by Bill Miller | Aug 22, 2018 | Medicaid, Medicaid Planning, Medicaid Qualification, Nursing Home
Medicaid, though funded by the federal government, is managed by state agencies. Each agency has the power to customize their program, and this can include imposing co-payments, deductibles, and so on. If you or a loved one receives Medicaid benefits, you need to know how Medicaid handles out-of-pocket costs.
Do I have to pay out-of-pocket expenses?
Many patients are expected to pay co-payments on expenses like:
- Office visits to doctors, optometrists, nurse practitioners, and other healthcare providers).
- Hospital care, including those provided at federally qualified health centers, rural health clinics, inpatient, outpatient, and ambulatory surgical centers.
- Durable medical equipment,
- Medical supplies and appliances, and
- Prescription drugs.
The co-payments are small. However, health care providers cannot deny services if a Medicaid recipient cannot pay the co-payment.
Are any services exempt from out-of-pocket charges?
Yes. Out-of-pocket fees by law cannot be charged for:
- Emergency services,
- Family planning services,
- Pregnancy-related services, or
- Preventive services for children.
Are any groups exempted from paying out-of-pocket fees and co-payments?
Yes, some Medicaid recipients are not expected to pay such fees:
- Children,
- Terminally ill people,
- Nursing home residents,
- Native American Indians with an active user letter from Indian Health Services,
- People receiving emergency treatments, and
- People receiving family planning services.
Check with your Medicaid caseworker to make sure you are not charged for co-payments and out-of-pocket expenses if you are included in one of these groups.
Will Medicaid repay my out-of-pocket expenses?
Not exactly.
Sometimes Medicaid will be awarded retroactively. This means that earlier costs that are eligible for Medicaid coverage may be paid. However, the patient is responsible for contacting the health care provider responsible for anything they paid for themselves. The provider will submit the services to Medicaid and typically reimburse the patient after receiving the payment from Medicaid.
First, You Have to Get Through the Medicaid Application Process.
It’s complicated and difficult, but we can help. We have helped many clients navigate federal and state guidelines to get the benefits they deserve.
The attorneys at Miller Estate and Elder Law assist their clients with all phases of estate planning and incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. Although we’re located in Anniston, we also help clients in the Birmingham, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Aug 13, 2018 | Elder Care Planning, Elder Law, Estate Planning, Medicaid Planning, Medicaid Qualification, Nursing Home
Jackie wanted her mother to have the best care possible. At age 82, Mom needed more assistance than she could get at home, even considering the great in-home nursing options available. As Jackie looked for a nursing home for her mom, she wondered how much her mom’s long-term care would cost? She came face to face with reality: long-term care is expensive!
What are the chances someone will need long-term care?
According to federal government statistics, 20% of people age 65 will need long-term care for more than five years. And if you are 65 right now, you have an almost 70% chance of needing some form of long-term care.
The families of people needing long-term care are affected also. In addition to the stress of caring for another person, they must also find the right type of care. Family members also usually have to struggle to find a way to pay for that care.
What type of care is considered long-term care?
It’s not just residential care at your local nursing home. There are other options.
- In-Home Care. Most older people want to stay in their homes as long as possible. When they need extra nursing assistance, they can often hire skilled in-home care providers.
- Assisted Living Facilities. While this is residential care, as is a nursing home, the resident has greater flexibility and privacy. Assistance, often from a trained nurse, is available if needed.
- Residential Care. Sometimes this type of care if unavoidable. Residents of nursing homes may lose some privacy but make up for it with greater skilled nursing care.
So, how much does long-term care cost?
It depends on where you live and what type of long-term care is needed.
The following figures reflect the 2017 cost for long-term care in Alabama:
- $42,900 – In-home care
- $41,688 – Assisted Living Facility
- $73,000 – Nursing Home (semi-private room)
- $76,650 – Nursing Home (private room)
These costs, of course, are averages and the actual cost may vary. Costs are expected to increase over time.
Start Planning Now.
At Adams & Miller, P.C., we make it our business to put our client’s needs first. We assist our clients in making thoughtful decisions regarding incapacity planning. For a free consultation, contact us at 256-251-2137 or use our convenient Contact Form. We have offices in Anniston and Birmingham and we assist clients in the Leeds, Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
by Bill Miller | Jun 1, 2018 | Medicaid Planning, Medicaid Qualification
The Willingham Family needs to apply for Medicaid to pay for their grandmother Joanne’s nursing home care.Before doing so, it is important to look at all of her financial transactions during the Medicaid look back period. In the past four years, she has given them monetary gifts, sold her car to her granddaughter for less than market value, and transferred the family home to her oldest son, Byron. Now, however, Joanne needs 24/7 residential nursing home care. She has no option but to apply for Medicaid. She and her family have no idea how Medicaid will view the financial transactions she made during the Medicaid look back period.
A Little About the Medicaid Look Back Period
Medicaid is funded by the federal government but administered by each state. Alabama Medicaid, then, distributes benefit money to Alabama residents. Medicaid programs provide benefits through a variety of programs. We primarily will be looking at Medicaid for elderly or disabled people and residents of nursing homes.
To receive benefits, people must complete applications. They must also meet financial and resource limits. In addition, applicants must provide substantial documentation, including financial records, for the 60 month period before the application date – the Look Back Period.
Medicaid caseworkers thoroughly review an applicant’s financial history during the application process. They are particularly interested in gifts and transfers for less than market value that occurred during the Medicaid Look Back Period which is the 60 months prior to filing the application. What they discover during their review could trigger a penalty period where the applicant cannot receive benefits.
Why Does Medicaid Care About Transfers Made Before You Applied?
Assets transferred during the Look Back Period could have been used to pay for the applicant’s care.
Not All Transactions Were Created Equal.
Some financial transactions are deemed okay by the Medicaid system. Some are not.
These deals may cause problems for the applicant:
Gifts. Taxpayers are allowed to gift money within certain guidelines without facing tax penalties. However, Medicaid typically does not consider gifts exempt.
Irrevocable Trusts. In some cases, assets transferred to irrevocable trusts during the look back period trigger a penalty.
No Documents. Some transactions will be considered in violation of the Look Back Period because of inadequate documentation. The applicant may have to prove that the sale price of a house, for example, falls in line with the market value of the house.
These deals may be allowed:
- Spouses. Transfer to a spouse in most circumstances.
- Disabled Children. Transfers to a blind or disabled child under the age of 21 are usually allowed.
- Deals with Siblings. If an applicant co-owns a home with a sibling if the sibling lived with the applicant for at least one year before applicant applies.
- Adult Children Caregivers. Applicants can give their home to an adult child who is their primary caregiver.
- Payments to creditors are usually allowed. In fact, one way to turn liquid assets into exempt assets is to pay off your mortgage or home equity loan.
Advance Medicaid Planning Can Help.
Planning for Medicaid eligibility can be tricky. Speak with an Alabama attorney and make Medicaid planning part of your estate plan. To learn more, click the link to get a copy of our Alabama Guide to Medicaid Qualification. Doing so could save you thousands of dollars.
For a free consultation with an experienced Alabama attorney, contact us at 256-251-2137 or use our convenient Contact Form. We have offices in Anniston and Birmingham and serve clients in Gadsden, Hoover, Talladega, Vestavia Hills, and surrounding areas.
