If you have an elderly loved one who is living on a fixed income, and also has regular monthly medical expenses, those expenses may be adding up quickly. If your loved one is lucky enough to have private healthcare coverage, then he or she is better off than many elderly Americans. Unfortunately, many of America’s elderly struggle with both the rising cost of healthcare and the increased need for medical services as a result of the natural aging process. Two government programs–Medicaid (called Medi-Cal in California) and Medicare– are potentially available to help with those costs.

Although there are a number of differences between the Medicaid (Medi-Cal) and Medicare programs, understanding the more important differences will help you get a better idea if either program might be able to assist your loved one.

Both programs are federally funded; however, Medicaid (Medi-Cal) is administered by the states which means that there may be slightly different eligibility criteria and benefits among the states. Medicare requires a monthly participation payment for some of its coverage. Medicaid (Medi-Cal) does not require the payment of any premiums or participation fees, but co-payments may be required for specific services.

Medicaid (Medi-Cal) is income and asset based whereas anyone over the age of 65 (and some disabled individuals under 65) may participate in Medicare. Medicaid (Medi-Cal) covers more services than the Medicare program, but getting approved is more difficult due to the strict income and asset eligibility guidelines. If your loved one has income or assets that you are concerned may prevent approval for the Medicaid program, there may be alternatives. Talk to your estate planning attorney about ways to structure his or her estate that will fit into the income and asset guidelines.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.

It can be heart wrenching to decide if a family member or friend you love can no longer safely live in their own home.  It can be scary for that loved one to think about his or her care needs and possible new living environments.  If you have concerns about a loved one , consider the following questions when determining care needs.  If you need help, consult with an experienced and qualified estate and elder care attorney.

• Does your loved one have medical needs that require special attention?

• Is your loved one unable to prepare meals?

• Does your loved one forget to purchase new food?

• Does your loved one have safety concerns?

• Is your loved one afraid to live alone?

• Does your loved one constantly have medical emergencies that require attention?

• Would your loved one benefit from a more organized daily schedule?

• Is your loved one constantly forgetting to take medication?

• Does your loved one frequently fall or slip in his or her home?

• Does your loved one forget how to handle simple tasks?

• Is your loved one afraid to ask for assistance?

• Is your loved one unable to handle household responsibilities such as cleaning?

• Does your loved one crave socialization and group activities?

• Has your loved one forgotten about important financial affairs?

• Does you loved one neglect his or her personal hygiene?

• Are you afraid that your loved one will have a medical emergency when no one is around?

• Are you and your family members unable to offer full-time supervision?

If you find yourself agreeing with several of the questions above, your loved one may need the supportive care of a care facility such as assisted living or a  nursing home.  If you have questions about your loved one’s care needs or if you need help choosing the place for the bestr care, consult with an experienced and  qualified elder care attorney.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.

Paying for long term care is a scary thing for most families. In California, the costs of a semi-private room (one roommate) is about $78,000 and a private room is approximately $91,000. Double these numbers if spouses or partners need care at the same time and there are additional expenses as well.

How to Pay for Long Term Care

1. Private Pay
2. Long Term Care Insurance
3. Veterans Benefits
4. Medicare
5. Medi-Cal

Private Pay

Some folks can self insure because they can afford to private pay; however, this isn’t usually the case and often those with larger estates will also purchase long term care insurance so preserve their estate.

Consult with a qualified and experienced estate and elder care planning attorney to plan for the possibility of nursing home in the future.

Long Term Care Insurance

Most folks find that all the premiums they pay for long term care insurance are recouped in the first few months of care. In many policies the insurance premiums are tax deductible and you get to choose how much coverage you wish to purchase.

Policies vary widely in terms of types of coverages (in-home, institutional, both), payment levels (which are typically a stated daily benefit), duration (from months to lifetime), and other criteria.

An experienced and qualified elder care attorney can assist in evaluating the types and amounts of coverage available.

Veterans Benefits

Veterans benefits are available for certain veterans and their families where the veteran has a service-related injury.  Other veteranas benefits are available to pay for long term care if you or your spouse served in the U.S. military during designated wartime periods and are financially needy.

Medicare

Medicare, which is the health insurance program for most Americans over age 65, has only a limited long term care benefit.  It is commonly triggered by a discharge into the nursing home from a hospital stay.  It’ primary purpose must be for rehabilitation and it maxes out at 100 days in most circumstances.

For persons with terminal illnesses, there is also a hospice benefit available through Medicare.

Medi-Cal

Medi-Cal pays for long term care if you are both medically and financially needy. With careful planning, carefully tailored legal documents and the assistance of an experienced and qualified elder care attorney, individuals can qualify for Medi-Cal benefits long before they exhaust all of their finances.

Get Qualified Legal Counsel

If you are age 50 or older (or are age 40 or older and have a family history of early onset dementia) consult with a qualified Elder Law attorney to add long term care planning to your estate plan.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.

As we pointed out in the first part of this article, at a certain point in most people’s lives, they become concerned about paying for long term care.

There are 5 basic ways to pay for long term care.  We discussed private pay, long term care insurance and Medicare in part one.  Now, we turn to Medi-Cal and Veterans Aid and Attendance.

Medi-Cal

Medi-Cal is a form of public assistance for families who meet specified income and asset requirements.  Eigible Californians use Medi-Cal to pay for long term care in a nursing home because they don’t have the personal resources and either can’t qualify for or can’t afford long term care insurance.

Elder Law attorneys help people qualify for and apply for Medi-Cal benefits.  With the guidance of a qualified, experienced elder law attorney,  many assets can be protected; you don’t have to lose them all to the nursing home.

Veterans Benefits

Veterans Aid and Attendence may be available to pay for long term care if you or your spouse is a Veteran who served for the United States military during designated war time periods and are financially and medically needy.

Veterans Aid and Attendance pays for long term care in assisted living, board and care and in a nursing home.  It’s in addition to any pension you may receive.  There is also a benefit available through the VA for persons who are homebound.

Long term care benefits are also available to certain veterans who have a significant service-related disability

Elder law attorneys who have been accredited by the VA can help veterans and their surviving spouses to qualify for veterans benefits. Attorney Tim Murphy is VA accredited.

If you have any questions about paying for long term care, consult with a qualified, experienced elder law attorney.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.

At a certain point in most people’s lives, they become concerned about paying for long term care.  There are 5 basic ways to pay for long term care:

1.  Private Pay

2.  Long Term Care Insurance

3.  Medicare

4.  Medi-Cal

5.  Veterans Benefits

Not all of these methods will be available to all persons.  For example, veterans benefits are limited to only certain veterans.  Long term care insurance may not be available for persons with certain pre-existing conditions.

Private Pay

If you have savings and investments, you can pay for long term care yourself.  Your social security check will pay part of the monthly fee, but because the average nursing home cost in California exceeds $82,000 per year, most people can’t afford to make these payments. The costs in some facilities can exceed $100,000.

You can private pay for care at home, in assisted living, or a nursing home.

Long Term Care Insurance

Like all insurances, you must purchase long term care insurance before you need it.  It is frequently recommended to  begin shopping for long term care insurance when you’re about age 50 or younger, if early onset dementia runs in your family.

The cost of long term care insurance will depend upon your age, health, and the coverage you choose, but it’s likely at least $1,000 to $2,000 per year.

Long term care insurance pays for care at home, in assisted living, or a nursing home.  Certain elder law attorneys work with insurance professionals who specialize in long term care products.  Ask your elder law attorney for a referral.

Medicare

Many people mistakenly believe that the Medicare program will provide considerable assistance in paying for long term care.  However, sadly, it just isn’t so.  Medicare primarily provides some assistance with long term care costs in two limited situations: rehabilitiation and hospice.

To trigger the available rehab benefit, one must typically enter the nursing home directly following discharge from an acute care hospital.  The maximum benefit is 100 days of coverage per spell.  But it could terminate sooner should the patient fail to continue to improve.

The hospice benefit is triggered by a physician’s determination that, due to a fatal condition, the patient is not expected to live six months.  The purpose of the program is to provide palliative care while one is dying.

In 5 Ways to Pay for Long Term Care (Part 2 of 2); we’ll discuss using Medi-Cal and Veterans Aid and Attendance to pay for long term care.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.

Many people are confused about the differences between Medicare and Medi-Cal. While these programs may sound similar, they are in fact two distinct and different programs.

Medicare is an entitlement program that is funded by the federal government. It does not depend on one’s assets or income. Benefits are earned by virtue of payments made into this program over one’s working lifetime. When one retires from the workforce at age 65 or so, or earlier due to a disability, Medicare coverage begins. Medicare coverage is often not complete coverage and many services require co-payments. Many seniors supplement their basic coverage by joining Medicare HMOs or purchasing supplemental insurance commonly called Medi-Gap coverage.

There are several parts to Medicare. Part A covers hospital bills, Part B covers doctor visits and other outpatient services, while Part D covers prescriptions.

Medi-Cal is different from Medicare in several important ways. It is a needs-based program, funded by the federal and California state government. It is known as Medicaid in other states.  To qualify, one must typically meet both asset and income requirements.

Medi-Cal is a program that many seniors rely on to help with the payment of the costs of nursing home care.  Currently in California, the average cost of nursing home care is over $6,800 per month. Unlike Medicare that pays, if at all, for only a limited number of days in a nursing home for rehabilitative care (up to a maximum of 100 days), Medi-Cal can pay for custodial care for someone in a skilled nursing facility for an unlimited time period.

Since there are strict eligibility requirements to qualify for Medi-Cal benefits, for many persons needing this care, it is important to work with an experienced, qualified elder law attorney to prevent an unnecessary denial of benefits.

Northern California Estate Planning Counselors, LLP is a member of the American Academy of Estate Planning Attorneys.