Medicaid Crisis Planning … versus Long-Term Care Insurance?

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Are you or a loved one faced with long-term care expenses in the immediate future? Is the cost of long-term care, nursing homes, assisted living, and home care getting to be too much?

If you or a loved one are facing long term care needs, then it is important that you speak to an attorney who specializes in Medicaid crisis planning as soon as possible. There is really no time to waste, as the sooner you consult with us and start your crisis plan, the sooner you may be eligible for Medicaid.

What is “Medicaid crisis planning”? Medicaid crisis planning is planning where your or a loved one are faced with catastrophic nursing home costs in the immediate future. Nursing home costs are currently

When we hear the word "crisis," we think of disasters or calamities of epic proportions. Well, that is where many Americans find themselves when they (or a family member) try to stay above water financially when dealing with the outrageous costs involved with senior care—especially when care facilities are involved.

Accordingly, “crisis planning” in this context is planning for those who have an imminent need for Medicaid eligibility. Nursing home costs in Virginia average $90,250 per year, with an average stay of up to five years. That is over $450,000! Many people are completely unprepared for such overwhelming costs. In a crisis planning situation, our goal is to help protect the “well spouse” from losing their life’s savings while qualifying the “sick spouse” for Medicaid assistance. Typically, even in crisis, we can protect up to 100% of the couple’s assets, and approximately 40-50% of a single person’s assets.

What if your husband or wife has been diagnosed with amyotrophic lateral sclerosis (ALS or "Lou Gehrig's Disease") ... or Parkinson's, Huntington's, or some form of dementia like Alzheimer's?

As your loved one needs long term care, you will need to discuss the Medicaid planning and application process with an experienced elder law attorney. An elder law attorney will have the necessary skills and contacts required to help you address the important issues, create a strategy, engage and direct the required healthcare staff, and work with you to get the Medicaid application approved by Virginia’s local Medicaid offices.

Does Medicare cover all of the nursing home bills?

Unfortunately, no.

Many people are under the impression that Medicare will cover all of the expenses for nursing home care.

That is not the case. The most Medicare will cover is the first 100 days of rehabilitative services following a three-night hospital stay (and you must be “admitted” to the hospital, not just “under observation”). Even during the first 100 days, Medicare will not cover 100% of the bill, but will co-insure with your Medicare Supplement, if any.

We have also heard people ask if Medicare is only for the poor. Of course, it is not. Medicare is the default health insurance for people 65-years old and older. Eligibility is not income-dependent, nor is it means-tested.

So Where Does Medicaid Come In?

For most people, Medicaid only becomes an option after Medicare benefits are exhausted. But what many people don’t realize is that Medicaid benefits are not automatic. In fact, to receive Medicaid, a patient and the patient's spouse (if married) must first "spend down" their "countable" assets. In Virginia, that limit is $2,000, but it gets a lot more complex for married couples. There are categories of assets that can be exempted with proper Medicaid “crisis” planning.

This gets complicated very quickly.

What is exempt? What is non-exempt? What do I do to protect assets? What do I do to convert assets without getting in trouble? Do I apply before or after we start getting care (and bills)?

These are all valid questions, and rather than attempting to answer them on your own with everything else that is swirling around you, you should seek professional advice from a qualified attorney who practices in Medicaid planning, understands the Medicaid system, and can help you get organized for the future. If you qualify, Medicaid benefits can help pay for various medical expenses, but most importantly:

  • Nursing home bills
  • Doctor and hospital Bills;
  • Prescriptions;
  • Very limited in-home care (in Virginia).

Medicaid rules are extremely complex, and crisis Medicaid planning should not be attempted without expert guidance. Once a Medicaid application has been filed improperly, the damage has been done. Call us first!

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