Understanding Medicaid Benefits

Medicaid is often confused with Medicare but they are different in multiple ways.

While Medicare is solely a federal program, Medicaid is a joint state-federal program. Each state operates its own Medicaid system, and may give it a different name, but it must adhere to federal guidelines to receive federal funds. Federal money pays for half the state’s Medicaid costs, and the state pays the rest. T

There are strict income and asset guidelines that must be satisfied to be eligible for Medicaid coverage.

When should Medicaid be Considered?

Medicaid benefits are typically utilized in situations of Long-Term Elder Care and Long-Term Medical Care.

According to commonly cited statistics, if you are age 65 and single, then the odds are about 50 percent that you will need long-term care at some point. For married couples, odds are about 75 percent that one spouse will need such care. The average long-term elder care stay runs about two and a half years. For a younger person diagnosed with a debilitating disease, the average stay can be much, much longer.

Long-term care in either care is very expensive.

Paying for Long-Term Elder Care

You may be thinking, “I have Medicare, so I don’t have to worry about long-term care, right?”

Wrong.

Medicare only pays for acute nursing home care, not chronic care. Think of acute care as rehabilitation after hip surgery. You will be going home to care for your own daily needs. Think of chronic care as needing help with “activities of daily living” like bathing, eating, dressing, continence, toileting or transferring, not to mention dementia or Alzheimer’s. Even for acute care in a skilled nursing home, Medicare is limited to paying for up to 100 days with strict eligibility requirements and full payments limited to the first 20 days and co-payments thereafter.

By the way, your Medigap (i.e., Medicare Supplement) policy will not pay for your long-term care, but may pay the Medicare co-payments for days 21 through 100.

Before facing a situation like this, you need to discuss the Medicaid planning and application process with an experienced Elder Care attorney. An Elder Care attorney will have the necessary skills and contacts required to help you address the important issues, create a strategy, engage and direct the required healthcare staff, and work with you to get the Medicaid application approved by your state Medicaid agency.

Paying for Long-Term Medical Care

How do you plan financially for a diagnosis of a debilitating disease like amyotrophic lateral sclerosis (ALS or “Lou Gehrig’s Disease”), or Parkinson’s, Huntington’s, or Alzheimer’s?

Along with the devastating news, the doctor may recommend that you or your spouse be placed in a nursing home. You have no idea what this will cost, let alone how you will pay for it. In short order, you learn that Medicare will not pay, especially for the long-term. You become familiar with Medicaid but have no idea whether your spouse qualifies or even how to apply.

Before facing a situation like this, you need to discuss the Medicaid planning and application process with an experienced Medicaid crisis planning attorney. A Medicaid crisis planning attorney will have the necessary skills and contacts required to help you address the important issues, create a strategy, engage and direct the required healthcare staff, and work with you to get the Medicaid application approved by your state Medicaid agency.

Stay Ahead of a Long-Term Care Crisis

Contact Estate Planning & Legacy Law Center, PLC, before you find yourself in a long-term care crisis.