Medicare Coverage Everyone over age 65; Up to 100 days of skilled - - PDF document

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Medicare Coverage

• Everyone over age 65;
• Up to 100 days of skilled nursing following a 3-day

hospital stay;

• “Admitted” vs. “Under Observation”
• For a medical condition either:
• Hospital related, or
• Which began while in skilled nursing care due to a hospital-related

condition

Examples “Admitted for Care” vs. “Admitted for Observation”

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Medicaid Eligibility

(largest single payer of long term care)

 Medicaid is a federal/ state partnership  Administered by states on federal regulations  In Virginia, by the Department of Medical Assistance

Services (“DMAS”)

 Eligibility is based on financial/ medical need  Qualified individuals may receive nursing home care,

limited alternatives, e.g. personal services, home health services…

Medicaid Eligibility (cont’d.)

 Supplemental Security Income

SSI = Eligibility

 Resource Test Less than $2000 of “countable” assets, (including your spouse’s assets)  Income Test Some percentage of the federal poverty level

(Medicaid) Resource Test

Before applying, may ask for a “Resource Assessment

 List all assets  Assets will be categorized as “countable” or “non-countable”  Spousal share determined (the part the spouse gets to keep)

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Resource Test (cont’d.) Assets “Countable” vs. “Non-countable” Assets with a meaningful possibility of being converted into cash are “countable.”

“Non-Countable Assets”*

 Home and contiguous property with equity up to

$552,000 for a married couple;

 Personal furniture and effects;  One vehicle, regardless of value;  Burial plots or arrangements and up to $1500 each

for final disposition; and

 Some insurance policies.

* (a/ k/ a “Exempt Resources”)

5-Year Lookback

There are stiff penalties for “uncompensated transfers” affecting Medicaid eligibility.

CAUTION

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(Medicaid) Income Test

 Income below 80% of the federal poverty level

 Countable Income greater than the SSI benefit

($733/ mo.)*, but less than 80% of FPL ($792/ mo.)*  “Medically needy” applicants

 Countable income greater than 80% FPL, but below

their medical need (or)

 Less than 300% of monthly SSI benefit ($2199 meets

income test)

 More than $2199/ mo. will require a spend-down *2016 figures

Income Test (cont’d.)

“Countable” vs. “Non-countable” income Everything is countable unless it is expressly excluded.

Examples:

 SSI payments  Tax refund payments  LTC policy payments  Refer to Medicaid Manual for additional exclusions

Planning to establish or maintain eligibility

 Financial planning

 Annuities  Long term care insurance  Some life insurance policies

 Legal planning

 Special Needs Trust (SNT)  Irrevocable Trust  Permissible property transfers

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CYA

THIS PRESENTATION IS OFFERED FOR EDUCATIONAL AND ENTERTAINMENT PURPOSES ONLY, AND IS NOT A SUBSTITUTE FOR COMPETENT PROFESSIONAL ADVICE

Planning to protect the home

 Do not sell or transfer until/ unless Medicaid

eligibility has been established

 If title to the home is in an LLC or RLT, tranfer to

individual owner(s)

 Life insurance is exempt from Medicaid lookback

Aging in place

 Medicare may cover:

 Intermittent skilled nursing care  Physical therapy  Speech/ language pathology  Occupational therapy

BUT NOT

 24-hr daycare at home  Meals delivered to your home  Personal care/ homemaker services

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Medicaid Waivers for Home and Community Based Services

 Adult day healthcare  Assistive technology  Companion services  Personal assistance services  Respite care  Environmental modifications  Assisted living (only Alzheimer’s assisted living

waiver)

Private Pay

 Health Insurance (very limited)  Long term care insurance  And life insurance benefits may be used  BUT this is very plan-specific

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Lelia Winget-Hernandez, Esq. Michael Winget-Hernandez, Esq.

Winget-Hernandez, P.C. 5570 Richmond Road, Suite 201 Troy, Virginia 22974 (434) 589-2958 lelia@winget-hernandez.com Also by appointment at Lake Anna: Commonwealth Life & Legacy Counsel, PLLC 200 Boardwalk Way, Suite B Mineral, Virginia 23117