What is the difference between Medicare and Medicaid?
MEDICARE is a government health insurance program for people over 65 and for those
who are on Social Security Disability. MEDICAID is a medical assistance program jointly
funded by federal and individual state governments. Individuals must meet specific
financial and health care requirements in order to receive benefits to the elderly and
disabled. Qualification for MEDICARE is based on age and disability alone, while
MEDICAID qualification requires recipients to be broke in addition to being aged and
disabled. Federal and state laws allow for certain strategies to protect assets while still
qualifying. Both provide coverage for basic medical expenses and hospitalization.
However, only MEDICAID provides coverage of long-term nursing care without a
maximum limit on the time period for care. MEDICARE requires medically beneficial
rehabilitation in a skilled nursing facility following a hospital stay of three days prior to
entering the facility. MEDICARE does not cover custodial care. Technically, there is a
maximum of 100 days of nursing home benefit. MEDICARE pays 100% the first 20 days,
and 80% for the latter 80 days with a 20% co-pay. In actuality, the requirement about
medically beneficial rehabilitation usually limits the payment of services to a period of
10-20 days.
What types of benefits will Medicaid provide?
In Kentucky, Ohio, and Indiana, Medicaid provides benefits for nursing home care,
which typically includes room and board, care, prescriptions, supplies, and medical
coverage. Other types of care, often referred to as 'community based care', such home
care and adult day care, are also covered.
If my loved one is on Medicaid, won't they get substandard care?
The quality of care is more a function of the specific facility, rather than the pay status
of the patient. The majority of long term care patients are already on Medicaid. Most
facilities will generally have a mixture of Medicaid and private pay patients. Usually, the
actual caregivers have no idea, nor do they care, which is which. Every facility must
abide by both state and Federal standards of care. It is against the law to provide
substandard care. In addition, every state has an Ombudsman program available to
patients and their families to investigate such problems. The more involved the family,
the better the care of the patient.
Don't you have to be broke to get on Medicaid?
Yes, but the question is: "How did you get there?" We can get you there AND STILL
protect thousands of dollars for your family, charity or whoever.
Is this legal?
Absolutely! In doing our planning, we are using the Federal and state Medicaid rules,
which allow for certain strategies, exactly as they are written. Our trained, experienced
legal and financial experts know how to use the rules to your advantage, and do not try
to get around them. When asked this question, we often compare "Medicaid Planning"
to "Tax Planning."
What is asset "spend-down"?
Spend-down is the process of exhausting all countable, available assets to the $2,000
Medicaid resource requirement or below. If an individual has a spouse, there is an
additional amount allowed, as well as certain other assets that the spouse is allowed to
keep (home, one car, etc.). USUALLY, Medicaid workers will inform you only that the
excess assets (resources) must be spent on medical care or burial. RARELY, if ever, do
they inform applicants and spouses that there are other exempt purchases that can be
made. NEVER will they tell you that gifting (transferring to children or grandchildren) is
part of the spend-down process.
Once in a nursing home, doesn't Medicaid require you to 'spend down' all your
money on care before you can get on Medicaid?
That is what Medicaid would like you to believe. You have to be technically broke before
you can qualify for Medicaid, but Medicaid does not require that you spend your money
on anything in particular, including care.
Is this going to get me in trouble with the IRS?
Medicaid qualification has nothing to do with the IRS. If you're talking about taxes, of
course you'll need to abide by any applicable state or Federal tax rules. But remember,
gifts of assets do not normally result in gift tax until the total of non-exempt gifts exceeds
1.5 million dollars per individual (current limit), or 3 million for a couple.
Who gets the saved assets?
The assets can be transferred to any person (or persons) the patient desires, although
the children or other family members are usually the ones chosen. From Medicaid's
point of view, though, it does not matter who gets the assets.
How secure is the money?
The money is as secure as you want to make it. Since the money is typically transferred
to family members, it's their decision as to where the money is placed, or to what use it
is put. Although we do recommend that the transferred money be maintained, intact,
until after the death of the patient, that is a personal decision on the part of the family.
How long will it take to become eligible for Medicaid?
That depends entirely on the particular situation, which is impacted by such variables as
income, expenses, value of assets, etc., as well as the particular state in which the
patient resides. What we teach you, though, is how to use the Medicaid rules to get a
patient financially qualified as quickly as possible, while protecting as much of the
patient's assets as possible.
Is it a permanent solution?
Once a patient is financially qualified for Medicaid, unless they were to acquire
additional assets (for example, an inheritance, sale of property, or lottery winning) they
would normally remain financially qualified for the rest of their lives. There is a required
annual redetermination of eligibility process for all nursing home and home care
recipients.
Won't my Long-Term Care Insurance policy and income cover me in the event
of an extended nursing home stay?
In most cases, no. Long-term care insurance and income combined usually falls far
short of covering extended nursing home stays for the lower and middle classes. For
more information on how to choose a long-term care policy or to read reports on the
option, click on the links below:
http://www.elderlawanswers.com/elder_info/elder_article.asp?id=2595
http://www.kff.org/medicaid/7458.cfm
http://www.kff.org/uninsured/7459.cfm
Isn't it against the rules (fraudulent) to give away your assets for the purpose
of becoming qualified for Medicaid?
No. What is a violation of Medicaid rules is to dispose of assets, for whatever reason,
and then not disclose that fact at the time of Medicaid application. What we teach you is
the optimum structure and timing of transfers to maximize the portion of a patient's
assets that can be protected. Plus, since everything is legal and "above board", and
you can share, with the Medicaid worker, the details of everything you have done, there
is absolutely no need to hide anything.
What does everyone, including my attorney, say I can't give anything away?
Because 'everybody else' is not intimately familiar with the Medicaid rules, has not spent
years studying every detail of the Medicaid rules, nor has 'everybody else' worked for
the several years helping hundreds of families apply these exact strategies, designed
specifically for single and married long term care patients.
Can't I find out from the Medicaid office how to protect assets?
Since rules are in place to penalize those who transfer assets to certain individuals, the
answer if likely "no." Government agencies administering Medicaid services are not
interested in helping you learn how to save assets while qualifying for Medicaid.
Besides, Medicaid workers are not trained, nor are they allowed, to give financial or
legal advice.
My mother gave me $10,000 last year. Isn't she disqualified from Medicaid for
three years?
No! That's one of the common misconceptions. The "look back period" is not the same
thing as the "penalty period".
If there was a way to protect assets from Medicaid, wouldn't my attorney tell me
about it (which he has not)?
Most attorneys know little or nothing about asset protect as it pertains to Medicaid
qualification or the eligibility process. Of those who do, very few have the knowledge or
experience to put together an aggressive PLAN to maximize the protection of assets
while preparing a patient for Medicaid qualification. That is exactly what we have been
doing since 2002. With our experience and knowledge, we can work with your attorney,
if you prefer.
My parent (or parents) is in a nursing home. I am interested in saving as much
of my parent's money as possible for the grandchildren and their college
education. What choices do I have?
(1). Keep paying his bills and gamble that the parent dies before his/her/their money is
gone. (2). Let us create a strategy and implement a plan to transfer a large portion of
his remaining estate to his grandchildren, while eventually qualifying him for Medicaid.
Is there anything I can do where I would not lose control of handling my
parents' finances, per their wishes?
Right now you are in charge until the money is gone. With a PLAN, we can help you
retain that control, no matter how long the parent lives.
My parent lives with me and I'm still able to take care of him/her, but it's
obvious that his/her mind is deteriorating quickly. Is it too early to get started
on a plan, or should I wait until he/she is in a care facility?
Don't wait! The sooner you get started, particularly if care costs are currently relatively
low, the greater the portion of her estate that can be preserved.
MEDICARE is a government health insurance program for people over 65 and for those
who are on Social Security Disability. MEDICAID is a medical assistance program jointly
funded by federal and individual state governments. Individuals must meet specific
financial and health care requirements in order to receive benefits to the elderly and
disabled. Qualification for MEDICARE is based on age and disability alone, while
MEDICAID qualification requires recipients to be broke in addition to being aged and
disabled. Federal and state laws allow for certain strategies to protect assets while still
qualifying. Both provide coverage for basic medical expenses and hospitalization.
However, only MEDICAID provides coverage of long-term nursing care without a
maximum limit on the time period for care. MEDICARE requires medically beneficial
rehabilitation in a skilled nursing facility following a hospital stay of three days prior to
entering the facility. MEDICARE does not cover custodial care. Technically, there is a
maximum of 100 days of nursing home benefit. MEDICARE pays 100% the first 20 days,
and 80% for the latter 80 days with a 20% co-pay. In actuality, the requirement about
medically beneficial rehabilitation usually limits the payment of services to a period of
10-20 days.
What types of benefits will Medicaid provide?
In Kentucky, Ohio, and Indiana, Medicaid provides benefits for nursing home care,
which typically includes room and board, care, prescriptions, supplies, and medical
coverage. Other types of care, often referred to as 'community based care', such home
care and adult day care, are also covered.
If my loved one is on Medicaid, won't they get substandard care?
The quality of care is more a function of the specific facility, rather than the pay status
of the patient. The majority of long term care patients are already on Medicaid. Most
facilities will generally have a mixture of Medicaid and private pay patients. Usually, the
actual caregivers have no idea, nor do they care, which is which. Every facility must
abide by both state and Federal standards of care. It is against the law to provide
substandard care. In addition, every state has an Ombudsman program available to
patients and their families to investigate such problems. The more involved the family,
the better the care of the patient.
Don't you have to be broke to get on Medicaid?
Yes, but the question is: "How did you get there?" We can get you there AND STILL
protect thousands of dollars for your family, charity or whoever.
Is this legal?
Absolutely! In doing our planning, we are using the Federal and state Medicaid rules,
which allow for certain strategies, exactly as they are written. Our trained, experienced
legal and financial experts know how to use the rules to your advantage, and do not try
to get around them. When asked this question, we often compare "Medicaid Planning"
to "Tax Planning."
What is asset "spend-down"?
Spend-down is the process of exhausting all countable, available assets to the $2,000
Medicaid resource requirement or below. If an individual has a spouse, there is an
additional amount allowed, as well as certain other assets that the spouse is allowed to
keep (home, one car, etc.). USUALLY, Medicaid workers will inform you only that the
excess assets (resources) must be spent on medical care or burial. RARELY, if ever, do
they inform applicants and spouses that there are other exempt purchases that can be
made. NEVER will they tell you that gifting (transferring to children or grandchildren) is
part of the spend-down process.
Once in a nursing home, doesn't Medicaid require you to 'spend down' all your
money on care before you can get on Medicaid?
That is what Medicaid would like you to believe. You have to be technically broke before
you can qualify for Medicaid, but Medicaid does not require that you spend your money
on anything in particular, including care.
Is this going to get me in trouble with the IRS?
Medicaid qualification has nothing to do with the IRS. If you're talking about taxes, of
course you'll need to abide by any applicable state or Federal tax rules. But remember,
gifts of assets do not normally result in gift tax until the total of non-exempt gifts exceeds
1.5 million dollars per individual (current limit), or 3 million for a couple.
Who gets the saved assets?
The assets can be transferred to any person (or persons) the patient desires, although
the children or other family members are usually the ones chosen. From Medicaid's
point of view, though, it does not matter who gets the assets.
How secure is the money?
The money is as secure as you want to make it. Since the money is typically transferred
to family members, it's their decision as to where the money is placed, or to what use it
is put. Although we do recommend that the transferred money be maintained, intact,
until after the death of the patient, that is a personal decision on the part of the family.
How long will it take to become eligible for Medicaid?
That depends entirely on the particular situation, which is impacted by such variables as
income, expenses, value of assets, etc., as well as the particular state in which the
patient resides. What we teach you, though, is how to use the Medicaid rules to get a
patient financially qualified as quickly as possible, while protecting as much of the
patient's assets as possible.
Is it a permanent solution?
Once a patient is financially qualified for Medicaid, unless they were to acquire
additional assets (for example, an inheritance, sale of property, or lottery winning) they
would normally remain financially qualified for the rest of their lives. There is a required
annual redetermination of eligibility process for all nursing home and home care
recipients.
Won't my Long-Term Care Insurance policy and income cover me in the event
of an extended nursing home stay?
In most cases, no. Long-term care insurance and income combined usually falls far
short of covering extended nursing home stays for the lower and middle classes. For
more information on how to choose a long-term care policy or to read reports on the
option, click on the links below:
http://www.elderlawanswers.com/elder_info/elder_article.asp?id=2595
http://www.kff.org/medicaid/7458.cfm
http://www.kff.org/uninsured/7459.cfm
Isn't it against the rules (fraudulent) to give away your assets for the purpose
of becoming qualified for Medicaid?
No. What is a violation of Medicaid rules is to dispose of assets, for whatever reason,
and then not disclose that fact at the time of Medicaid application. What we teach you is
the optimum structure and timing of transfers to maximize the portion of a patient's
assets that can be protected. Plus, since everything is legal and "above board", and
you can share, with the Medicaid worker, the details of everything you have done, there
is absolutely no need to hide anything.
What does everyone, including my attorney, say I can't give anything away?
Because 'everybody else' is not intimately familiar with the Medicaid rules, has not spent
years studying every detail of the Medicaid rules, nor has 'everybody else' worked for
the several years helping hundreds of families apply these exact strategies, designed
specifically for single and married long term care patients.
Can't I find out from the Medicaid office how to protect assets?
Since rules are in place to penalize those who transfer assets to certain individuals, the
answer if likely "no." Government agencies administering Medicaid services are not
interested in helping you learn how to save assets while qualifying for Medicaid.
Besides, Medicaid workers are not trained, nor are they allowed, to give financial or
legal advice.
My mother gave me $10,000 last year. Isn't she disqualified from Medicaid for
three years?
No! That's one of the common misconceptions. The "look back period" is not the same
thing as the "penalty period".
If there was a way to protect assets from Medicaid, wouldn't my attorney tell me
about it (which he has not)?
Most attorneys know little or nothing about asset protect as it pertains to Medicaid
qualification or the eligibility process. Of those who do, very few have the knowledge or
experience to put together an aggressive PLAN to maximize the protection of assets
while preparing a patient for Medicaid qualification. That is exactly what we have been
doing since 2002. With our experience and knowledge, we can work with your attorney,
if you prefer.
My parent (or parents) is in a nursing home. I am interested in saving as much
of my parent's money as possible for the grandchildren and their college
education. What choices do I have?
(1). Keep paying his bills and gamble that the parent dies before his/her/their money is
gone. (2). Let us create a strategy and implement a plan to transfer a large portion of
his remaining estate to his grandchildren, while eventually qualifying him for Medicaid.
Is there anything I can do where I would not lose control of handling my
parents' finances, per their wishes?
Right now you are in charge until the money is gone. With a PLAN, we can help you
retain that control, no matter how long the parent lives.
My parent lives with me and I'm still able to take care of him/her, but it's
obvious that his/her mind is deteriorating quickly. Is it too early to get started
on a plan, or should I wait until he/she is in a care facility?
Don't wait! The sooner you get started, particularly if care costs are currently relatively
low, the greater the portion of her estate that can be preserved.
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FREQUENTLY ASKED QUESTIONS