What Does Medicaid Cover…and What Does Medicaid NOT Cover?

What Does Medicaid Cover…and What Does Medicaid NOT Cover?

by | Jan 11, 2022 | Elder Law, Medicaid, Medicaid Planning, Medicaid Qualification

what does medicaid cover

Medicaid is a government-administered health insurance program that provides coverage to low-income Americans during all stages of life, from birth to age 65+. Given the massive breadth of this program, it should not come as a shock that it’s an incredibly complex system, governed by a confusing set of rules. This article aims to answer the questions, what does Medicaid cover, and what does Medicaid NOT cover?

While Medicaid can support individuals of any age, it’s an especially excellent resource for seniors. Long-term nursing care costs in Alabama average $78,000 per year, and that is for a shared room. However, qualifying for Medicaid can be a challenge. Applicants must meet certain financial and medical eligibility requirements. There are strict income and asset limits, with policies designed to prevent individuals from giving away their assets in order to qualify. A qualified elder law attorney can help you navigate the Medicaid maze, and avoid unsuspecting mistakes that could leave you or a loved one without the coverage they need.

For seniors who qualify, Medicaid is a wonderful program that works in collaboration with Medicare to cover a variety of healthcare needs

What Does Medicaid Cover?

Medicaid covers mandatory healthcare services, including:

  • Hospital care
  • Skilled nursing
  • Home healthcare
  • Doctor’s appointments 
  • Preventative care & wellness screening
  • Transportation to and from medical appointments
  • Diagnostics

Optional benefits include hospice care, case management, prescription drugs, physical or occupational therapy, rehabilitation, dental, vision, and more.

However, Medicaid does have some limitations…

What Does Medicaid NOT Cover?

In most circumstances, Medicaid will not cover medical care provided outside of the United States, though certain circumstances—such as if a foreign hospital is closer than a domestic hospital—may be covered. Like with private health insurances, Medicaid will also not cover services deemed unnecessary, or services paid for by another insurance provider. 

Some other services that Medicaid will not cover include:

  • Free health screening or medical devices that are given away
  • Cosmetic surgery or complications that result from cosmetic surgery
  • Personal comfort items or beauty services

Every state has slightly different Medicaid qualifications and coverage, so the best way to gain comprehensive (and accurate) understanding is to speak with a qualified elder law attorney in your home state.

Miller Estate and Elder Law is happy to offer a number of free resources to help you better understand how Medicaid planning works, and how to avoid going broke paying for long-term care. Gain access to our brief 20-minute webinar about how to get you or a loved one qualified for Medicaid by completing the brief form below, or download one of our free guides.

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Fixing a 5-Year Look-Back Penalty: Tips from an Elder Law Attorney

Fixing a 5-Year Look-Back Penalty: Tips from an Elder Law Attorney

by | Jan 4, 2022 | Elder Law, Medicaid

elder law attorney

Medicaid is a wonderful government program that helps low-income seniors with limited assets to afford healthcare and long-term nursing care. Applicants must meet certain medical criteria, and there are strict financial eligibility requirements that must be met when applying for Medicaid, and while already qualified. 

Many seniors find that their countable assets and/or income exceed their state’s Medicaid limits. To meet the financial requirements for Medicaid qualification, they must carefully minimize—or spend down—excess funds. Funds may be spent down on things like medical expenses, home improvements, and prepaid funerals, etc. Gifting assets to children and grandchildren, friends, and loved ones may sound like a smart way to spend down assets, however, this can cause the applicant to become disqualified for Medicaid.

To prevent applicants from simply giving away their money or resources in order to qualify for Medicaid, the federal government implemented a “look-back period.” This is a set period of time prior to the individual’s application during which the Medicaid administering agency can review the financial transactions that a senior has made. If a transaction is found to be in violation, the applicant will be assessed a penalty. 

Each state’s Medicaid program uses slightly different eligibility rules, but most states examine all of a senior’s financial transactions dating back five years from the date of their application. If a senior is found to have gifted assets during this look-back period, they will be disqualified from receiving benefits for a certain number of months. The length of the penalty depends on the total amount of assets the applicant gifted, and their state’s penalty divisor. 

When it comes to the length of the penalty period, there really is no limit. Many find themselves wondering what will happen if a senior needs care, but has spent all their assets in a way that makes them ineligible for Medicaid coverage. Unfortunately, if a senior has gifted their assets during the look-back period and requires nursing home care, the cost of care will have to be paid out of pocket until the penalty period runs out, and they become eligible for Medicaid. 

Fortunately, there are exceptions to the rules and exemptions made for families who find themselves in difficult situations. Under these exceptions, applicants are permitted to transfer assets—to certain parties—during the look-back period, without incurring a penalty. Additionally, a penalty can be “cured” if transferred assets are returned in their entirety, or reduced if the transferred assets are partially returned. In order for this to work, the person who returns the assets needs to be the same person who received the gift. 

Less fortunately, these exceptions and exemptions are often confusing and difficult to take advantage of without the expertise of an elder law attorney. Reaching out to an attorney is the best way to navigate Medicaid’s complicated rules and application process. The best time to start planning for the cost of long-term care is well before you or your loved one’s need it. 

We encourage you to call attorney Bill Miller to discuss how to best preserve your assets and avoid going broke paying for long-term nursing care. You can reach Miller Estate and Elder Law at (256) 251-2137 or by emailing info@millerestateandelderlaw.com.

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The Pros and Cons of Long-Term Care Insurance Explained

The Pros and Cons of Long-Term Care Insurance Explained

by | Nov 20, 2021 | Elder Law, Long-Term Care

It might be hard to think about this now, but chances are—somewhere down the road—you may need help taking care of yourself. One question that arises from this situation is: how will you pay for it? One way to prepare for the potential cost of long-term nursing care is to purchase long-term care insurance. Unlike traditional health insurance, long-term care insurance is designed to cover the cost of long-term care services and support in a variety of settings, such as your home, a nursing home, or another facility.

Long-term care insurance policies cover such costs as assistance with routine daily activities, like bathing, dressing, or getting in and out of bed. They also help cover the cost of care if you have a chronic medical condition, disability, or disorder.

Taking into consideration long-term care costs is an important part of any long range financial plan. If you wait until you need care to buy coverage, it will be too late. Most policies require medical underwriting, and if you already receive long-term care services, you may not qualify. As a result, most people purchase long term care insurance plans in their mid 50’s to mid 60’s.

As we mention in the above video, there are two different types of long-term care insurance policies: traditional long-term care insurance, and asset based (hybrid) long-term care insurance. Both of these options have their pros and cons, but—as we mention—asset based insurance is usually the preferred option.

Traditional long term care insurance is a “use it or lose it” type policy, similar to homeowner’s insurance. If you do not need it or use it during your lifetime, you do not benefit from paying the monthly premium. The monthly premium that you do pay is based on your age, and how much coverage you want. This premium payment will increase over time, and can also continue to increase…even after you take out the policy.

On the other hand, a hybrid policy creates a pool of money for long-term care that is equal to several times your premium payments. The pool of money created for long-term care can either be used for a specified minimum period of time, or for a lifetime (depending on the insurance company). If you do not need these benefits, the policy pays a death benefit to your heirs upon your passing.

Long term care insurance is something everyone should consider, and it is important to understand the differences in the types of policies that are available. If you are apprehensive about navigating the long-term care maze, please join estate planning attorney Bill Miller for an upcoming free workshop using the form below. We’ll answer 

Register for our Next FREE Estate Planning Workshop



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Estate Planning 101: Last Will and Testament

Estate Planning 101: Last Will and Testament

by | Nov 12, 2021 | Elder Law, Estate Planning

last will and testament

For many, when they hear the term “estate plan” they immediately think of a last will and testament. While a last will and testament is not the entire estate plan, it is an important part of it. Let’s take a deeper look at what exactly a last will and testament is. 

Last Will and Testament, Defined

The last will and testament is a legal document that communicates a person’s final wishes as to how they want their assets distributed when they pass away, medical care, and dependents.  In the last will and testament, a person can leave instructions as to whether they want certain people to get certain assets, or whether they just want their assets divided among their heirs. In addition, if there are minor children involved, a last will and testament can include instructions for who would raise their children, as well. 

How Does a Last Will and Testament Work?

A person can write their last will and testament while they are still alive and of sound mind. When they pass away, the instructions will be carried out by a named personal representative (also called an executor or executrix) of the estate. The personal representative is normally named when the will is initially drafted.

Necessary Requirements

Since the last will and testament is vital to distributing the assets of a person’s estate, there are a few requirements that must be met in order for the will to be considered valid. 

First, the person who is writing the will must be of sound mind and mentally capable. For example, someone who has severe dementia would not be able to write a will, or make changes to their existing will. In addition, for a will to be considered valid, not only should the person signing it be of sound mind, but two unrelated and mentally sound witnesses must sign it, as well. If these requirements are not met, then the document will not be considered legally binding. 

What a Will Doesn’t Do

While the last will and testament is the foundation of a solid estate plan, it should not be the only part of an estate plan. This document outlines your wishes, but does not grant any individual the ability to make medical or financial decisions for you if you were to become incapacitated, but not die. It also cannot protect your assets from creditors, or from the costs of long-term care if that becomes necessary. A power of attorney, advanced directive, and trusts are other planning documents that you need considerations to consider include in your estate plan. 

The best way to ensure that your estate plan is complete is to speak with an estate planning attorney. If you have questions about creating a Last Will and Testament—or an estate plan altogether—we encourage you to contact Miller Estate & Elder Law at (256) 251-2137 or or register for one of our free estate planning workshops.

 

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Estate Planning During a Pandemic: 3 Reasons to Quit Stalling

Estate Planning During a Pandemic: 3 Reasons to Quit Stalling

by | Nov 10, 2021 | Asset Protection, Estate Planning, trust

pandemic

It is hard to believe that we are heading into our second winter season while still in the midst of a pandemic. At this point, Coronavirus has taken a toll on our finances, as well as our physical and mental health. Most people likely know someone who has been seriously impacted by Covid-19, and it is worrisome. To add some peace of mind to this otherwise stressful situation, right now is an opportune time to make sure your health and finances are appropriately protected with an effective estate plan. 

Many people think that estate planning is only for the wealthy, but this is simply not the case. Estate planning ensures that someone you trust will be able to make medical and financial decisions for you, should you become incapacitated. Estate planning can also ease the process of settling a person’s affairs after they pass away, helping your family and loved ones avoid emotionally-draining, lengthy, and costly legal affairs. Without a plan, the probate court will appoint someone to manage your financial affairs—and ultimately, the transfer of assets upon death—following intestate laws governed by the state. 

Consider these three reasons for why now is a better time than ever to plan your estate:

A Plan for You

An estate plan is not just for when a person dies, but it can also protect someone in the event that they become incapacitated or cannot make decisions for themselves—for example, if someone was placed on a ventilator. Entrusting a specific family member or loved one to make medical or financial decisions on your behalf can help ensure your needs will be met, and that you will receive medical treatment in alignment with your beliefs and wishes. There are several estate planning documents that help protect your own best interests. 

Your healthcare power of attorney designates an agent to act on your behalf, or be your representative, in situations where you are unable to make decisions regarding your own healthcare. A living will is also something to consider, as it includes an advanced healthcare directive, which provides instructions for end-of-life care.

A durable power of attorney may be one of the most important pieces in your estate plan. This document gives someone else the power to act on your behalf in financial and legal situations. Being “durable” means that the authority of the individual you have assigned remains, even if you become incapacitated. The power of attorney stays in effect until you die, or revoke the document.

A Plan for Your Children

So many things right now are uncertain with the pandemic, and sometimes there doesn’t seem to be a rhyme or reason to why things happen. If you are the parent of minor children, they need to be protected in case the unthinkable should happen. An estate plan will help ensure that children are cared for by approved guardians if the parents die before they turn 18. Without legally binding documents in place, the courts could be responsible for deciding who will raise your children.

A Plan for Your Assets

With no documented estate plan, such as a will or living trust, the state in which a person resides will typically decide how assets will be distributed after a person dies. By having an estate plan, however, the courts will have clear (and legal) documentation about how assets should be transferred upon death. This can save a family time and frustration, and ensure that assets are dispersed in the intended manner.

A last will and testament dictates who will serve as the executor or personal representative for your estate, what power they have, and what they will be responsible for after your death, for example, collecting documents, paying debts, and distributing assets. The last will and testament also identifies how, when, and to whom your assets or property should be transferred. 

A living trust is also known as a revocable living trust, and is a legal document that allows the transfer of assets from a trust to your beneficiaries—without needing to go through probate court proceedings. 

Note that everyone has unique needs when it comes to estate planning, and the above considerations are just some general guidelines for you to think about. It is most important that you reach out to Miller Estate & Elder Law to help you craft an estate plan that fits your specific situation and needs.  Give us a call at 256 251-2137 or register for one of our free estate planning workshops.  

 

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