Medicaid planning is essential to help fill in important gaps in Medicare that can arise. Many seniors mistakenly believe that when they turn 65 and qualify for Medicare, they will be able to get all of the medical help they need covered. Unfortunately, this is not actually the case. While Medicare Part A and B pay for hospital coverage and doctors visits, patients still have a responsibility to pay for a part of the cost of their care. Medicare pays for 80 percent of covered services, so seniors end up having to pay- sometimes thousands of dollars- for the treatment they need.
Not only does Medicare require patients to pay a part of the cost of treatment, but there is also a “donut hole” in the prescription drug coverage provided by Medicare Part D. Finally, and perhaps most importantly, the biggest Medicare gap relates to Medicare coverage for nursing home care.
Seniors need to be aware of all of these substantial gaps in coverage and need to make plans to ensure that they do not end up losing all of the money they have saved because they have a medical issue or because they have to go into a nursing home. Medicaid planning with the help of experienced professionals can help to ensure that seniors are able to get the care they need without spending down their personal assets.
Mark S. Eghrari & Associates PLLC provides invaluable assistance with Medicaid planning. The sooner you start, the sooner you can ensure your plan protects the maximum assets, so give our Smithtown attorneys a call today for help.
Medicare Gaps Can Affect a Patient’s Financial Security
Seniors need to understand all of the different things that Medicare does not cover.
Medicare Part D provides prescription coverage. However, there is a coverage gap, which is commonly called the “donut hole.” This gap exists because there is a temporary limit on Medicare coverage for prescription medications.
In 2016, once $3,310 has been spent on covered drugs, the patient falls into the gap. When you are in the coverage cap, you’ll pay 45 percent of the plan’s cost to purchase covered brand-name prescription drugs and 58 percent of the price for generic drugs. Although you pay just 45 percent of the actual cost, 95 percent of the cost of the drugs counts towards out-of-pocket expenditures.
Medicare also does not generally provide coverage for nursing home care. Medicare.gov explains that Part A, Hospital Insurance, covers care in a certified Skilled Nursing Facility (SNF) only under limited circumstances. This type of care is covered when you require skilled nursing care, such as changing sterile dressings after a surgical procedure. There is no coverage when the only care required is custodial care, such as getting help with dressing or bathing. If you only need basic care and aren’t getting skilled nursing help for a specific medical issue, Medicare will not pay for a nursing home.
Medicare also does not cover the cost routine dental care, eyeglasses, or hearing aids, and it only pays for 80 percent of covered series so seniors still have to pay when they go to the hospital or the doctor. While seniors can get supplementary medical insurance policies to pick up some or all of their share of the cost for medical services, it is generally not possible to get private health insurance to pay for nursing home care. Long-term care insurance policies are available, but are separate from health insurance and are often prohibitively expensive.
Because of the high costs of nursing home care, most seniors want to ensure they have planned ahead in case they need to go into a skilled nursing facility. Medicaid planning involves strategically structuring the ownership of assets so you can qualify for Medicaid without having to spend down your nest egg first. You can create a special type of trust and transfer assets into it so the assets in the trust do not count when an assessment is made of whether you qualify for means-tested Medicaid benefits.
The process of Medicaid planning needs to begin early, because Medicaid will impose a period of disqualification if you transfer assets within five years of the time you need nursing home care.
How a Smithtown Medicaid Planning Lawyer Can Help
A Smithtown Medicaid planning lawyer at Mark S. Eghrari and Associates PLLC can provide you with the help you need to deal with Medicare coverage gaps without facing financial loss. Give us a call at (631) 265-0599 or contact us online to learn more about how an experienced lawyer can help you.