect eligibility and recommends adjustments to the plan as needed. Continuous oversight helps families respond to evolving needs and maintain access to benefits where appropriate.
Frequently Asked Questions About Medicaid Planning
What is Medicaid planning and why is it important?
Medicaid planning involves arranging finances and legal documents to help someone qualify for Medicaid coverage for long-term care while attempting to preserve allowable resources for the applicant and family. It includes reviewing assets, income, and recent transfers, considering relevant exemptions, and recommending approaches such as trusts or allowable spend-downs that comply with Tennessee regulations.The importance lies in protecting family resources and securing access to care without unnecessary delays. Careful planning helps avoid unexpected penalties, supports clear documentation for the application, and aligns decisions with the family’s goals for care and legacy, making the process less stressful during an already difficult time.
How does the Medicaid look-back period affect transfers?
The look-back period is a timeframe during which Medicaid reviews asset transfers to determine whether they were made for less than fair market value, potentially resulting in a period of ineligibility. In Tennessee, transfers within the look-back can create penalty periods calculated based on the value of transferred assets and local cost-of-care figures.Because of this review, timing matters. Transfers made outside the look-back are less likely to affect eligibility, while recent transfers may require planning alternatives such as spend-downs or structured transactions. Documentation and clear records of any transfer are essential when responding to agency inquiries about eligibility.
Can I keep assets for my spouse while applying for Medicaid?
Yes, Tennessee Medicaid allows certain protections for a community spouse so they can retain resources necessary to maintain a reasonable standard of living. Rules define the community spouse resource allowance and the types of assets and income that count, which can help preserve a portion of the couple’s resources while the other spouse receives care.Determining the correct allowance requires careful calculation and documentation. Planning can identify which assets are countable, whether reallocations are appropriate, and how to structure income to maximize permitted retention for the healthy spouse while pursuing benefits for long-term care.
What types of trusts are used in Medicaid planning?
Common trust types used in Medicaid planning include irrevocable trusts and certain specially structured trusts intended to remove assets from countable resources. Irrevocable trusts typically require transfers to be completed outside the look-back period to be effective for Medicaid purposes. The precise trust type and structure depend on the client’s goals and timing.Trusts must be drafted to align with Tennessee rules and the family’s overall estate plan. They are not always appropriate, particularly if care is needed imminently, but when used correctly they can protect assets for heirs and help achieve both care and legacy objectives.
Will Medicaid take my house to pay for care?
Medicaid can seek recovery from an estate after the applicant’s death in certain circumstances, which sometimes includes claims against real property. However, rules and exemptions vary, and a surviving spouse or qualifying heir may be protected from immediate recovery efforts. Proper planning, including homestead protections and coordinated estate documents, can reduce the risk that a primary residence will be lost to estate recovery.It is important to review the specific circumstances and possible exemptions in Tennessee. Planning options may preserve a family home for surviving relatives while still meeting Medicaid eligibility requirements, depending on timing and ownership structure.
What is a spend-down and when is it appropriate?
A spend-down is the process of using assets to pay for allowable medical or care expenses until a person’s resources fall within Medicaid eligibility limits. This approach is often used when immediate eligibility is needed and other planning tools cannot be implemented quickly enough because of the look-back period.Spend-downs must be documented carefully with receipts and clear records, showing that funds were used for qualifying expenses. Proper documentation helps support the Medicaid application and demonstrates that resources were spent in ways accepted by the agency, reducing the chance of disputes or delays.
How long does the Medicaid application process take in Tennessee?
The processing time for a Medicaid application in Tennessee varies depending on the complexity of the case, the completeness of submitted documentation, and agency workload. Straightforward applications with clear documentation may proceed faster, while cases requiring clarification about transfers or additional medical records can take longer.The firm helps prepare thorough applications and responds promptly to agency requests to reduce delays. Timely follow-up and complete evidence of medical necessity and financial details can significantly shorten processing times and improve the likelihood of a favorable determination.
Can gifts or transfers I made years ago affect my eligibility?
Yes, gifts or transfers made during the look-back period can affect Medicaid eligibility by triggering a penalty period. Transfers made well before the look-back period are less likely to affect current eligibility, but it is important to know the exact timeframe and how transfer values are calculated.Documents that prove the date and nature of transfers, as well as records showing why funds were spent, can help agencies evaluate whether a penalty applies. Reviewing the transfer history early allows families to pursue strategies that mitigate penalties or bridge gaps while eligibility is resolved.
What documents do I need to apply for Medicaid long-term care?
Essential documents for a Medicaid long-term care application include recent bank and investment statements, deeds and titles, retirement account information, insurance policies, income statements, and records of any transfers or gifts. Medical documentation such as physician statements and hospital records demonstrating the need for long-term services is also critical.Having organized records, copies of estate planning documents, and receipts for care-related expenses speeds the application and supports responses to follow-up requests. The firm helps identify and assemble the necessary materials to present a complete and accurate application to Tennessee Medicaid.
How can I coordinate Veterans benefits with Medicaid planning?
Veterans benefits may provide supplemental assistance for long-term care in certain circumstances and can sometimes be coordinated with Medicaid planning to maximize available resources. Understanding eligibility criteria and timing for both programs helps families determine the optimal approach to benefit coordination.Coordinating benefits requires documentation and careful planning to ensure rules for each program are met without jeopardizing eligibility. The firm can review Veterans benefit options with families and propose strategies that align those benefits with Medicaid planning goals to reduce out-of-pocket costs for care.