Contact UsA Look At The Differences Between Medicare and Medicaid (Medi-Cal)
Wills and trusts lawyers in Menlo Park frequently get inquiries about arrangements for long-term care. Life expectancy continues to rise, due in part to more effective treatments for diseases previously thought to be terminal.
This is great news, but with a larger elderly population new dilemmas arise, including uncertainties related to assisted and rehab care facilities. Two of the most frequently asked questions are, “How do I pay for short-term and long-term care?” and “What is the difference between Medicare and Medicaid and what can each offer me?”
Medicare and Medicaid both pay for certain aspects of rehabilitation after a hospital stay, but there are specific requirements that must be met. A knowledgeable wills and trusts lawyer can give you the exact stipulations and explain the difference between Medicare and Medicaid provisions.
In general terms, Medicare provides coverage to people over the age of 65, and is similar to regular health insurance. Since Medicare is a federal program, benefits and requirements are universal for all states. 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. In a sense, Medicare pays for an acute occurrence and the rehabilitation from it. Since Medicare coverage is not intended for custodial care or long-term care, the patient must demonstrate a need for skilled care, in-home or in a care facility, and show that progress is being made toward recovery. If qualified, Medicare will cover a total of 100 days, the first 20 days paid in full and the next 80 days with a co-pay of $124 per day.
On the other hand, Medicaid (Medi-Cal in California) is a state-run entity intended for those in financial need with different rules and qualifiers which vary from state to state. Just as wills and trusts 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 two thousand dollars, although some states exempt certain assets – such as your house and car – up to a predetermined value. Any subsequent income the patient gets, including social security, goes first to paying for long-term care.
Unlike Medicare, Medicaid does offer custodial care, but not all facilities are Medicaid approved. Due to the small percentage of nursing homes which offer Medicaid approved housing, and possible waiting lists, it is best to explore all options with the hospital social worker prior to the patient being discharged. Anecdotally, Medicaid approved nursing homes are crowded, so it would be wise to check out a number of facilities in person ahead of time.
Wills and trusts lawyers in Menlo Park will be the first to tell you that investigating and understanding your options, and implementing preparations before a crisis occurs, is the prudent course of action to take.
We work with families every day to explore such options and also help families implement the best asset protection strategies to preserve the things they’ve worked so hard for without jeopardizing the ability to qualify for Medicaid. If you would like to know these options, we invite you to give our office a call at (650) 422-3313 and ask about our Legacy Planning Sessions.
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