Why is it important to know the difference between Medicare and Medicaid?

This article discusses the difference between Medicare vs Medicaid medical insurance in long-term custodial care, also known as nursing home care, in Michigan. It is important to understand these distinctions as they can significantly impact an individual's ability to access the health coverage needed for necessary medical treatments. Medicare health insurance only covers up to 100 days in a skilled nursing facility.  Most people will need the assistance that Medicaid coverage provides.

This article is not intended to provide legal advice.  It is for general informational purposes only.

Summary

• Long-term care prices in Michigan are increasing more than the national trend, which means that someone just using Medicare might not be able to afford the treatments they need while in the facility. 

• Medicare part A only covers up to 100 days in a skilled nursing facility, and any services provided...

With PACE, teams of health care professionals focus on the unique needs and circumstances of participants, and their families, to make sure participants receive the coordinated care they need.

The Program of All-Inclusive Care for the Elderly (PACE) is a program that helps seniors meet their health care needs at home & in their community as an alternative to a nursing home or other care facility.

SERVICES

With PACE, an individualized plan of care is developed and maintained by a team of health care and service professionals to meet specific needs. These services include all Medicare and Medicaid-covered services and may include, but are not limited to:

• Primary and Specialist Care (including Women's Health)
• Medications
• Medical Transportation
• Therapy (Occupational, Physical, Speech)
• Recreational Day Center Activities
• Home Care
• Hospital & Emergency Services
• Dental
• Vision
• Hearing
• Foot Care
• Nursing Home
• End of Life Supportive Care

In Michigan, the areas serviced by PACE...

Individuals seeking to obtain Long-Term Care services outside of a nursing home must navigate a different set of Medicaid eligibility rules, depending on the type of services required.

One of the primary goals expressed by our clients is to remain in their own homes or at least in the most independent setting possible.

Navigating the maze of community care requires an in-depth knowledge of the services available in the home, and in adult homes and assisted living facilities, and an ability to manage income and resources to maximize their value, while utilizing Medicaid services wherever available to supplement the care provided by the individual and their family. Learn more about elderly care here.

Community-based Medicaid services are available through the MI Choice Waiver. Generally, however, Medicaid does not pay for adult home or assisted living care, which under existing rules must be paid for privately.

In order to access community-based...

For the final topic in our series on Medicaid qualification rules, we'll be looking at important information in regard to spousal protections. As with part six of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s always a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere. To start at the beginning of our series, click here. 

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Spousal Protections

The spouses of nursing home residents are provided certain protections under Medicaid law. Here is a brief overview:

• Snapshot of Couple’s Assets – With married applicants, Medicaid takes a “snapshot” of the couple’s assets when the ill spouse enters a hospital or long term care facility for at least a 30-day stay.
• Community Spouse Resource...

What Are the Rules for Medicaid Qualification (Part 6)? - Some Simple Planning Options

Below are possible options to keep in mind when considering Medicaid planning. As in part five of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s always a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere.

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• If you are married, your home is exempt and cannot be taken if one spouse applies for Medicaid. If you are single or widowed, up to $636,000 of equity in your home is exempt (many states have raised the limit even higher). Some states permit a “Homestead Exemption” which protects a married or single applicant’s home regardless of value. Transferring your home to your children will result in immediate ineligibility for...

Today we'll be taking a brief look at some aspects of long-term care. For more detailed information, it’s best to consult with a qualified legal advisor. So think of this as an introduction.

There are many complexities to long-term care planning, it’s important to understand that there are options, and programs intended to help families like yours. Long-term care planning is the best way to ensure you protect as much of your hard-earned assets as the law allows, and to receive the care you need.

Let’s Get Started…

What About Private Long-Term Care Insurance?

Most Americans will not be able to self-insure for Long-Term Care.  Therefore, based upon the current condition of health care, long-term care and Medicaid, if you are insurable and long-term care insurance premiums are affordable, such a policy should be integrated into your estate plan to provide protection without the need for transferring assets. 

Long-term care (LTC) insurance has...

Today we'll be taking a brief look at some aspects of long-term care. For more detailed information, it’s best to consult with a qualified legal advisor. So think of this as an introduction.

There are many complexities to long-term care planning, it’s important to understand that there are options, and programs intended to help families like yours. Long-term care planning is the best way to ensure you protect as much of your hard-earned assets as the law allows, and to receive the care you need.

Let’s Get Started…

What About Paying Your Own Long-Term Care Expenses?

A. Self – Insuring

“Self-insuring,” or paying your own way, may be an option.  However, you can expect to pay approximately $88,000 per year for base nursing home care, and more for better facilities (in Southeast Michigan, generally closer to $100,000/year). Home care can be even more expensive, with 24/7 care costing in excess of $150,000 - $200,000 per year....

What Should I Do to Plan For Long-Term Care? - See Part 1

A properly drafted “income-only” trust that gives a Trustee no discretion to distribute principal to the Grantor-Beneficiary, or to his or her spouse, is still a viable long-term care planning tool.

Therefore, a senior doing estate planning may keep the income from an irrevocable, “income only” trust for himself or herself, with the remainder distributable to specific beneficiaries, and qualify for Medicaid (once the applicable “penalty period” has expired) without the assets in the trust being considered by the Department of Human Services as available to pay for the cost of long-term care.

If the home is the only asset to protect, a deed which transfers the property upon death to your trust or your children, will protect the property and the right to Medicaid.  Consideration must also be given to the fact that if the property is sold and the grantor is in the...

What can be done to plan for long-term care, ensure that a health crisis or chronic illness will not erode an individual's security and dignity, and provide for family and loved ones?

As you may have already gathered, the answer is not simple. A careful analysis of each individual's personal and financial situation must be done to formulate the proper plan. Factors such as income from social security, pensions and investments; the nature and value of assets; age and health; family situation; and other considerations must be evaluated in order to make the right choices.

If long-term care insurance is not an option, and personal income and resources are not sufficient, one planning technique is to transfer assets into an “Asset Protection” Trust, retaining the income for the “Grantor” and preserving the principal of the assets (the assets held by the Trustee) for spouses, children or other beneficiaries. When properly drafted, the trust will provide ...

MEDICARE AND MEDICAID...

The Facts...

Eligibility

Medicare is a health-care benefit provided by the federal government to individuals over age 65, or under age 65 and disabled. Medicare covers doctor visits, tests and care provided in a hospital   and limited benefits in a nursing home (see below). 

Medicaid is a health-care benefit provided by the federal government for people under certain asset and income limits.  With nursing home care costs between $70,000 - $100,000/year, even people that consider themselves relatively comfortable financially may eventually need this important benefit. If your income or assets exceed the qualifying limits, you will not be eligible, but with proper planning, you can be. There is no age restriction to qualify.

Qualification

To qualify for Medicare, you must be over 65, and eligible for Social Security benefits. You may also qualify if you are under age 65 and disabled...