In today’s world, seniors have a variety of options in choosing a residence for their retirement years.
Many retirees choose to remain at home with supplemental care. Accessing in home or community services through the department of aging, private companies or the Veterans Administration often involves a complicated application process. Also, funding these services through insurance, government benefits or a reverse mortgage can present complicated legal issues, for which an attorney can provide important advice.
If a senior chooses to move to a senior apartment complex, an assisted living facility or a continuing care retirement community, he or she must review and sign complicated contracts, which will impact both his or her finances and the management of his or her health care. An attorney can provide valuable advice in understanding these agreements and ensuring the rights of the client/senior/retiree are protected.
In the event an elderly person requires long-term care in a nursing home, the resident and his or her family must navigate the admission process, including the admission contract and satisfying health and financial eligibility requirements. An elder law attorney can work with family members to minimize financial liability and ensure the nursing home resident receives appropriate care.
Many seniors are familiar with Medicare, which is the government health insurance program for individuals over the age of 65 or individuals who under age 65 but determined to be disabled for purposes of receiving Social Security disability income.
Medicare Part A provides coverage for inpatient hospital care. Medicare Part B provides coverage for physician’s services and outpatient care. Medicare Parts A and B only cover skilled care and do not provide coverage for custodial care, such as that received in a long-term care facility or nursing home.
Medicare Part C, also known as Medicare Advantage or Medicare + Choice, provides coverage for services not covered under Part A or B, through enrollment in an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PSO (Provider Sponsored Organization) Religious Fraternal Benefit Society Plan, or Private Fee-for-Service Plan. Medicare Part D provides enrollees with assistance in paying for prescription drugs.
Although Medicare generally is available to all U.S. citizens over the age of 65, as well as the disabled, it is important that seniors select coverage that is appropriate for their individual needs. In addition, Medicare coverage should be coordinated with a retiree’s coverage under a former employer’s group health insurance plan or an individual Medigap/Supplemental health insurance plan. An attorney can provide valuable advice in selecting the appropriate insurance program/coverage and direction for accessing benefits under these programs.
Medicaid is the federal program (administered through the Medical Assistance program in Maryland) that provides benefits to assist in paying for long-term care in a nursing center. To qualify for Medicaid, an individual must satisfy strict requirements pertaining to income, health and assets. Satisfying these requirements can be even more difficult in cases in which one spouse requires nursing home care while the other spouse remains in the community (“the community spouse”).
Maryland allows income eligibility as long as the nursing home resident’s monthly income is less than the nursing home bill. The nursing home resident will be required to apply his or her monthly income toward the payment of the nursing home bill, but in some cases a spouse will be permitted to retain a portion of the resident spouse’s income. Medical eligibility is based upon an evaluation of the resident’s medical needs, including the ability to perform activities of daily living, such as ambulation, feeding, bathing, and dressing.
Requirements relating to assets are much more complex. An individual is limited to Twenty-Five Hundred Dollars ($2,500.00), with exemptions for a primary residence and a pre-paid funeral. The value of the assets, which the community spouse is permitted to keep, is based upon the application of a complex formula applied to a snapshot of the couple’s assets on the first day of the month in which the spouse entered the nursing facility.
In submitting an application for Medical Assistance benefits, the nursing home resident must provide the State with a number of supporting documents, including award letters from payers of income, health insurance cards and premium notices, funeral arrangements, tax returns, and statements for bank accounts, brokerage accounts, whole life insurance policies, annuities, stocks, bonds and other investments for the previous five years.
Upon reviewing this information, the State may impose a penalty, which will disqualify the nursing home resident from receiving benefits, for any gifts the resident made during the previous five years. Exemptions from the penalty are available for certain transfers, so it is important to seek advice from an attorney to determine whether a nursing home resident is eligible for Medicaid benefits, as well as what assets can be preserved for other family members.