Martha W.’s family knew she needed help, and she needed it now. She suffered from several serious medical conditions. As a result, she found it increasingly difficult to carry on with her activities of daily living, like cooking or getting dressed. Martha’s family had never looked into government assistance programs and became confused when they finally did. For example, what’s the difference between Medicare and Medicaid? Let’s look at some of the important benefits offered by each program.
First, the Basics
Both are programs offered and managed by the federal government. Also, both help with medical care.
Medicare is essentially a government health insurance policy that is available to a certain group of qualifying individuals. Workers pay taxes to cover future Medicare costs for themselves and their family members.
Medicaid is more of a public assistance program funded by public tax funds that cover healthcare expenses.
Qualifying for Medicare and Medicaid
The eligibility requirements for these programs are very different. For example, Medicare is generally available for people:
One important difference between the programs is that Medicare eligibility is not income-based, while Medicaid is. Additionally, both Medicare and Medicaid offer benefits with different requirements.
Benefits Provided by Medicare and Medicaid
Both offer more than one program. In fact, Medicaid programs can vary from state to state. We’ll just look at the programs offered by Alabama Medicaid.
Medicare:
Part A (hospital insurance) is premium-free for most people who paid Medicare taxes.
Part B (medical insurance) covers some doctors’ services, outpatient care, medical supplies, and preventive services.
Part D (prescription drug coverage) pays for some prescription drugs.
Medicaid:
Medicaid for Children
Medicaid for Parents and Caretaker Relatives
Medicaid for Pregnant Women
Medicaid for the Elderly and Disabled
Medicaid in the Nursing Home
Breast and Cervical Cancer Program
Plan First Family Planning Program
Help Paying for Medicare Costs
People can apply for either program, depending on their needs.
The Application Process
Applying for Medicare is fairly easy. Just complete an online application. There’s no need to submit documentation.
Contact Bill Miller at 256-251-2137 to schedule an appointment. The attorneys at Miller Estate and Elder Law can explain the difference between Medicare and Medicaid and help your Medicaid application. Even better, we can help you with Medicaid planning to increase your chance of getting Medicaid and keeping as much property as possible. Though our office is located at 818 Leighton Avenue in Anniston, we serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
In determing how to pay for long term nursing home care, the first way, and by far the best way, is with long-term care insurance. There are different kinds of long-term care insurance policies out there. Unfortunately, most people do not have long-term care insurance, and they wait too long to get it. By the time they apply for it, they are either too sick, or it is no longer affordable. If you can get a long-term care policy, I would encourage you to do so because it is the best way to pay for care.
Medicaid
The second way to pay for long-term care is through the Medicaid program. The Medicaid program is a federal program that is administered by the states, but it has very strict requirements in order to qualify. An individual cannot have more than $2,000 in non-exempt assets in order to qualify. Most people have way more than $2,000 in assets. If you are married, the rules are a little different, but Medicaid can still be difficult to qualify for.
Out of Pocket
The third way to pay, and what most people are doing, is out of pocket. Right now, nursing home costs in this area are around $7,000 a month. Within 10 years, they will probably be $10,000 a month. Every month, these long-term care costs are due and are eating away at your nest egg at the rate of about $10,000. If you don’t have long-term care insurance and you don’t qualify for Medicaid, then you are going to have to pay out of pocket.
I hope this answers the question about how to pay for long-term care. Our clients are encouraged when told how to minimize out-of-pocket expenses and get qualified for Medicaid more quickly if they don’t have long-term care insurance.
It’s easy to be intimidated by a Medicaid application. You have to provide much information and satisfy many strict regulations. Knowing a little more about the process – especially in the form of tips from experienced people – can really help.
Know What Benefits Are Available
Before starting the whole application process, check out Medicaid’s programs. Do any of the programs meet your needs? Will the services offered meet your individual needs?
For example, Alabama Medicaid covers many services, including:
Dental services, but only for an applicant who receives full Medicaid. Only certain age groups may be eligible.
Doctor Appointments. Medicaid typically pays for 14 visits each year. Will you need more than 14 visits?
Family planning services. Some of the services are only available to men or women over age 21.
Transportation – Ambulance. Medicaid will only pay for transportation when it is medically necessary.
Of course, this list is not complete. Medicaid offers other services with restrictions and limitations, so confirm that you can get the help you need.
Make Sure You Qualify
Talk over your financial situation with your attorney. To qualify for Medicaid, you have to be careful not to exceed income and resource limits. With careful estate and financial planning, you may be able to increase your chances of Medicaid approval.
Get the Application Right the First Time
Probably one of the best ways to have your application denied is to submit incorrect or incomplete paperwork. You will submit quite a few supporting documents, as well as the application itself. In fact, Medicaid expects to review five years of financial data.
Talk to an Experienced Medicaid Attorney
This may be the best way to get your application approved. However, an Alabama Medicaid attorney can do more than get you through the application process. Medicaid planning should begin years before you actually apply for Medicaid. It’s in your best interests to consult with a lawyer as soon as possible.
Contact us at 256-472-1900 for a free consultation. The attorneys at Miller Estate and Elder Law know how to help you with Medicaid planning and with estate recovery concerns.
Also, receive a free download of Medicaid Planning in Alabama: What You Need to Know by clicking here.
For many of us, the time will come when we have no choice but to seek extra attention and care for our spouse. Is it time to consider moving your spouse to a nursing home? This can be a difficult decision as there are many things that you want to protect your spouse from, including abuse and general mistreatment. Even though you may not have a choice but to place him or her in a nursing home, that does not mean that it has to be a horrible experience for either you or your spouse.
First and foremost, you want to ensure that the home you have selected is Medicaid/Medicare approved as this will help you make the best choice financially. Here are a few other things you can add to your checklist to help you make the best decision for your spouse as well as your peace of mind.
1. Ask if residents can have their personal belongings, including furniture, in their rooms. You may also want to find out whether your spouse will have storage space, such as an appropriately sized closet and drawers in the room.
2. Verify amenities provided by the nursing home. Will your spouse have computer and internet access in his or her bedroom? Will there be a television? Will there be a window to provide natural light? Access to these types of comforts can help ease the transition into the nursing home.
3. Inquire about what type of activities the home offers and if the facility helps residents who may not be mobile. Find out if the nursing home has outdoor areas for your spouse to use. You may also want to ask if your spouse will be able to choose what time to get up, go to sleep, or bathe.
4. Look into the support provided for residents with advanced health care needs. For many of us who are struggling with this decision, our spouses may not be in very good health. For example, a common disease that impacts many Older Americans is dementia. If this is the case with your spouse, you may need to know if the nursing home has specific policies and procedures related to the care of residents with dementia. If the facility does, what types of non-medication based approaches do they employ when trying the first attempt to respond to behavioral symptoms for residents living with dementia? What percentage of residents have dementia and are currently being prescribed antipsychotic medication? This can help you to understand the type of residents that your spouse will be surrounded by as well as the home’s workload.
These are just a few tips to help guide you in making a difficult decision and help you to do what is best for your spouse. These kinds of major life changes often come with complicated legal issues. Miller Estate and Elder Law can provide you with guidance to help you make informed decisions on long-term care planning and nursing home issues. Get in touch with our office today to schedule a meeting.
Benefit programs like Medicaid often include strict requirements and rules. To qualify for Medicaid, for example, an applicant must show a financial need by staying below Medicaid’s income and resource limits. However, some people need Medicaid benefits but exceed the amounts Medicaid allows. In this article, we will look at those limits, and, more importantly, how to spend-down your assets and monthly income to meet them.
Medicaid Limits on Income and Resources
A nursing home resident typically can possess no more than $2,000 in resources as of the first day of the month.
However, Medicaid does not count all of your assets and income. Some resources might be considered as countable, including cash, real estate, and one automobile per household. The status of some assets may change in certain situations. For example, real estate held as a life estate or that is on the market may not be counted.
It’s to your benefit to consult with an experienced attorney before applying for Medicaid or attempting any sort of spend-down activities.
Planning a Spend-Down
After learning you may not qualify for Medicaid because of income and asset limits, you may want to plan a spend-down of your assets. But how exactly do you go about doing this? Here are some important considerations:
Where are you living?
Are you married or single?
What is the source of your income?
What type of assets do you have?
The answers to these questions may make a difference in how you spend proceed. Make sure your lawyer has all the information needed to advise you about spending down your assets.
Actions That Spend-Down Your Assets and Monthly Income
After carefully assessing your resources compared to Medicaid’s requirements, you may start taking some of the following steps:
Pay your medical bills. Certain medical bills can be paid to reduce your countable cash assets. In addition to your own, you may be able to pay medical bills for your spouse and your children. You can pay past and current medical expenses, which may include transportation costs, therapists, personal care attendants, home health aides, rehabilitation programs, prescription drugs, and medical equipment ordered by a doctor.
Pay off other debts. You may be eligible to use excess income to reduce mortgage, auto loan, and credit card balances.
Sell certain assets. In some situations, countable assets may be sold to pay off medical bills and debts to reduce a recipient’s resources.
Set up a Miller Trust. Excess monthly income can be diverted to a Miller Trust to stay below Medicaid’s monthly income and resource limits. Funds in the Miller Trust can be used for eligible expenses.
Keep in mind that transferring, selling, or spending assets may result in reductions or delays in benefits.
Spend-Down Your Assets and Monthly Income Wisely
The rules are complicated. Always speak with an experienced attorney before trying any kind of spend-down strategies.
It’s true. There’s no place like home, especially for people who have lived in a family home for years. Louisa, for example, created many happy memories in the house she had shared with her husband and three children. However, there came a time when Louisa’s health was declining. She needed someone to help with her activities of daily life, including taking her medication and tracking several health conditions. Her family looked for a residential long-term care facility, but then they learned about the Alabama Elderly and Disabled Waiver provided by Medicaid. This may be the answer Louisa needs.
Paying for Long-Term Care
Many people to turn Medicaid when they need help paying for nursing home or institutional care. For those who qualify, Medicaid provides important benefits to meet their healthcare needs. In fact, Medicaid programs are available for children, caretakers, pregnant women, elderly people, and people with disabilities.
Staying Home May Be an Option
Some people like Louisa need assistance but at a level that still allows them to remain at home. The Alabama Elderly and Disabled Waiver does just that for qualified seniors.
Two groups manage this home and community-based waiver program: the Alabama Medicaid Agency and the Alabama Department of Senior Services. The following services may be offered:
Case Management. A case manager analyzes the benefit recipient needs, then works to line up services that meet those need.
Homemaker Services. A trained aide may assist the elderly or disabled person with meals, grocery shopping, cleaning, and personal needs.
Personal Care Services. In conjunction with a doctor’s plan of treatment, an aide may assist with bathing, dressing, walking, eating, taking medication, and more.
Adult Day Health Services. Recipients participate in social and health care activities, like health education and health screening.
Respite Care. A personal care attendant, home health aide, homemaker, LP, or RN providers short-term assistance.
Companion Services. This type of assistance is non-medical. Paid Companions may supervise or assist with activities of daily living and housekeeping as needed.
Home Delivered Meals. A registered dietician approves menus for food delivered to individuals age 21 or older.
These services not only make life better for an elderly or disabled person but typically cost less than institutional care.
Will the Alabama Elderly and Disabled Waiver Work for You?
Talk to an experience Alabama attorney to find out.
The attorneys at Miller Estate and Elder Law have years of experience working within the Medicaid system. They help clients like you with Medicaid applications as well as advanced Medicaid planning.
Schedule a consultation with one of the attorneys at Miller Estate and Elder Law. Our phone number is 256-472-1900. We are now located at 818 Leighton Avenue in Anniston, but we serve clients in communities like Hoover, Vestavia Hills, Irondale, and Calera.
Also, take a look at some of the free guides offered on our website.
