What benefits can I receive from Medicaid?
There are three types of Medicaid:
• Community Medicaid - for those under 65, they must apply on the NYS Health Plan Marketplace. Those over 65, must apply through their Local Department of Social Services. This coverage is for doctors and hospitals. This DOES NOT cover home care or nursing home. There is no resource review for this coverage.
• Community Medicaid with Long Term Care - this coverage is for individuals who are over 65 or disabled. Benefits include licensed home health care, adult day care, hospice, Medicaid Assisted Living Programs, Managed Long Term Care in the community, and the Consumer Directed Personal Assistance Program (CDPAP). There is a resource review of current resources only for this coverage. This type of Medicaid can also cover short term rehabilitation services of LESS THAN 29 days (one per every 12 months only).
• Nursing Home or Chronic Care Medicaid - this is coverage for those who are over 65 or disabled and in a nursing home for Long Term Care. Medicaid pays for nursing home coverage after Medicare and any other supplemental policy. There is a resource review, a five year look back period and transfer penalties apply.
How do I become eligible for Medicaid?
In order to be eligible for Community Medicaid with Long Term Care or Nursing Home Medicaid, the resources of the Applicant must be below $15,450 (2019). Resources include, bank accounts, stocks, bonds, CD’s, brokerage accounts and life insurance. Different rules apply for spousal cases, which must be reviewed individually.
Do I need a lawyer?
A lawyer is not needed to become eligible for Medicaid or to apply for Medicaid. We know the ways to protect your hard earned income and resources, without incurring the high fees of an attorney. We keep ourselves abreast of all new and changing Medicaid regulations. You should feel confident choosing us as we are trained by NYS in Medicaid regulations as well as experience as a head paralegal for a prominent elder law firm.
Does retirement money (i.e.; IRA, 401K, Retirement CDs etc) count as a resource?
Retirement funds are NOT counted as a resource as long a maximized monthly distribution is taken as income. This amount is different than the Required Minimum Distribution (RMD).
Does a home make me ineligible?
Your home is exempt as long as you, or your spouse, live in it. Medicaid can place a lien on your home if it remains in your name and you are a long term resident of a nursing home. Your home can be transferred to a spouse or a disabled child with no transfer penalty. A home can also be transferred to a caretaker child, if that child has lived in your home for two years or more.
Does Medicaid have income limits?
Yes. For individuals over 65 or disabled, the income level is $879 for 2019. For couples, the income level is $1,287 for 2019. Income is handled differently for Community Medicaid with Long Term Care and Nursing Home Medicaid. When living in the community, there is an excess income program. Any excess income (also called a surplus or overage) that exceeds the appropriate Medicaid levels, must either be paid to Medicaid monthly, or deposited to a Pooled Income Trust. When in a nursing home, your gross income, less any health insurance premiums, must be paid to the facility each month. The Nursing Home Medicaid recipient is only allowed $50 per month. Different income rules apply to spousal cases and these must be reviewed individually.
What is a Medicaid Pooled Income Trust?
This is a trust which allows the Medicaid recipient to shelter excess income from Medicaid. There are fees associated with starting and maintaining this trust. Fees are minimal and based on income. The funds in this trust may be spent on any NON medical expenses incurred by the person enrolled in the trust.
What is a pre-needs burial fund?
This is an irrevocable fund that is held through New York State. A Medicaid Applicant can pre-pay for a funeral in any amount through a funeral home.
What is the difference between Medicare Part A, Part B, Part C, and Part D?
Medicare part A covers hospital, skilled nursing home care, hospice and Certified Home Health Care (CHHA) services such as physical therapy when prescribed by a doctor. Most people who have worked enough quarters or were married to someone who worked enough quarters, will be automatically eligible for this when they turn 65. If you worked enough quarters, there is no cost for this coverage. Most people get this when they turn 65 or 2 years after they have been determined disabled by the Social Security Administration.
Part B Medicare is medical coverage. This covers medically necessary and preventive services, as well as Durable Medical Equipment (DME). There is a monthly fee for this benefit, which in 2014 is $104.90 per month. It is withheld directly from your Social Security Retirement or Disability check. If you are low income in NY, sometimes the state can help pay for this premium. You do have to apply for this assistance.
Part C is a Medicare Advantage Plan is supplementary to Part A and B. These plans can be purchased at any time, except when already in a nursing home. These plans can be purchased through private insurance companies such as AARP and State Farm.
Part D Medicare is prescription drug coverage. A Medicare Prescription Drug Plan (PDP) can significantly cut down costs. These plans can be purchased separately from Medicare, or through a Medicare Advantage Plan.
What is the difference between Medicaid and Medicare?
Medicare is the Federal health insurance program for those over 65 or are disabled. Medicaid is health insurance program available to those who qualify. There are income and resource restrictions and they vary from state to state.
Do I have to cancel my supplemental insurance? Do I lose my Medicare?
No, Medicare will always be your primary insurance coverage. Also, supplemental health insurance is an allowable deduction from your income when on Medicaid. A supplemental policy is beneficial and can help with skilled nursing costs, as well as be accepted by more doctors, and specialists.
This is just a few of the many questions that arise when a loved one needs assistance. Call today for clarification on all your questions, worries, and needs.
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