Medicare and Medicaid Planning

When preparing for a loved one to enter a skilled nursing facility, there are likely many concerns you and your family have, one of the most is the cost. Many facilities cost upwards of $10,000 a month–something that you may wonder–will Medicare cover that?

Long-term care planning can be stressful which is why it is imperative that you and your family meet with a skilled elder law attorney who focuses on Medicare and Medicaid planning. The Scranton elder law attorneys of Mazzoni Karam Petorak & Valvano understand how confusing and simply time-consuming this process can be. We will work with you to ensure the needs of your loved one are met while also protecting his or her assets into the future.

Understanding Medicare and Medicaid Planning in Pennsylvania

Many of us aren’t sure what the difference is between Medicare and Medicaid until we have to use them. But understanding what each does, and does not do, is critical to your long-term care planning.

Medicare is the federal health insurance program for:

  • Americans who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease

Depending on what you need Medicare for, will determine the plans you select. For example,

  • Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Part D helps cover the cost of prescription drugs.

However, the misconception is that Medicare covers it all; in reality, Medicare only covers a portion of many elder care expenses, which leaves many Pennsylvania residents depending on Medicaid for extensive stays in nursing facilities or services.

Medicaid is a federal and state funding health insurance program that covers many eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

Often, when Medicare doesn’t cover a cost, elderly adults will look to their Medicaid coverage to see what options exist for them. However, this is complicated as there are numerous deadlines, eligibility requirements, and hoops you must be aware of.

Medicare won’t cover nursing home expenses. What can I do?

Though many older Americans depend on their Medicare coverage for most of their healthcare needs, the reality is Medicare only covers a very minimal amount of coverage for patients in nursing homes.

In addition, very few elderly Pennsylvanias have long-term care insurance to cover the costs Medicare won’t. In these cases, you or your family are left paying for the care yourself until assets have been used and you can apply for Medicaid.

In general, to be eligible for Medicaid, you cannot have financial resources more than $2,400. This includes cash, stocks and bonds, bank accounts, IRA, and real estate.

In addition, if you have transferred any assets to family or friends within five years of applying for Medicaid, your eligibility may be impacted.

But dwindling your assets can be risky. What do you have?

Protecting Your Assets from Medicaid

Just because the eligibility requirements may make it seem that you have to have no assets and zero income, it doesn’t mean there are not ways to protect yourself from financial ruin.

The number one way to protect your estate from the financial ruin Medicaid eligibility may create is through an asset protection trust. While trusts can also be part of that five-year lookback period for Medicaid eligibility, when done correctly, an asset protection trust in the form of a Medicaid Trust (Income Only Trust) can avoid it.

What is the Medicaid Trust (Income Only Trust)?

A Medicaid trust is an irrevocable trust used for the purpose of having assets in place should the individual need skilled nursing care in the future. The restrictions built into a Medicaid trust work to prevent assets from disqualifying the individual from medical assistance.

Be mindful, not every attorney is knowledgeable in elder law and the intricacies of Medicaid asset protection which is why you need a skilled elder law attorney to guide you through the Medicare and Medicaid process.

Protect Your Future with Mazzoni Karam Petorak & Valvano – Medicaid Planning & Medicare

When a loved one needs skilled nursing care, your first concern is likely how it will get paid for. If you are in need of an elder law attorney, don’t delay. Call (570) 348-0776 and schedule an appointment with Mazzoni Karam Petorak & Valvano. We can walk you through the Medicare and Medicaid process, help you create asset protection plans, and get your loved one the care he or she needs.

Put your trust in a law firm that puts your best interests first. We offer a free case evaluation to all potential clients.

Practice Areas

Back to Top