June 2, 2011
As an estate planning and elder care lawyer in Sacramento, I’m often asked what is the difference between Medicare and Medicaid and how can you best prepare for long-term care.
For starters, Medicare provides coverage to people over the age of 65, and is similar to regular health insurance. Medicare is also a federal program, which means benefits and requirements are universal for all states.
To qualify for Medicare in a nursing home or skilled nursing facility, an individual must have been hospitalized for at least 3 days and 3 nights before transferring to a nursing or rehabilitative facility, and the move must be made within 30 days of the hospital stay.
To break it down further, I often say that Medicare pays for an acute occurrence and the rehabilitation from it.
It’s certainly not intended for custodial care or long-term care, and that’s why the patient must demonstrate a true need for skilled care or in-home care with the prospect of recovery before Medicare will pick up the tab.
If qualified, Medicare will then cover a total of 100 days, with the first 20 days paid in full and the next 80 days with a co-pay of $124 per day.
Medi-Cal (Medicaid), on the other hand, is a state-administered federal program that does cover long-term care for those in financial need. But just as wills and trusts in Sacramento are subject to the specifics of state law, so must certain criteria be met to be eligible for benefits.
In nearly all states, the patient would need to spend down his/her assets to around $2,000 to qualify. Some assets may be exempt up to a pre-determined value such as your house and car, but this again depends on the state.
And of course any subsequent income the patient gets, including social security, would get spent first before Medi-Cal picks up the tab for long-term care.
However, it’s important to keep in mind that even if you can qualify, not all facilities are Medi-Cal approved, and those that are usually have long-waiting lists.
That’s why it’s best to explore all of your options with the hospital social worker prior to being discharged if you need further care. It’s important to realize that because social workers have large case loads, it is unlikely that they will be able to provide the detailed guidance you desire and you may feel pushed into making a decision before you are ready.
Although we don’t want to think we will ever need nursing home care, a single event such as a broken hip or stroke can land us there. Take a pro-active approach and speak with knowledgeable placement specialist before the need for nursing care ever arises. A placement specialist will educate you about the various types of facilities and provide you with information about area facilities. Then you can check some out ahead of time when you are more relaxed.
It’s also wise to talk with an experienced Sacramento elder lawyer if you are concerned about losing everything you’ve worked so hard for just to qualify for Medi-Cal coverage.
At the Chubb Law Firm, we work with families every day to implement asset protection strategies designed to preserve your assets and inheritance without jeopardizing the ability to qualify for Medi-Cal. If you would like to know more about these options, we invite you to give our office a call at (916) 241-9661 and ask about our Peace of Mind Planning Sessions.