As a Marietta Medicaid planning lawyer, I can tell you that Medicare and Medicaid have long been a mystery to many consumers. In fact, it can baffle and confuse even some of the smartest citizens. Like me, you might have thought, “I don’t need to worry about this right now.” However, it is never too early to gain a little understanding and awareness that just might help you help an aging loved one or yourself down the road. As the saying goes, “Time flies,” and you will be there sooner than you think. Let’s break it down and learn some of the differences and basics of Medicare and Medicaid to unlock the mystery.
Medicare is a health insurance program provided through the federal government. In order to receive Medicare, a person must meet certain requirements. A person must be 65 years old or older or have a severe disability. In order for a disabled person under the age of 65 to be eligible for Medicare, they must have received Social Security Disability Insurance (SSDI) for two years. In order to be eligible a person must have Social Security retirement benefits or Social Security disability benefits. Because Medicare is run and administered by the federal government, it is uniform from state to state. If a person meets Medicare eligibility requirements, they can receive Medicare no matter their income or assets. Costs for Medicare are based on the recipient’s work history. This means that costs are determined by the amount of time a person paid Medicare taxes. These costs like all insurance include premiums, copays, and prescriptions.
Medicare can be confusing because there are four parts. The commercials talk about Parts A, B, C, D. What does it all really mean? Parts A, B, and D can be somewhat simplified. Part A is hospital insurance, Part B is medical insurance, and Part D is prescription drug coverage. Parts A and B are covered in Original Medicare offered by the government. Part C is often called the Medicare Advantage Plan. This is a private health plan. The Medicare Advantage Plan or Medicare Part C plan are required to include the same coverage as Original Medicare but usually also include Part D as well. It is important to do your homework on these plans to find what works best and is most cost effective for you.
Medicaid is a health care assistance program. Its guidelines come from the federal government, but it is administered by each state. Medicaid is for people who cannot afford to pay for their care on their own. It is based on income and assets, and is available to people who belong to one of the eligible groups. The eligible groups are children, people with disabilities, people over age 65, pregnant women, and the parents of eligible children. Seniors who require nursing home care can qualify for Medicaid and only pay a share of their income for the nursing home. Medicaid then pays the rest.
A person can be eligible for both Medicare and Medicaid and can have both. The two programs work together to help the recipient best cover the expenses of health care. For example, Medicare costs include premiums, copays, and deductibles. Full Medicaid benefits can cover the costs of Medicare deductibles and cover the 20% of costs not covered by Medicare. Medicaid can also help with Medicare assistance and may cover costs of premiums for Part A and/or Part B.
Although Medicaid and Medicare can be quite confusing, it is important at a minimum to know the basics. When you or someone you love is eligible or in need of the benefits, there are organizations willing to help and your Marietta elder law attorney is also a valuable resource.
If you have any questions about something you have read or would like additional information, please feel free to contact our Marietta Medicaid planning lawyers at 770-425-6060.
Longer lives are among the greatest achievements of our modern era. Advances in healthcare and other progress related to human safety have resulted in what the United Nations says is one of the most significant social transformations of the 21st century.
However, with the success of longer lives come problems that catch most of us off-guard. According to a study by the U.S. Department of Health and Human Services, 70% of Americans over the age of 65 will need long-term care services at some point in their lives. Few families are in the position of being able to step-up and take over the care of their elderly loved ones, so they must seek outside help.
Unfortunately, many wait until their loved one is in full-blown crisis to seek long-term care assistance. Making decisions in this way can be fraught with emotion and very expensive. That is why we highly recommend that our clients not wait until their parents are in dire need to begin the long-term care planning process. If you are struggling with finding and paying for the right long-term care option for your parent in Marietta, Georgia, here are some things you need to consider.
Appropriate Level of Care
Long-term care encompasses many different levels of care, so it’s important to match up the facility with the individual needs of your parent. Different types of facilities include skilled nursing facilities, custodial care facilities, and intermediate care facilities. While it’s not always possible to plan ahead for nursing home care, it is a good idea to become familiar with some of the long-term care facilities in your area and select the ones that you and your parent would prefer. When the time comes for long-term care, a Marietta GA elder law attorney can assist you in determining the level of care required for your parent and work with the long-term care facility of your choice.
Paying for Long-term Care
You will also need to think about how to pay for your parent’s long-term care. Facilities can cost anywhere from $5,000 to $10,000 per month, depending on the level of care required. Long-term care insurance policies may help defray some of these costs, but very rarely do those policies cover the entire amount needed. Special benefits are available to veterans through the VA, and Medicare may help pay for a very limited amount of time in a nursing home based on the illness/injury. Medicaid is the most common option to help pay for long-term care, but there are strict eligibility requirements attached to that assistance, and it is very easy to become disqualified from that care if your parent exceeds asset or income limits without the proper planning in place. It is important to speak with a Marietta elder law attorney to review your available options and determine the best course of action to pay for your parent’s long-term care.
Planning ahead for long-term care can make a world of difference in your life and contribute to the comfort of your parent when the time comes. If you would like to start this conversation with a Marietta elder law attorney who has extensive experience helping people find the best long-term care solutions, call our office at 770-425-6060 and schedule a consultation.
If you are providing care to your parent, you are probably doing it without being asked and without compensation. It probably isn’t on your mind at all. But, I can tell you as a Marietta elder law attorney, it should be.
As a society, we value our elders and provide the care they need without being asked, just as they did for us. In most cases, the last thing on a caregiver’s mind is being compensated for their time. We value your commitment, but you should know that getting compensation for helping them might actually benefit everyone in the long-run. This is because paying you may help them become eligible for Medicaid – and once eligible they can get the professional care they need.
Medicaid is an income-based benefit. If you have too many assets (money or property) you would not be eligible. To become eligible, you must “spend down” assets to a certain level. Paying you, as the caregiver, is a perfectly legal way to do that. However, it is best to set up a caregiver contract to keep the terms of the agreement clear.
The caregiver contract should be carefully drafted so that there is no confusion about whether your parent simply gave you the money. (Medicaid will look back 5 years to see if the recipient gave away money to become eligible – a BIG no, no!) However, if the money is earned in exchange for providing caregiver services, then it is acceptable.
Please consider these points when creating a caregiver contract:
- Contact an experienced elder law attorney in Marietta GA to ensure that the compensation will count toward the spending down of their assets.
- Include a detailed list of the caregiver’s responsibilities including transportation, laundry, cleaning, etc.
- Make sure the compensation is in line with what professional caregivers charge.
- The caregiver must report the compensation as income earned on their taxes.
If you are caring for a parent – especially if that parent is likely to need long-term nursing home care – call our Marietta elder law attorneys at 770-425-6060 right away for a free Georgia Family Treasures Elder Planning Session.
Do you have concerns about:
• Running out of money if you (or your spouse) become ill and require significant care
• Having no control over who provides care for you if you need it
• Choosing the type of care you want and where you want to receive it
• Leaving an inheritance to your loved ones, only to have it taken by their creditors
• Your children misusing the property or money you leave to them
• Providing support to a loved one with a disability both during your lifetime and after your passing
• Making sure your wishes about care and your finances are carried out
If you answered YES to any of the questions above, we can help. A long-term care asset protection plan is not a one-size-fits-all set of documents. Each plan is designed based on your concerns, your desires, and your goals.Call our Atlanta elder law attorneys at or email me at email@example.com.
“Does mom want to live in a nursing home?”
“What does dad feel contributes to, or takes away from his idea of ‘quality of life’?”
“Do mom and dad have legal documentation in place that ensures someone can act financially on their behalf if they are unable to?”
These are just three of many questions local residents are encouraged to ask their parents and aging loved ones during Sandwich Generation Month, a month-long observance in July of each year that focuses on the legal and financial burdens facing adults who are caring for young kids and their older parents at the same time.
Without knowing the answers to such questions, families could be left battling over long-term care, struggling financially, and not truly honoring their parents’ wishes in the event of a future healthcare crisis.
Far too many families avoid talking about aging and long-term care until it’s too late. Especially from a legal standpoint, if you don’t know your parents’ wishes or the documentation they have in place (or don’t), you could be left with a huge mess on your hands if they become sick or disabled.
This month, it’s advisable for adult children to have 5 specific conversations with their parents as soon as the opportunity presents itself:
- Long-term care preferences – Do mom and dad want to live in a nursing home or would they prefer in-home care if the need presented itself? If they prefer a facility, what amenities and activities are important to them at this point in their life? If they want to live alone in their home, will that suit their personality or will loneliness and depression result? These are questions that if discussed in advance can make the transition into an assisted living facility or a home-health care program much easier on everyone when the time comes.
- Current Legal Documentation – It’s imperative that adult children find out what legal documentation their parents have in place before incapacity occurs. This includes making sure their parents have a financial durable power of attorney, health care directive, and HIPAA documents so someone can easily step in to make financial or medical decisions on their behalf. Otherwise, the family will be forced to petition the court for control over their parents’ affairs if they passed the point of legal capacity.
- Medical Preferences and Wishes – Adult children should find out what type and how much medical care their parents want as they age, or following a debilitating diagnosis such as Alzheimer’s and Dementia. Do they have specific wishes about life support or other end-of-life medical treatments? Who do they want to make such decisions on their behalf? The answers to these questions will help your parents to feel secure knowing their wishes will be carried out during an otherwise emotionally-charged time.
- Current state of financial affairs – To ensure finances are properly managed, adult children should start asking tough questions about their parents’ financial affairs. This includes finding out the location of any safety deposit boxes, bank accounts, investment or brokerage accounts, long-term care insurance, outstanding debts, or other assets unknown to the family. Otherwise, necessary assets needed to cover long-term care or other expenses could go overlooked and unaccounted for. You should also ask your parents how they plan to pay for long-term care. Most expenses are not covered by Medicare or private insurance. Medicaid may be able to help, but you will likely need an attorney to help you create the right kind of trust or utilize other planning strategies in order to meet the income and asset thresholds and protect your assets from being “spent down” while qualifying for benefits.
- Important contacts and information – While their memory is still sharp, adult children should work with aging parents to compile a list of important contacts and information that will be useful to the family. This includes documenting key doctors, professional advisors (e.g. accountant, attorney, financial advisor), and important passwords for online accounts.
While these conversations are certainly not easy to have, families can make the transition into a parent’s senior years easier by planning ahead. Not to mention, mom or dad will appreciate your willingness to make sure their wishes are honored if and when incapacity, sickness or disability occurs.
For more information and help, please download our FREE guide, “Surviving The ‘Sandwiched’ Years: How To Protect Your Parent’s Assets, Honor Their Wishes & Provide Long-Term Care….Without Losing Your Money—Or Your Mind!” by clicking here.
One of the most common issues that Marietta elder law attorneys deal with is how to help clients when it comes to both short-term and long-term care. Folks are living longer than they ever have before due to advances in both health care and technology. Certainly, this is what people have been hoping would happen for generations, but it does bring with it some new challenges. High on that list is the increased need for short-term care (to recover from an illness or injury, for example) and long-term care. What people so often want their East Cobb elder law attorneys to explain is how they can afford it and whether Medicare or Medicaid can help.
The answers to these questions are, of course, fairly complicated; but it’s worthwhile to have at least a little knowledge to get started. In the case of Medicare and Medicaid, you will find that both of them can help when it comes to paying for rehab services, but under different guidelines. This is something that Marietta elder lawyers spend a lot of time researching, and with laws constantly changing, it’s best to confer with someone knowledgeable about the current status of these programs.
If you are over 65, then Medicare might be a reasonable option for you. While similar to health insurance, Medicare is a federal program. Whether you live in Georgia or any other state, you can expect the same benefits and requirements. For example, to qualify, you need to transfer to a rehab facility (or nursing home) only after staying three days and three nights in the hospital; and the move needs to take place within 30 days of the hospital stay.
Basically, Medicare is there to help when an unexpected illness or injury arises so that you can get through it and recover. It’s not a plan for long-term care, rather it’s for those who need skilled care as they’re making their recovery. For that reason, Medicare will only pay for 100 days of care, and the last 80 days require a co-payment from the patient.
Your elder lawyer will tell you, however, that Medicaid is a state-run program. It is in place for those who have a demonstrated financial need. And that need must be pretty significant. In fact, you may have to prove that you have less than $2,000 in assets to qualify, and if you have more, you might have to get creative in how to reallocate it to qualify. Again, and elder law attorney in Marietta, Georgia, may be able to offer advice and suggestions on how to do this appropriately. The good news is that there are some exemptions to this $2,000 worth of assets rule, and you may be able to keep your house and your car while still qualifying.
Getting the most out of Medicaid can be difficult to figure out, so gaining clarification from an East Cobb elder law lawyer is definitely recommended. Social workers and staff at the hospital may also have suggestions and recommendations. This is one of those times when it pays to be prepared in advance, too, so that you know what your options will be and can set things up to work to your utmost advantage should you need to rely on Medicaid.
If you are a caregiver and you want to learn more about Medicare, Medicaid and long term care planning for your elderly loved one, please check out my free guide, “Hope For Caregivers: ABC’s of Long-Term Care and Legal Planning.” You can download it by clicking here.