how can a medicare lawyer help with assisted living

An elder law attorney can devise a plan for a married couple to spend down their assets to qualify for long-term care Medicaid

but still retain enough resources for the healthy spouse to remain in their home and cover their costs of living. Read: Spousal Impoverishment: Medicaid Spend-Down Rules for Married Couples

Full Answer

Do I need an elder law attorney to plan for Medicaid?

If you decide that your situation warrants a lawyer’s help, be sure to look for a certified elder law attorney who has specific education and experience in the area of Medicaid planning for your state.

What does a Medicaid lawyer do?

A Medicaid lawyer will take all aspects of a senior’s personal and financial situation into consideration to determine when they should apply and whether additional steps must be taken to avoid disqualification for benefits. The financial Medicaid eligibility rules for married couples are different from those for unmarried applicants.

Does Medicare Part a cover assisted living?

While Medicare Part A helps cover the costs of skilled nursing care, Medicare does not typically cover assisted living care that focuses on custodial care.

What is an assisted living benefit from Medicaid?

This is a regular Medicaid benefit (an entitlement, meaning anyone who is eligible to receive services is able to do so) that pays for personal care and allows beneficiaries to receive that care in assisted living communities.

What are the benefits of assisted living?

Based on one’s state of residence and the specific Medicaid program in which one is enrolled, the benefits Medicaid will pay for vary. The following are typical services that are available for persons living in assisted living residences: 1 Personal Care Assistance (help with dressing, bathing, toileting and eating) 2 Homemaker Services (housecleaning, laundry, shopping for essentials such as groceries, and meal preparation) 3 Transportation 4 Case Management 5 Personal Emergency Response Systems

What is assisted living certified?

In addition to being a resident in the state in which one is applying for Medicaid, one must be residing in an assisted living facility that is licensed by the state and accepts Medicaid. These residences are often called “Medicaid certified”. Persons must also meet financial (income and assets) and functional requirements for the Medicaid program for which they are applying. The criteria below are specific to seniors who are aged 65 and over.

What is state medicaid?

State Medicaid, which is an entitlement program, provides a variety of health care benefits that are mandated by the federal government. For instance, all states are required to cover the cost of nursing home care for all state residents who meet the eligibility requirements. There are also optional benefits left to the discretion of each state. One such optional benefit is state plan personal care. Since anyone who meets the eligibility requirements for state Medicaid is guaranteed to receive benefits, if a state offers personal care assistance and a resident meets the criteria for eligibility, he/she will receive services. Stated clearly, there are never waitlists for state Medicaid plan benefits.

What are waivers for home care?

Waivers do this by providing care services and other benefits that aid independent living, such as personal emergency response systems, adult day care, respite care, home modifications, personal care assistance, home health aides, meal delivery, and housekeeping.

Is there a waiver for assisted living in Virginia?

Waivers may not be available statewide (unlike with the state Medicaid plan) and may target specific populations. For instance, Virginia used to offer assisted living services via a HCBS Medicaid Waiver, but only for persons with Alzheimer’s disease and related dementias. (This waiver has since expired and is not being renewed).

Does Medicaid cover assisted living?

Does Medicaid Pay for Assisted Living? Yes, Medicaid will help to cover the cost of assisted living including memory care (Alzheimer’s care units). To be clear, long-term care services, such as personal care and homemaker assistance, are covered by Medicaid for those who meet the eligibility requirements.

Is there a waitlist for Medicaid?

Stated clearly, there are never waitlists for state Medicaid plan benefits. States may also help cover the cost of assisted living services via a 1915 (k) Community First Choice (CFC) program, also a state plan option, made possible by the Affordable Care Act. Via CFC, home and community based services are offered, ...

What Assisted Living Costs Does Medicare Advantage Not Cover?

Despite the expanded coverage options available through Medicare Advantage plans, seniors cannot receive assisted living coverage through these plans. Room-and-board fees, activities fees and meals are not eligible for coverage under Medicare Advantage.

How much does assisted living cost?

Unfortunately, this type of senior care is costly. According to the Genworth Cost of Care Survey 2019, the average American pays $4,051 per month ...

How much does Medicare Advantage cost?

In 2019, the standard Part B premium was $135.50. Seniors with Medicare Advantage plans are also required to pay this monthly premium and may also have an additional monthly ...

How long does Medicare cover skilled nursing?

Following a qualifying inpatient hospital stay, Medicare covers a stay in a skilled nursing facility for up to 100 days, after which the patient is responsible for 100% of the costs. In some cases, skilled nursing services may be provided in an assisted living facility. In this instance, these services would be covered by Medicare Part A ...

Can assisted living facilities receive Medicare?

However, in instances in which an assisted living facility is considered a home, the facility could receive reimbursement from a resident’s Medicare Advantage plan for certain types of care, such as transportation services and personal care services.

Do Medicare Parts A and B have dental coverage?

While these plans are legally required to provide the same coverage as Original Medicare Parts A and B, many plans offer additional benefits like dental and vision coverage and non-medical in-home care services, making them an attractive option to many retirees.

Does assisted living have financial aid?

Some states offer financial aid programs for seniors in assisted living , but many do not, leaving seniors and their families with burdensome out-of-pocket expenses. For many seniors, a Medicare Advantage plan is a practical option for funding some services provided in assisted living. However, while many Medicare Advantage plans cover some senior ...

What can an attorney do for a nursing home?

An attorney can also help you and your loved one to understand the terms of the residential agreement, so that your loved one knows his or her rights and obligations, and knows what services the nursing home is agreeing to provide.

What are the rights of a nursing home resident?

Detailed list of the rights of nursing home residents, such as the right to see family members and friends; the right to keep personal belongings; and the confidentiality of medical records.

Is it hard to place a loved one in a nursing home?

Deciding to place a loved one in a nursing home can be a heart-wrenching choice. Making the final decision might be the hardest part of the process, but there are still many issues to face after the decision is made.

How much does assisted living cost?

The average monthly cost of assisted living is $4,300 nationwide, so it can be challenging to find the resources to pay for it. Seniors who have Medicare coverage may wonder if it will pay for any of the expenses of assisted living. Although assisted living isn’t covered under Medicare at this time, other resources are available to help seniors afford it.

How long does Medicare cover nursing home care?

Seniors with a disability or chronic health problem that requires around-the-clock care may qualify for Medicare nursing home coverage for up to 100 days. However, Medicare will only cover skilled nursing needs, and it isn’t available for assisted living facilities that provide help with the everyday activities of life.

Who Qualifies for Medicare?

Everyone who has paid Medicare taxes qualifies for Medicare health insurance coverage when they turn 65. Younger people with disabilities may also qualify, and people who have not paid Medicare taxes may be eligible to buy Medicare Part A coverage.

Can seniors get Medicaid for nursing home?

Seniors with low incomes and few assets may qualify for additional nursing home care through Medicaid. Initially, most seniors pay out of pocket for nursing home care until their resources run out. After that, Medicaid may eventually fill the gap, depending on each person’s income and assets.

Do seniors get Medicare Part A?

Medicare Part A is funded by taxes on income, and most people over 65 get this insurance at no cost. If a senior or their spouse has worked for a certain amount of time and paid taxes, they should be eligible. This coverage may start automatically for seniors already receiving Social Security payments. However, those who are not enrolled need to go to the Medicare enrollment site and sign up to receive benefits.

Does Medicare cover assisted living?

government for seniors age 65 and older and some younger people with disabilities. Although it doesn’t pay for assisted living, it covers medical expenses for seniors. Medicare is divided into sections that cover different areas of health care:

Can Medicare Part B be changed?

Medicare Part B, the insurance for doctors’ office visits, must be chosen during enrollment to avoid paying an extra penalty for adding it later. After the initial enrollment, Medicare coverage choices can be changed at certain times of the year without a penalty.

How often do you need assisted living?

Assisted living care services may only be needed once a day or once per week. Someone who is recovering from a medical condition or who is limited by a medical condition may not require 24-hour care, but they may need help doing things that are considered daily functions like bathing, cooking, cleaning, shopping or housework.

Why do seniors turn to alternative options?

Many seniors turn to alternative options when income restrictions prevent them from obtaining certain benefits. A number of religious organizations across the country offer financial assistance to individuals and families who are facing difficult choices regarding assisted living care.

What is skilled nursing?

A skilled nursing facility is usually a medical facility where the staff are medically trained professionals who specialize in different types of rehabilitative care. Assisted living, on the other hand, is care that is meant to help individuals live a life that is as close to independent as possible. Skilled nursing care is used for ...

Can you discuss your needs with an elder care professional?

If you’re concerned about the possibility of needing assisted living care in the future, or if you have a loved one who is currently in need of assisted living and has been unable to secure government assistance through healthcare programs, now would be a good idea to discuss your needs with an elder care legal professional. Doing so will help you to understand your legal rights and ensure that you or your loved one are receiving the right level of benefits in your state.

Does Medicaid pay for room and board?

Medicaid services do not pay for room and board directly for people needing care in an assisted living facility, but some states may provide funds to supplement coverage for room and board.

Can you get assisted living outside of the home?

Many people who receive Medicaid also face medical challenges that require assisted living care. In some cases, this care can be administered at home, but when someone is in need of around-the-clock care, assisted living outside of the home may be recommended in order to maintain health, monitor conditions during convalescence, and provide comfort for individuals facing end-of-life decisions.

Does Medicare cover assisted living?

While Medicare Part A helps cover the costs of skilled nursing care, Medicare does not typically cover assisted living care that focuses on custodial care. Custodial care is assistance with the activities of daily living, which can include dressing, bathing, eating, cleaning, and more.

What is long term care insurance?

Long-term care insurance: These policies cover expenses associated with an extended stay in an assisted living community, skilled nursing facility, or home care. While these policies are expensive, they could pay for themselves quickly if you need long-term care services. A new type of hybrid policy combines long-term care insurance with annuities or life insurance.

Does Medicare cover long term disability?

Although the insurance provides a broad range of care, it doesn’t cover everything .

Does Medicare pay for skilled nursing?

Medicare will also pay for any conditions that develop during a stay at a skilled nursing facility. An example of this would be an infection that occurs during rehab from surgery.

What does a Medicaid lawyer do?

A Medicaid lawyer will take all aspects of a senior’s personal and financial situation into consideration to determine when they should apply and whether additional steps must be taken to avoid disqualification for benefits.

What is a good lawyer for Medicaid?

A good lawyer will devise a personalized Medicaid planning strategy that enables an applicant to retain as much of their wealth as possible for current and future needs while ensuring they will qualify for the long-term care services they require.

What is a personal care agreement?

In some instances, a personal care agreement is a great way for a senior to compensate their family caregiver (s) while legally spending down to meet Medicaid asset and income limits. The ways in which bank accounts and even real estate are titled can help or hurt an applicant’s Medicaid eligibility as well. Attorneys are well-versed in these and many other legal, medical and financial factors that determine if and when a senior’s application is approved.

What is elder law?

Elder law attorneys specialize in helping older adults with long-term care planning, estate planning and government benefits. Those with experience in Medicaid planning understand each state’s rules and regulations and help families by identifying comprehensive strategies to legally obtain and maintain eligibility for public benefits.

Can you reorganize assets for Medicaid?

It may also be possible for an applicant to reorganize their assets and income in ways that help them continue living in the community for as long as possible but also ensure they will qualify for long-term care Medicaid when they need it. Applicants can retain ownership of certain types and amounts of assets while still maintaining their eligibility for benefits.

Can you avoid a penalty period for Medicaid?

In some cases, there are exceptions that can help applicants avoid a Medicaid penalty period. In other situations, applicants who have made disqualifying transfers during the look-back period may be better off delaying their Medicaid application.

Can an elder law attorney help with Medicaid?

Note that it is not illegal for someone other than an attorney to assist you with the application, as long as you request them to do so. That being said, not all attorneys are knowledgeable about this very narrow area of specialization. Medicaid programs differ so much between states that most Medicaid attorneys are only familiar with the rules and regulations in the state (s) where they are licensed to practice law. If you decide that your situation warrants a lawyer’s help, be sure to look for a certified elder law attorney who has specific education and experience in the area of Medicaid planning for your state.

Why is assisted living changing?

Since many families pay for assisted living from their savings, they are in a state of continuously diminishing resources. Most assistance programs determine eligibility based on an individual’s resources. Therefore, the assistance available to an individual is constantly changing. In other words, the longer a person resides (or is projected to reside) in assisted living, the more assistance options that become available to them.

What is financial planning for assisted living?

The creation of a financial plan for assisted living is a complicated process and one that must accommodate various health scenarios. Fortunately, there are a variety of different resources available to help families with financial planning for assisted living and each of the resources has its pros and cons.

What are the benefits of life insurance?

Life Insurance Benefits and Conversions 1 Life settlements are an option in which a policyholder sells their right to collect the death benefit from their policy and they stop making monthly premium payments in exchange for an immediate lump sum of cash. 2 Viatical settlements are similar to life settlements but are designed for terminally ill individuals. Typically, viatical settlements fetch a higher buyout for the policy than a life settlement. 3 Accelerated death benefits are an option that enables terminally ill individuals to receive a portion of their death benefits in advance of their death. 4 Death benefits loans are loans taken against the cash value of the policy, not the death benefit. These must be re-paid or the death benefit will be reduced. 5 Life insurance conversions directly convert the value of a policy in exchange for care. For example, an individual with a $100,000 policy may exchange that for several years in an assisted living or senior living community. Of these five options, it is likely life insurance policyholders will receive the greatest value for their policy using this approach.

What is a regular Medicaid benefit?

This is a regular Medicaid benefit (an entitlement, meaning anyone who is eligible to receive services is able to do so) that pays for personal care and allows beneficiaries to receive that care in assisted living communities.

How long are assisted living loans good for?

Assisted living loans are designed for short term financial gaps typically for periods of less than 2 years. They are ideal when families have unexpected assisted living costs and are waiting for other resources to become available. For example, if an individual is moving into assisted living and is waiting for a home to sell and they are uncertain how long that process will take, a loan is a very good option. Another example is when a veteran has applied for the Aid & Attendance benefit. The approval process can be lengthy but once approved, the benefits are paid retroactively to their application date in a lump sum. The lump sum is then used to pay off the assisted living loan. Read a detailed analysis of the costs and benefits of assisted living loans here.

How many assisted living residents are satisfied?

93% of assisted living residents are satisfied with their overall quality of life, their level of independence and the level of personal attention they receive from staff.

How much is assisted living for veterans in 2021?

As of 2021, this program can provide assistance up to $1,936 / month for a single veteran and up to $2,295 / month for a married veteran. However, eligibility is complicated and there can be extensive wait times ...