Medicaid and Medicare are two easily, and frequently, confused terms, so clear up a bit of the mystery. MediCARE is for medically-necessarily care; MedicAID is for aid or assistance with certain medical costs and custodial (long-term care, or LTC) costs for the truly poor. What IS the Medicaid dilemma?
Medicare is a largely federal program. Medicaid, on the other hand, is a state-federal partnership with the states having the main say in who gets covered, what the income and assets can be, and what types of care (nursing home-only, home care, assisted living, and so forth) are covered.
Qualifying for Medicaid Benefits for LTC
Many people assume that Medicare will pay for LTC. That is true in perhaps five percent of cases. Source for this statistic? Then they expect that Medicaid will pay these costs. That is true in about 49 percent of dollars spent. Source for this number?
The following rest of this paragraph and the next one need to be rewritten for greater clarity in explaining countable and noncountable assets. There also needs to be a simple summary sentence to introduce the concept that Medicaid eligibility depends on the total amount of your assets and income. Also explain “spend down” and “lookback.”
But, if your individual income exceeds your state’s limits (ranging from about $603 to $1,809, depending on where you live), you will have a hard time getting Medicaid to foot the LTC bill. There are also limits on assets, with certain temporary why temporary? exclusions such as the residence if a spouse still lives there. The amount of assets you – who is ‘you” -- the person who is institutionalized, or the community can keep changes each year and depends to some degree on your state’s rules.
You this excludes the single person – rewrite so this paragraph can apply to both married and single people qualify for Medicaid-funded LTC based on your joint assets and personal income, not your joint income. In addition, there are provisions that let a certain amount of the Medicaid-qualified spouse’s income be retained by the spouse not currently requiring care. Check with your advisor for details and specifics for your case.
If You Plan to Use Medicaid for LTC
If you go into LTC using Medicaid, here are a few things you should consider:
- You can only keep about $60 per month for personal care (haircuts, Bingo, adult diapers, tissues, clothes, and so forth). All other pensions and sources of income in your name go to the Medicaid entity in your state.
- Your personal assets must be depleted to $2,000 or less, depending on your state.
- The house is left alone if your spouse or other qualified person is still living in it, or if you might return to it, but at the death of the last resident your state generally reserves the right to sell the house and use the proceeds to help reimburse the costs of your care.
- You will not have full choice of care facilities. Some facilities don’t accept Medicaid patients; some confine them to one wing.
- You will very likely have a same sex roommate—and often not one of your choosing.
Medicaid and LTC Planning
Some seniors and their advisors look at “Medicaid Planning,” what is Medicaid Planning? This is a controversial topic. Explain why. especially when you are just over the income or asset maximums or there are other mitigating circumstances. Others look to LTC insurance, or rely on personal assets, or assume their family will take over their care. The options are many, and planning is critical.
References and useful links:
The Georgetown University Long-Term Care Financing Project (January 2007): http://ltc.georgetown.edu/pdfs/medicaid2006.pdf. This is a very interesting and educational fact sheet covering a wealth of LTC concerns and considerations related to Medicaid.
About Medicaid Long-Term Care: http://www.longtermcarelink.net/eldercare/medicaid_long_term_care.htm An interesting consumer-focused site.
The Federal Government:
http://www.cms.hhs.gov/home/medicaid.asp
This article is provided courtesy of…
Randy Walden, CSA
Certified Senior Advisor
Heartwarming Care, LLC
http://www.heartwarmingcare.com
(253) 460-1574
10209 Bridgeport Way SW Ste. C-6
Lakewood, WA 98499
Posts
No comments:
Post a Comment