Medicaid & Benefit Planning

Medicare and Medicaid are very different programs. Medicare is a program for providing health services to individuals over age 65, regardless of income. Medicaid is a program which provides health benefits to individuals who are not able to afford them based on their income.

Medicare and private health insurance have limits on what they will pay for long term care. Such services can be very expensive, and families with moderate income and assets may find themselves facing the possibility of exhausting all of their resources so that a loved one may receive the care he or she needs. For people who qualify financially, Medicaid will be available to pay these expenses.

If the individual who needs care is a veteran, the availability of certain benefits under the Veterans’ Administration should be investigated. In some cases, the spouse of a veteran may also be eligible for benefits.

When you apply for Medicaid for yourself or your spouse, social services will request five years of financial records, including income tax returns, bank and brokerage statements, insurance policies, and real estate records. They will scrutinize these records to look for “hidden assets”, and transfers that may have not been for full value. A transfer of assets for less than full value (including gifts to children) could disqualify the individual from receiving benefits for a period of time.

Medicaid rules are complicated but they exist to provide access to appropriate care for those who need it and have limited financial resources. Medicaid Planning ensures that all of the rules are followed to the benefit of the person who needs care and his or her family. Proper planning and management with an attorney who understands the rules can ensure that the person qualifies at the earliest possible time and is eligible for a suitable quality of care. Proper planning can also help preserve property, and secure the maximum allowable assets for the spouse who remains at home.

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