Who Qualifies for Medicaid?

August 19, 2014

By Rick Law, founder of the Estate Planning Center at Law Elder Law in West Suburban Aurora, IL Medicaid imposes some strict qualification criteria, but in general, it will cover long-term care in a skilled nursing facility when the patient meets two conditions:

The patient’s personal income and asset holdings are under strict limits
The patient meets medical criteria that are established by his or her state

Medicaid divides individuals’ assets into three classes. These are:

Countable assets (also referred to as non-exempt or available assets in some states)
Non-countable assets (also called exempt assets)
Inaccessible assets

Countable assets include any personal financial resources that are owned or controlled by the applicant for Medicaid benefits. These resources must be spent on the patient’s care. Countable assets typically include:

Cash
Stocks
Bonds
All general investments
All tax-qualified pension plans if the applicant is retired
Deferred annuities if they are not annuitized
A primary residence (if the net value of the residence exceeds a cap that is set by the individual state). Note that this rule does not apply if there is a spouse living in the home.
All life insurance with cash surrender value, if the death benefit exceeds $1,500
Vacation property
Investment property

Non-countable assets are acknowledged by Medicaid, however, they are not used in determining eligibility. These assets typically include:

A small sum of money, called a cash allowance, that is normally under $2,000. (This amount differs from state to state).
A primary residence (if it does not exceed a certain cap amount)
A prepaid funeral plan (there are limitations to these plans)
Term life insurance
Business assets (if the applicant derives their livelihood from them)
A car for personal use
Personal items

Inaccessible assets are resources that would have had to be spent on the Medicaid applicant’s care, or in the case of a primary residence, have been subject to a lien for recovery of benefits. However, there particular assets can be considered inaccessible if they have been transferred to another individual or have been placed in a certain type of trust. Medicaid also has the right to review an individual’s financial records at the time that an application for benefits has been received. State Medicaid programs evaluate each applicant’s financial situation prior to granting access. And, they look for transfers of countable assets within certain time periods, referred to as a look-back period. Currently in Illinois, that look-back period is 60 months. Among other things, they look to see if the applicant has given away money or an asset, or sold an asset for less then fair market value in the 5 year period prior to applying for Medicaid assistance. Penalties apply if non-allowable transfers are found. Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner for Retirees. Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

What is Medicaid?

By Rick Law on

August 17, 2014

- Long Term Care, Medicaid

By Rick Law of Law Elder Law in Aurora, IL Medicare is a health insurance program that is an entitlement – regardless of an individual’s income or assets. Medicaid is not. Medicaid is jointly funded and administered by the federal government through the Centers for Medicare and Medicaid Services and each state. The responsibility for developing the guidelines for the federal/state cost sharing lies with the U.S. Department of Health and Human Services. This department is also responsible for overall supervision of state and provider participation in Medicaid. Each individual state government has a fairly wide latitude in running their Medicaid Medicaid is considered to be a means-tested program; this means that participants must meet strict income and asset criteria in order to qualify. It is considered the safety net for the impoverished. And, in many cases, Medicaid is the “payer of last resort” for skilled nursing facility benefits. Even though additional benefits may be added by individual states at their own option, all states are required to cover the following long-term care-related services:

Inpatient hospital services (with the exception of services in institutions for tuberculosis or mental diseases)
Outpatient hospital services and rural health clinic services, including any ambulatory services that are offered by such clinics and otherwise included in the state’s Medicaid plan
Other laboratory and X-ray services
Transportation to medical facilities
Physicians’ services furnished in the office, the patient’s home, hospital, skilled nursing facility, or elsewhere, or medical and surgical services that are furnished by a dentist where state law permits either doctors or dentists to perform such services
Skilled nursing facility services, including custodial care, but excluding services in institutions for tuberculosis or mental diseases, for individuals who are 21 years of age or older

Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

Remember: Medicare is Not Designed to Pay for Long-Term Care!

By Rick Law on

August 16, 2014

- estate planning, Long Term Care

by Estate Planning Attorney Rick Law of Law Elder Law in the West Chicagoland suburb of Aurora, IL. Few people realize the limitations of Medicare. Medicare was designed to care for those with acute medical conditions like gall stones or broken bones. It does not take on the cost for diagnoses such as Parkinson’s Disease, Alzheimer’s, dementia, or long-term mobility problems. Medicare really only covers short-term or “acute care.” In other words, Medicare only covers your healthcare expenses if you are expected to get well. Thus, Medicare does not provide care when someone is diagnosed with a long-term chronic condition from which they are not expected to recover. In order to qualify for home care coverage, the patient must need at least one or more of the following:

Part-time nursing care
Physical therapy
Speech language therapy
Occupational therapy

These services are typically covered by Part A or B of Medicare. The patient will pay $0 for all covered home health visits. If the patient has a Medicare Advantage Plan or a Medicare Supplement policy, they need to contact their plan and ask about their coverage, as they may need to use one of the home care agencies that the plan lists as approved. Seniors need to be made aware that Medicare leaves many “gaps” in coverage by way of coinsurance and deductibles. Even those who own a Medicare Supplement policy must understand that these policies only offer coverage that is supplemental to what Medicare covers. So, if an individual incurs expenses that are not covered in the first place by Medicare, such as non-essential cosmetic surgery, then their Medicare Supplement policy typically won’t pay for the coinsurance or deductible. As a general rule, Medicare Supplement policies also do not cover custodial care or long term nursing home or home healthcare. Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

Meeting the Medicare Criteria

By Rick Law on

August 14, 2014

- estate planning, Long Term Care, Uncategorized

By Estate Planning attorney Rick Law of Law Elder Law, Illinois’ leading Elder Law attorneys. As you may have read in our previous blog entries, Medicare only cares about you if you can get better. Many seniors expect that Medicare will take care of them if they need to have long term care later in life, and that’s simply not true. If you have an ongoing chronic diseases such as Parkinson’s, Alzheimer’s, and other degenerative memory and mobility issues, you will have to pay for the bulk of your costs – especially if you need long term care. Fortunately, there are tools that a qualified Elder Law attorney can use to help you save some of your assets and even your home. Be sure you have the right tools in place as soon as possible – because if you’re already out of money, you may be out of options. Medicare will also pay some of the costs of home healthcare. If you need help only with basic daily activities, then Medicare won’t cover these costs. However, Medicare will cover the expenses of medical care in the home, including help with daily living activities, if it is part of a doctor’s orders. In order to receive home care coverage from Medicare, the home care agency that is used must be Medicare-approved, and the patient must also meet certain qualifications of their Medicare, Medicare Advantage or Medicare Supplement plan. To meet the criteria set by Medicare in order to qualify for home care coverage, the patient must need at least one or more of the following:

Part-time nursing care
Physical therapy
Speech language therapy
Occupational therapy

In addition, the patient must be homebound. This means that leaving their home is a major effort and the person only does it rarely. For example, the patient would only leave their home to:

Attend regular church services
Obtain medical treatment, including therapeutic or psychosocial care

If qualified for coverage, the patient must receive their home care services from a home healthcare agency that is approved by Medicare, and/or an adult day care program that is Medicare-approved and state-certified to provide adult day care services. Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

When Will Medicare Pay for a Nursing Home?

By Rick Law on

August 13, 2014

- Elder Law, estate planning, Financial Planning

By Rick Law of Law Elder Law in Aurora, IL, Serving Seniors and Boomers in the Western Suburbs. Many people are under the misconception that Medicare will pay for the bulk of their long-term care services. However, nationally, Medicare covers only about 5 percent of all nursing home costs, and the parameters for qualification are many. If you have a condition needing short-term care, such as rehab following a surgery or care following an accident, then there is a chance you may qualify for some skilled nursing facility benefits from Medicare. In order to qualify to receive skilled care in a nursing facility, for example, a patient must meet all of the following criteria:

Require daily skilled care, which as a practical ma!er, can only be provided in a skilled nursing facility on an inpatient basis.
Be in the hospital for at least three consecutive days – not including the day of discharge – before entering a skilled nursing facility that is certified by Medicare.
Be admitted to the skilled nursing facility for the same condition for which the patient was treated in the hospital.
Generally be admitted to the skilled nursing facility within 30 days of their discharge from the hospital.
Be certified by a medical professional as needing skilled nursing or skilled rehabilitation services on a daily basis.

If an individual does meet all of the above qualifications to receive payments for a skilled nursing home stay, their benefits will be paid as follows:

All approved charges for the first 20 days are fully paid by Medicare.
After day 20, the patient will be responsible for a daily co-insurance amount of $141.50 (in 2011).

If the patient requires more than 100 days of care in the skilled nursing facility, then he or she will be responsible for the entire amount due, beginning on the 100th day. What this means is that essentially, between days 21 and 100, even if a patient qualifies for a Medicare-approved nursing home stay, they are still responsible for paying a daily co-payment of $141.50 (as of 2011). They will still need to pay $11,320 out-of-pocket ($141.50 x 80 days). And after day 100, they would be responsible for paying 100 percent of the charges due. It is easy to see that even with some coverage by Medicare, the cost of nursing home care can add up quickly. Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

Medicare’s Limitations

By Rick Law on

August 11, 2014

- estate planning, Financial Planning, Long Term Care

By Rick Law, Estate Planning Attorney at Law Elder Law in western suburban Aurora, IL. At the time Medicare was established, it marked a major shift in society’s view of who should carry the cost of providing medical care for senior citizens. Medicare is the federal health insurance program that is provided on behalf of persons who are over the age of 65, blind, and/or disabled. Medicare was designed to provide healthcare for the individual who has a probability of recovering from his or her ailment. Contrary to what many believe, Medicare does not cover all medical expenses of seniors. For example, it does not cover routine physicals, eye and hearing exams, dental care, self-administered prescription drugs, and many other medical products and services. Also not covered is custodial care, which is helping with daily living activities or meeting personal needs, along with private nursing care. Nor does Medicare cover care that is not considered to be “reasonable and customary.” Few people realize the limitations of Medicare, and they can wind up with substantial loss of funds and dignity if they get hit with long-term care expenses. Medicare was designed to care for those with acute medical conditions like gall stones or broken bones. But it was not designed to pay for chronic diagnoses such as Parkinson’s Disease, Alzheimer’s, dementia, or long-term mobility problems. Medicare really only covers short-term or “acute care.” In other words, Medicare only covers your healthcare expenses if you are expected to get well. Medicare does not provide care when someone is diagnosed with a long-term chronic condition from which they are not expected to recover. Remember this: Medicare is not designed to pay for long-term care, such as a nursing home or assisted living stay. Medicare only cares about you if you can get better… and relatively quickly! Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner Rick was named the #1 Illinois elder law estate planning attorney for the last 3 years by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

Is Medicare a Right or a Privilege?

By Rick Law on

August 10, 2014

- Alzheimer's and Dementia, Elder Law, estate planning, Financial Planning, General Interest

By Elder Law Attorney Rick Law of the Estate Planning Center at Law Elder Law in Chicagoland. Many U.S. citizens assume that Medicare is their right. They assume that the health reimbursement program that is provided by the United States government has always been there and always will be. But this is not the case The federal government’s role of providing America’s seniors with some degree of financial security began with the Social Security Act of 1935. In its original form, Social Security was designed to provide a retirement benefit for a worker, to be drawn on when that worker reached the age of 65 – the age established as “normal retirement age.” Later added to this program were benefits for unemployment compensation, worker’s compensation due to injuries sustained on the job, and personal disability and survivor benefits for a deceased worker’s family. In 1965, the Medicare Act was signed into law. The purpose of this legislation was to provide affordable healthcare for older Americans, as well as to prevent the impoverishment of seniors due to health-care costs. The Medicare Act was part of a number of reforms implemented by President Lyndon Johnson and the Democratic majority. President Johnson stated: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles and their aunts. And no longer will this nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.” So what exactly is Medicare? In its most basic form, Medicare is a federal health insurance program for persons age 65 or older, persons of any age with permanent kidney failure, and certain disabled persons. The Medicare program covers Americans age 65 and over, regardless of their income and their assets, as well as certain disabled individuals under the age of 65. The Medicare program does not provide medical care directly, but instead it pays doctors and hospitals directly for their services or reimburses patients who have paid bills themselves. Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner for Retirees. Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.

Who Qualifies for Medicaid?

What is Medicaid?

Remember: Medicare is Not Designed to Pay for Long-Term Care!

Meeting the Medicare Criteria

When Will Medicare Pay for a Nursing Home?

Medicare’s Limitations

Is Medicare a Right or a Privilege?

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