Two of the most important medical programs in the U.S. are also ones that can cause the greatest confusion. This week, we take a look at both Medicaid, Medicare and what they could mean for you at some point.
Under both Medicare and Medicaid, an adult beneficiary must meet criteria, generally, they must be at least 65 years old or disabled.
For Medicare coverage, the beneficiary or beneficiary’s spouse will often be required to have made some payroll contributions through the Social Security program over the course of their lives. Medicare coverage is sometimes defined as a health insurance policy purchased through premiums deducted from payroll checks over the years. While a beneficiary doesn’t necessarily have to have made those contributions, he or she must have both limited resources and income. Many begin to “spend down” their assets as they prepare for Medicaid qualification; however, there are important dynamics that can affect coverage.
Medicaid monies come from the government of both the applicant’s state and on the federal level. While the rules vary slightly from one state to another, the basics often mirror one another. Medicaid was designed to be a safety net for those with inadequate healthcare resources and while that remains true today, due to the upcoming healthcare laws, there could a shift in the role of these programs.
Nursing Home Coverage
Often, it’s not until one realizes a nursing home is in his future that he begins considering the details associated with qualifying for Medicaid or Medicare. It may be that he hasn’t met with an elder care or estate planning lawyer until then. Each program has its own methods of paying for nursing home care and the right legal representation can ensure fewer mistakes.
Remember, Medicaid is considered more of a safety net for those with no other options. Because of that, Medicaid will cover the costs for nursing home care indefinitely. That said, the recipient must qualify and that’s determined via his assets – or rather, his lack of assets. If the Medicaid recipient is married, his spouse’s assets might also play a role.
Meanwhile, Medicare will cover the cost of nursing home care for a limited period of time – usually just 100 days per benefit period. A new benefit period starts when the Medicare beneficiary has not received Medicare covered inpatient care in the nursing home or in a hospital within the previous 60 days. Then, only a limited number of those days are paid in full. Co-payments are required by the recipient, either via a supplement insurance policy or out of pocket. Also, each year, those figures change, based on a number of factors. Medicare is applicable only if the patient spent at least three nights in a hospital the previous 30 calendar days and the hospital stay must be related directly to what requires a stay at a nursing home.
Medicaid, Medicare and the Legalities
As mentioned, each state often has its own requirements and guidelines, so it’s important to meet with an elder care lawyer who’s familiar with Medicaid and Medicare to ensure you’re in compliance with both state and federal laws. He can help you with the 5 year look back period (when Medicaid looks to the past five years to see if you’ve given assets away for the purpose of qualifying for Medicaid).
It’s never easy to prepare for these kinds of changes, but with the right guidance, you can at least ease the stress associated with these important programs at a time you need them most.