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Get the Facts on What it Will (and Will Not) Cover 


Wouldn’t it be great if Medicare were like an all-inclusive resort and whatever you needed was included? It’s probably not as fun to envision as cocktails poolside, but it’s still better than reality. In fact, what Medicare doesn’t cover may catch you by surprise, leaving you in a tough situation. 


While you can always cut back on cocktails that cost extra, you can’t forgo care you need, especially when it comes to critical services like long-term care. The best remedy is being in the know about what Medicare does and does not cover so you can plan now and be prepared. 



But First, a Clarification 


Before we dive in, it’s important to distinguish the difference between Medicare and Medicaid. While both programs involve government healthcare, they’re administered by different entities. Medicare falls under the purview of the federal government, while Medicaid is a joint program between the federal government and the states. It is possible to be eligible for both Medicare and Medicaid; this is called dual eligibility. Depending on your income, you may find Medicaid will pay your Medicare Part B premiums, or you could continue to receive full benefits. 


Speaking of Part B, let’s take a quick look at the Medicare alphabet soup. Your basic Medicare coverage, also called Original Medicare, consists of Part A and Part B. Part A provides hospital coverage. If you worked 10 years or more and paid Medicare taxes, Part A won’t cost you anything (aside from your deductible, coinsurance, and annual benefit caps).  


Part B covers services deemed medically necessary (like doctor office visits, wheelchairs, x-rays, and lab work). It also covers preventative services—like your annual flu shot—and disease screenings. Your income determines how much you’ll pay in premiums and there is a small deductible as well as coinsurance. 


If you want to receive hearing, vision, and dental benefits, you’ll need to purchase a Part C plan. These are offered by private companies approved by Medicare. Some Part C plans have prescription drug coverage, but if you purchase one that does not, it’s also available through Medicare Part D. 



So, What’s Missing? 


While that might sound fairly comprehensive, there’s one important service that’s not covered: long-term care. That’s a problem because long-term care has the greatest potential to throw a wrench in your retirement finances. 


Medicare will pay for the first 20 days in a skilled nursing facility, and days 21-100 with a co-pay of $185.50 per day. After that, you’re responsible for all costs. Ideally, you’d be rehabilitated and return home. But some patients are unable to return home because their condition is not expected to improve. Instead, they’ll need to move to a long-term care facility.  


In this situation, it’s important to talk to an elder care attorney as soon as possible. You may qualify for programs that could help with the cost of care, like Medicaid, PASSPORT, and VA Aid & Attendance benefits. An experienced elder care attorney can navigate the application process and help you avoid errors that could result in delays or denials. 



Planning Ahead 


While no one can know for sure whether they’ll need long-term care, you can take actions now to protect your hard-earned savings from the possibility. An elder care or estate planning attorney can help you examine which options may best fit your situation, including legal tools like trusts. One popular trust for protecting against the cost of long-term care is aptly named the asset protection trust. It’s important to note, however, that your assets must be in the trust for at least five years to be fully protected. That’s why it’s never too early to consult a trusted attorney to develop your plan. 


Now that we’ve taken the mystery out of Medicare coverage, let’s not take away all the fun. Feel free to resume your poolside cocktail daydream. And remember, should you need help demystifying Medicare and protecting yourself from long-term care costs, our caring attorneys are here to help. Get in touch anytime to set up a complimentary phone consultation. 

- AlerStallings

Not only is home care expensive, but it can be difficult to know where to begin when you need to set it up. Thankfully, we have resources to make the process easier and less expensive. Let’s take a look at what to consider. 


In-home care can be an attractive alternative to a long-term care facility if you’re eligible. The first step in making that determination is a Level of Care Assessment, which our team at AlerStallings can help you complete. Level of Care Assessments are a requirement for benefit programs that can help you pay for care. The assessment identifies your needs for care and assistance—physically, mentally, and in terms of daily living.  


When it comes to obtaining assistance with home care support, you have a couple options: Veterans Administration Aid & Attendance (A&A) benefits and PASSPORT (Medicaid). Both will help provide the care and comfort you desire but have some key differences. In this table, we’ve made it easy to compare the details: 



While the above table lays out the major details, it’s important to note that each program has its complexities. As such, it’s not a bad idea to enlist the help of an attorney. Errors or difficulty navigating the application requirements could make it harder to get the benefits you need in a timely fashion. For example, when applying for VA A&A, an incomplete or incorrect application can be delayed for months. 


Or in the case of PASSPORT, what many people don’t realize is that there is a five-year lookback period for gifts or transfers that begins at the date of your application. That means if you gave away assets or sold them for less than fair market value during that time period, it could render you ineligible for Medicaid. This underscores why it’s important to work with an attorney who understands eligibility requirements and can help you ensure you’ve dotted every “i” and crossed every “t.” 


It’s also important to note that in some cases, home care simply isn’t enough. We understand the desire to remain in the comfort of your own home, but we also know that it’s important to have a plan for when it’s no longer an option. This too is an important step to undertake with your attorney. Doing so now will provide you and your family with a clear path forward during a difficult time.  


At AlerStallings, we’ll be with you every step of the way. We’ll help you get the care you need, when you need it, and be ready to assist should your needs change down the line. Here, you don’t just have an attorney to solve the matter at hand; you have a relationship for life.