Do you get mixed up between Medicaid and Medicare? During Medicare’s Open Enrollment Period, it is important to remember that Medicare is not Medicaid. Let us highlight four differences to keep in mind.
1. Qualifications. Medicare covers adults aged 65 and older and individuals younger than 65 with a qualifying disability. Medicaid, on the other hand, is generally available to individuals of all ages based upon qualifying low-income. Another important difference in coverage is that Medicare only provides coverage for individuals, it does not offer family plans. Medicaid, however, can provide coverage for qualifying families.
2. State v. Federal. Medicare coverage plans are more uniform because it is run through the federal government. Medicaid benefits can vary state to state because it is a state run program governed by federal guidelines.
3. Cost. Medicare recipients pay premiums, deductibles, and some out of pocket costs depending on their plan. Medicaid recipients do not pay for coverage, although they may have small co-pays in some states for certain services.
4. Coverage. Medicare is meant for acute health issues and does not cover long-term inpatient care or nursing home care. Medicaid can assist qualifying individuals with long-term care while also providing coverage for routine medical care. Unfortunately, there are many times when families are forced to navigate the muddy waters between where Medicare stops and Medicaid begins when dealing with an elderly relative’s acute health issue that has turned into a long-term care problem. For example, consider the scenario of an elderly relative suffering a fall and breaking her hip. Now this relative needs surgery to repair the hip and then requires long-term care because she will not recover from the surgery successfully enough to be able to ever live independently again. If this elderly relative is on Medicare, her Medicare plan will cover the surgery and perhaps some of her rehabilitation, but she will need Medicaid coverage to cover her long-term care. Oftentimes, obtaining this coverage can be difficult and confusing. This is just one of the many examples of why it is beneficial to have a comprehensive plan in place to address the possibility of requiring long-term care.
For help understanding Medicaid and Medicare benefits as well as planning for long term care coverage, please feel free to reach out to our office with any questions or concerns you may have.
Did you know Baby Boomers are a designated group of people who were born between 1946 and 1964? In fact, 76.4 million people were born during that 22-year period. This group comprises about one-quarter of the U.S. population.
A Baby Boomer born before 1954 is at least 65 years of age and is accordingly entitled to Medicare medical assistance if he or she has received Social Security credits for 40 quarters of coverage. This means he or she has paid into Social Security for at least 10 years.
A person aged 65 and older who has not received credit from Social Security for 29 quarters of coverage has to pay a $437 per month premium in 2019 for Medicare coverage. An individual who has 30-39 quarters of Social Security credits must pay a $240 per month premium in 2019 for Medicare coverage. Persons of any age who have end-stage renal disease or amyotrophic lateral sclerosis can also receive this coverage at no cost. Likewise, a person who has received Social Security disability benefits or Railroad Retirement Disability Income for 24 months or longer is eligible for Medicare.
A person under 65 years of age is only categorically entitled to Medicaid medical assistance if his or her income is less $12,060 per year and his or her countable assets are less than $2,000. Fortunately, persons under age 65 with expensive health care needs may still be entitled to the Medicaid share of cost program. This is for people who make too much money to qualify for regular Medicaid but not enough money to pay for their healthcare needs.
This program essentially allows people to subtract their medical expenses from their income and qualify for Medicaid if and when their medical expenses reach a certain amount determined by the Department of Children and Families. The day a person’s health care expenses for the month exceed his or her share of cost, Medicaid coverage begins. From that day until the end of the month, the person has full Medicaid coverage. On the first day of the next month, a person is again without coverage until health care expenses exceed his or her share of cost.
These are critical considerations for both our Florida Baby Boomer clients and their loved ones.
Knowing just what health care coverage you are entitled to and what is paid for needs to be a priority, especially during the annual Medicare Open Enrollment period. Remember, in almost all instances, there is a provider who will cover custodial long-term care needs. We can plan forward with you and your loved ones for these expenses. Do not wait to contact us to schedule a meeting.
‘Tis Better to Give than Receive, but … It’s the giving season. Whichever holiday you celebrate, most enjoy showing their affection by giving gifts to loved ones. For larger families, these gifts can amount to a lot of money each year.
And that’s wonderful, but if you might need to apply for Medicaid long-term care benefits, you need to be careful. Giving away money or property can jeopardize your eligibility. Here’s why you need to speak with an experienced elder care/elder law attorney about gifting.
If you give assets away to someone other than your spouse within five years before applying for long-term Medicaid, you might be ineligible for benefits. Medicaid pays for some or all your care at home, in an Assisted Living Community, or in a Nursing Home.
The length of time you’ll be ineligible depends upon how much you give away. Even small gifts affect eligibility. The 2017 IRS rules allow gifts up to $14,000 a year, but Medicaid rules allow the government to deny benefits anyway.
And there is no exception for gifts to charities. So, gifts for holidays, weddings, birthdays, and graduations could all cause ineligibility. If you buy something for a friend or relative, this could also result in a denial.
If you face this problem, you can overcome it, but you’ll need help. To overcome a denial, you’ll have to prove by “clear and convincing evidence” that the purpose of the gift had nothing to do with becoming eligible for Medicaid. “Clear and Convincing” is almost the same as “Beyond a Reasonable Doubt.”
So, before giving away assets or property, check with your elder law attorney to ensure that it won’t affect your Medicaid eligibility. Contact us today with any questions you may have.
Original Medicare coverage, also known as Medicare Parts A and B, is reserved for what’s considered “medically necessary” health care. In other words, care that’s required to diagnose or treat an illness or condition. What this means is that, unfortunately, dental and vision care does not fall into Medicare’s medically necessary framework.
So are seniors just out of luck? Not at all!
There are two main ways to obtain important dental and vision coverage. One is through Medicare Advantage, or Part C. Another is through supplemental coverage.
Medicare Advantage is an alternative to Original Medicare, with approved coverage plans being administered through private insurance companies. While these plans must offer the same basic hospital and medical services coverage as Parts A and B, they can also offer more options on top, such as prescription drug coverage, and dental and vision benefits.
Keep in mind that Advantage plans’ costs and coverage features may depend on where you live and what plan you choose. They may also require a monthly premium.
Medicare supplemental insurance, sometimes called Medigap, is another avenue to secure dental and vision coverage. It helps pay for items Original Medicare does not cover. This can include deductibles, copays and coinsurance for doctors’ visits, hospital stays, and other medical services. It is also issued by private insurance companies.
While Medigap itself may not provide dental and vision coverage, certain insurers can offer their Medicare supplemental insurance customers additional options for dental and vision care, or discount programs to help save money on dental and vision costs. Supplemental insurance plans can also depend on where you live, although unlike Medicare Advantage, coverage is standardized by the federal government.
One of the best ways to explore supplemental insurance offerings in your area is to log on to Medicare “Medigap Policy Search” webpage and type in your zip code. The site provides plan details from insurance companies.
The online Medicare “Plan Finder” tool is also a great way to search for the right Medicare supplemental insurance plan. It also offers search assistance for Medicare Advantage plans.
For most people, and especially for senior citizens, dental and vision coverage is just too important not to have. Exploring Medicare Advantage and Medicare supplement insurance options can help you get the services you want and need. Do you not wait to find the answers you need during this Medicare Open Enrollment Period, which will end on December 7th of this year.
We know that this article may raise more questions than it answers for you. Do not wait to contact our office and schedule meeting with Attorney Scott Selis.
Research tells us that more retirees are traveling than ever before. The AARP shares in the 2017 Travel Research Survey that “most Boomers (99%) will take at least one leisure trip in 2017, with an average of five or more trips expected throughout the year.” There continues to be a steady trend that Baby Boomers and older age groups will travel abroad as well, as opposed to staying in the continental United States. How much do you really know, however, about health care when traveling?
Both retirement and travel should be fun! The key to you and your senior loved ones having fun, however, is preparation. Unfortunately, a healthcare crisis can happen at any time. In most instances, traditional Medicare will not pay for your health care needs overseas. Let us share our insights with you on how to best protect yourself as a senior when you travel overseas.
1. Carefully review your health care coverage before you travel.
Traditional Medicare only provides healthcare coverage in the United States and its territories. Therefore, if you’re traveling to tropical destinations such as Puerto Rico, Guam, or the Virgin Islands, Medicare coverage will basically be the same. If you’re traveling outside the United States, however, you may not have any healthcare coverage. Before you leave, it is critical to read through your Medicare plan policy to know what is covered and what is not.
2. Travel with enough medicine to be covered for a longer duration of time.
Most Americans today take at least one prescription medicine. When packing for a trip, it may seem logical to pack just enough medicine to cover the duration of the trip. Best practice when traveling, however, is to pack enough medicine for at least one week beyond your scheduled travel days. You never know when airlines, cruise ships or your travel plans can be significantly delayed or how difficult it will be to have your emergency medicine order shipped to you.
3. Purchase a travel health care insurance policy.
One of the best ways to protect yourself while traveling is to purchase a travel health care insurance policy. Travel health care insurance policies are designed to provide for a gap in your existing coverage. Foreign doctors, hospitals and expedited medicine shipments can all be a part of the coverage. Be sure to read the policy before purchasing it and make sure none of the activities you are considering taking part in are excluded from coverage.
4. Look into emergency evacuation coverage.
In extreme medical situations, you may need to be transported back to the United States by ambulance. This can be extremely costly and not covered in any way by your health care plan. You may want to consider foreign transport or ambulance insurance when you are traveling abroad to make sure every contingency is covered.
Whether you are traveling abroad or staying close to home, when it comes to elder care planning preparation is key! Don’t wait to speak with a member of our legal team about the planning you and your loved ones need today.
Medicare Open Enrollment is here. This is the annual time period for seniors to select the Medicare Plan that will provide the majority of their health care coverage in the following year. During Open Enrollment, seniors can enroll for the first time, change plans and ask questions about the coverage being offered. The key to selecting the right Medicare Plan is to make an informed decision based on your own health care needs and the services provided by the plan.
As a senior, how do you know which plan is right for you? Is there a significant advantage in Florida of one Medicare Plan over another? Should you switch plans during Medicare Open Enrollment? What are the questions you should ask before you make your selection? These are just a few of the questions that our clients have recently asked us. We know choosing the right Medicare Plan for you can be difficult and want to share our information that can help you make the right decision this Medicare Open Enrollment period.
When it comes to your health care coverage, you need to candidly assess your health needs before you talk to a plan provider or start to research. Begin by making a comprehensive list that identifies your health needs, who your doctors are, and the medications you take. With this list in hand, you can evaluate the coverage in each plan and determine if what you need is offered by the plan you are considering.
After you have completed your checklist of needs, review your current coverage. Medicare Plans can change from year to year. For Florida seniors who have traditional Medicare coverage, you can review the Medicare & You handbook to determine the costs and benefits that will be available to you next year. For Florida seniors who have a Medicare Advantage Plan or a stand-alone Part D prescription drug plan, you should have received an Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) statement from your provider. In some instances, you may have received both. Do not wait to review these documents and compare them not only to your coverage this year, but to your list of health care needs.
In all instances, it is important for you to remember that Medicare is an acute health care system. The support it provides includes, but is not limited to, assistance in paying for doctor visits, lab work, hospital stays and prescription drugs. It is not designed to pay for or support your long-term care needs.
Should you or a senior loved one need long-term care assistance at home, in an assisted living facility or a skilled nursing facility, Medicare is not designed to pay for one hundred percent of these costs. We are here to help you and your family find a way to pay for the Florida elder care you need, without losing all of your savings. Don’t wait to talk to us about the limitations of Medicare coverage in the long-term care setting, no matter what coverage you choose. You may call our office at 877-977-ELDER or contact us through our website to schedule an appointment.