Medicaid and Medicare Open Enrollment: Remember Medicare is Not Medicaid

Medicaid and Medicare Open Enrollment: Remember Medicare is Not Medicaid

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.

The VA Benefits Available to Florida Seniors to Help Them With Long-Term Care

The VA Benefits Available to Florida Seniors to Help Them With Long-Term Care

As we look to care for our parents and grandparents as they age in Florida, we need to think about their current and potential long-term care needs. How will they be able to find good care should they need it? Where should they look for help? What is available in our community? How will they be able to afford the care they need should the time come?


Unfortunately, many Florida seniors do not begin to plan for the high cost of long-term care until it is too late. For a myriad of reasons, they did not plan forward to think about what they may need both now and for a future that includes an increased need for long-term care assistance. Most of us today simply cannot afford the additional thousands of dollars per month it would cost to have support from home healthcare or a semi-private room in a skilled nursing facility without rethinking our finances and looking for help from public benefits.


While many Florida seniors turn to Medicaid and other local community programs for assistance, for Florida veterans, there are additional benefits available. They range from health care and funeral assistance to disability support and pension assistance. For many veterans the available benefits remain unused and hard to obtain due to the qualification that is required to gain access to them.


Perhaps the most beneficial program for the Florida senior veteran in need of long-term care assistance is the VA Pension program.

The VA Pension program is in no way tied to a service-connected disability.


In fact, the health care disability standard associated at the basic level is met simply by being over age 65. This a monthly, tax-free benefit that can increase based on the health care needs of the veteran.

The rules changed substantially for this program on October 18, 2018. This program is not an automatic benefit for wartime veterans and their dependents. They must prove, first, that the veteran served for at least 90 days of active service with one day during a period of war. Second, he or she must prove that he or she was discharged under conditions other than dishonorable.


Now, to access this program, the new rules created a few more qualifications. For example,  there is an asset limit for the veteran’s countable resources. Prior to the rule changes, there was no set amount in place. This year the veteran may have $126,240, excluding exempt assets, and this amount will change each year.

Further, through these rules the Department of Veterans Affairs created a “look-back” period. A “look-back” period is a period of time during which the Department may review assets to determine if the veteran has made gifts of his or her resources. A similar set up currently exists for the Florida Medicaid program. The “look-back” period will be for thirty-six months. If the VA determines this occurred the veteran may face a disqualification period.
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These are just a few ways the VA Pension program has changed.


We know this article may raise more questions than it answers and encourage you to schedule a meeting with us to get the answers you need for yourself and your loved ones.

7 Tips for Evaluating Your Parents Potential Long-Term Care Needs Over the Holidays

7 Tips for Evaluating Your Parents Potential Long-Term Care Needs Over the Holidays

Choosing to visit your aging parent during the holidays can be a great gift from you to them. It is during these visits, however, that you may learn that your parents are not physically or mentally able to care for themselves as well as in the past. You may determine during your visit that your aging parents are having significant problems dealing with activities of daily living and may need more help in the home.

 

We know how difficult this realization can be for you and your parents. As you face these challenges together, it is important for you to determine what strategies may best provide the support they need. Let us share seven tips for talking to your aging parents this holiday season that we share with our clients, friends, family, and local professionals in our community.

 

  1. Are they having issues driving? As we age, driving becomes more difficult. It is not just the physical act of driving, but also, response times and observations. Be sure to let your parents drive you both short and long distances to determine how they are managing this task.

 

  1. How is their day-to-day health? Observe your parents throughout your visit, taking time to see how they are doing throughout the day. Are mornings easier? Do they go to sleep after dinner? How quickly can they move between tasks?

 

  1. Can they easily prepare meals? If your parents offer to prepare a meal, let them. Although many families go out to eat during visits or an adult child cooks, ask your parents to help. Be on the lookout for whether or not your parents have a hard time remembering frequently used recipes, where ingredients are placed, or remembering to turn off kitchen appliances, such as the oven.

 

  1. How many medicines are they taking? Medicines increase for many Older Americans. Ask them to share their medication list and schedule for taking prescriptions. Are there duplications? Can your parents tell you why they take specific medicines? Is anything expired? Do they need help opening bottles? There are many pharmacies now that will organize medications by day and time. Talk to your parents about this type of service and if it would be beneficial.

 

  1. What is the state of their house? If you can, stay at least one night in the home as you may not be able to observe the state of the house in a quick visit. Is it clean? It it well-maintained? Do your parents need help with organization or clutter?

 

  1. Is their estate planning up to date? Ask your parents about their estate planning. The documents within their planning, such as the durable power of attorney, will be necessary in a crisis should you need to make decisions for them. What documents do they have included in their estate plan? Who is their decision maker? Is there an attorney you may talk to in a crisis?

 

  1. Have they created a plan for long-term care? It is never too early to plan for long-term care. Ask your parents what plans they have created so far. Although this can be a difficult conversation to have, it is never too early to talk to them about what they want so you can both be prepared for the future.

 

We want you to know that we are here to help you answer these questions. We can work with your aging parents and you both now and in the new year. Do not wait to contact us to ask us your questions.

Do You Know the Ways You Can Say Thank You to a Caregiver?

Do You Know the Ways You Can Say Thank You to a Caregiver?

While many of us consider November and Thanksgiving the season of giving back, did you know that November is also National Family Caregivers Month? This is a great time to show your appreciation and gratitude to the caregiver in your life. Whether your caregiver is a hired professional that is considered part of the family or an unpaid family member who sacrifices his or her time to care for your loved one, being a caregiver is one of the most selfless roles there is.

Caregiving is a full-time profession that goes further than a typical nine-to-five job. Being a caregiver is a 24-hour, 7 days a week commitment that follows the caregiver home each day. Many caregivers share that because of the intense nature of the position, they frequently neglect to take care of their own health and well-being. This is why we want to share with you four ways to say thank you to the caregiver in your life this National Family Caregivers Month and into the remainder of the holiday season.

  1. Educate yourself about caregiver health.

Caregivers spend so much time taking care of your loved one, they sometimes neglect to take care of themselves. Becoming familiar with signs that your caregiver is overwhelmed and may be in need of some time off is one way that you can show your appreciation for your caregiver.

  1. Encourage respite breaks.

Respite care is an effective way of allowing the caregiver in your life to take a well-earned break. These programs provide a place where your senior loved one can go and interact with other seniors in a supervised facility, so you know they are still being watched over and their needs taken care of.

  1. Propose counseling or support groups.

Sometimes, the best gift is just having somebody to talk to. Your loved one’s caregiver may not feel like they can openly discuss their frustrations or feelings with you. Encouraging him or her to attend one-on-one counseling or a caregiver support group can provide an outlet for the caregiver to discuss their feelings and receive advice from people who can relate.

  1. Purchase a small gift.

You do not need to spend a lot of money to give your caregiver a meaningful gift. Purchasing a gift card to his or her favorite coffee shop for an afternoon pick-me-up, or offering to take the caregiver out to lunch can help put a smile on his or her face.

Above all, remember to say thank you to the caregiver in your life. A simple thank you can be especially meaningful and shows the caregiver that you recognize and appreciate the work he or she is performing. Do not hesitate to contact our office if you would like some more ideas on how to say show your appreciation to your caregiver this holiday season.

Two Under-Used VA Pension Benefits That Can Help Pay for Long-Term Care Needs

Two Under-Used VA Pension Benefits That Can Help Pay for Long-Term Care Needs

We know that Florida seniors often find themselves in a difficult situation. As their health care and living expenses increase, their ability to work and generate income decreases. It is an unsettling scenario, but one that the Veterans Administration may be able to help with for those eligible for VA pensions.

A VA pension is a tax-free monetary benefit paid to low-income wartime vets who are either age 65 or older, disabled, living in nursing homes, receiving Social Security Disability Insurance or Supplemental Security Income. An additional, and under-used, type of pension benefit that all impacted veterans should be aware of is called Aid and Attendance. This is available for veterans and the surviving spouses of veterans whose unreimbursed medical expenses exceed their monthly income. The purpose is to provide financial assistance for those who need help performing activities of daily living.

If you are not sure if you or your loved one qualifies, consider contacting an accredited VA attorney to help determine your eligibility or for information about how to access the VA Pension with the Aid and Attendance benefit. Remember, veterans whose income is above the limit for a VA pension also may qualify if they have large medical expenses that are not reimbursable. Your VA accredited attorney can discuss with you options to become eligible or how to find the long-term care support you need.

Aid and Attendance support is available for vets who served at least 90 days, with at least one day during wartime. It is not reserved for those with service-related disabilities. Veterans, and their surviving spouses, are eligible if they meet the above criteria and if they need aid from another person to help them perform basic living activities, such as:

  • Assistance with personal care needs, like bathing, dressing and using the bathroom.
  • Living in a nursing home.
  • Are mentally or physically incapacitated.
  • If they are bedridden.
  • Suffer from extremely poor eyesight.

A second long-term care benefit tied to the VA Pension program is known as the Housebound Allowance. This underused pension feature offers an additional monthly monetary benefit for veterans who are significantly restricted to their homes because of a permanent disability. Eligibility rules may require a written statement from a doctor describing a qualifying vet’s needs and limitations and you will want to discuss this with your VA accredited attorney as well.

Finally, Aid and Attendance and Housebound Allowance benefits are paid on top of monthly pension payments. This means that they increase the overall pension amount, making people who are not normally eligible for a basic VA pension due to excessive income potentially eligible for these long-term care items.

We know this article may raise more questions than it answers for you. We encourage you to ask us your questions this Veterans Day or, at any time, schedule a consultation with attorney Scott Selis to get the elder care support you need.