People either take care of the elderly in their families or outsource the care to third parties. Either way, the costs associated with this care can be paid out of pocket, by long-term care insurance, Medicare or Florida Medicaid. Which source of payment a family uses depends on whether there is a long-term care policy in place, whether there was a recent medical expense covered by Medicare and whether the elderly person qualifies for Medicaid.
Activities of Daily Living
As people get older, they are more likely to need assistance with the following activities of daily living: bathing, dressing, eating, transferring from a bed to a seat and back again, toileting defined as the ability to get on and off the toilet and continence. When an elderly person is unable to perform at least two of these activities of daily living, then they may qualify for long-term care coverage via one of three methods, either Medicaid, Medicare or long-term care insurance.
Using Medicaid for Long-Term Care
Medicaid is a government program that helps with medical costs for people with low income and resources. In Florida, Medicaid pays for long-term care in a variety of settings, including nursing homes, assisted living facilities, and adult day care centers. To be eligible for Medicaid long-term care, the recipient must meet certain income and asset requirements. Recipients must also be residents of Florida and have a need for long-term care.
The income and asset requirements for Medicaid long-term care vary depending on marital status and the type of care needed. For example, if a person is single and applying for Medicaid to pay for nursing home care, that person cannot have more than $2,000 in assets. If married and applying for Medicaid to pay for nursing home care, a recipient cannot have more than $2,000 in assets.
Although a primary residence and car under a certain value is permitted, the State of Florida reserves the right to recover those items after the death of the Medicaid recipient in compensation for the cost of long-term care covered by the state.
If someone meets the income and asset requirements, that person may still be eligible for Medicaid long-term care if they spend down their assets. “Spending-down” is the amount of money a person must spend on medical costs out of their own pocket before they become eligible for Medicaid. The amount of the spend-down varies depending on a person’s income and assets.
If eligible for Medicaid’s long-term care program, an application needs to be submitted. Applicants can apply online, by mail or in person at a Florida Medicaid office. Once an application is submitted, the applicant will be interviewed by a Medicaid worker. The worker will review the application and determine if the applicant is eligible for the program.
“The income and asset requirements for Medicaid long-term care vary depending on marital status and the type of care needed.”
Once approved for Medicaid long-term care, the person will receive a letter from the Florida Agency for Health Care Administration (AHCA). The letter will explain the amount of money the recipient will be allowed to spend on long-term care each month. It will also explain the types of long-term care services that are covered by Medicaid.
Using Medicare to Pay of Long Term Care Expenses
Medicare can cover long-term care expenses in specific situations, such as:
- Skilled nursing care in a nursing home or rehabilitation facility.
- Home health care, such as help with bathing, dressing, and eating.
- Hospice care for people who are terminally ill.
However, Medicare has many limitations when it comes to long-term care coverage. For example, Medicare only covers skilled nursing care for a limited number of days. And, Medicare does not cover custodial care, which is care that is not medically necessary, such as help with bathing, dressing, and eating.
Here are some of the limitations of Medicare when it comes to long-term care coverage:
- Medicare only covers skilled nursing care for a limited number of days.
- Medicare does not cover custodial care, which is care that is not medically necessary, such as help with bathing, dressing, and eating.
- Medicare does not cover long-term care in a nursing home or assisted living facility unless you are also receiving skilled nursing care.
- Medicare does not cover home health care if you are able to get the care you need from a family member or friend.
Using Long-Term Care Insurance
Long-term care insurance is a type of insurance that helps pay for long-term care, such as nursing home care, assisted living, or home health care. It can help cover the costs of care if the insured person becomes unable to perform at least two activities of daily living.
To qualify for long-term care insurance, an applicant typically needs to be at least 50 years old and in good health. Applicants may also need to pass a medical exam and answer questions about their health history.
The cost of long-term care insurance varies depending on a number of factors, including age, health, and the type of coverage chosen. Premiums are typically higher for people who are older, have health problems or choose a more comprehensive policy.
When considering long-term care insurance, it’s important to shop around and compare policies from different companies. Applicants can make sure they understand the terms and conditions of the policy before you buy it.
Here are some of the benefits of long-term care insurance:
- It can help pay for long-term care if needed.
- It can protect assets from being depleted by long-term care costs.
- It can give the insured and their family peace of mind knowing that they’ll be able to afford the care needed if the insured is unable to care for his or her self.
- It can sometimes pay a death benefit to beneficiaries similar to a life insurance policy.
Here are some of the drawbacks of long-term care insurance:
- The premium can be expensive.
- It may not cover all long-term care costs.
- Applicants may not qualify for coverage if they have health problems.
- The policy may have exclusions or limitations.
If someone is considering long-term care insurance, it’s important to weigh the benefits and drawbacks carefully to decide if it’s the right solution to pay for long-term care costs.
Qualifying for Medicaid with Losing all Your Assets
Your property and other valuable assets form an important part of what you pass on to loved ones. At the same time, Medicaid presents the opportunity to save significant amounts in long-term care costs but it can also present a threat to your assets if it is not planned correctly. We assist in planning for Medicaid coverage later in life including assistance with completing Medicaid applications and restructuring assets to protect your family home from the Medicaid Estate Recovery Program.
The attorneys of South Florida Law, PLLC have the experience and resources to handle complex estate planning and Medicaid planning matters in the following areas:
- Management of cases through probate
- Drafting of official Wills and formation of Trusts
- Matters related to creditor access
- Medicaid application preparation
- Appealing unsuccessful Medicaid applications
- Avoiding losing your home due to the Medicaid Estate Recovery Program
If you are in the process of applying for Medicaid in Florida and have assets and income to protect contact us today for a consultation by calling (954) 900-8885 or reach out via our contact form.