Medicare - Simms Law Firm

Few decisions are more difficult than the one to place a spouse or parent in a nursing home. Most families try to care for a loved one at home for as long as possible, only accepting the inevitable when no other alternative is available.

The placement decision can be less difficult if, to the extent possible, all family members are included in the process, including the senior, if he or she is able to participate.

I recommend the following steps as you begin this process.

Try to have a family meeting, either with the family alone or with medical and social work staff. If you cannot meet in person, use the telephone or e-mail.
Research all options. Look at-home care, daycare, respite care, assisted living and skilled nursing.
Consider using an Elder Law attorney and a geriatric care manager to help with placement and cost decisions. Try using a senior placement service such as Assisted Living Made Simple in Florida– they know how to “match” the senior with the care facility.

These steps won’t make the decision easy, but they can help make it less difficult.

Call the Law Offices of Debra G. Simms at 386.256.4882 to learn more.

This blog post is not case-specific and is provided only for educational purposes and is not intended to provide specific legal advice. Blog topics may or may not be updated and entries may be out-of-date at the time you view them.

NURSING HOME MYTHS AND REALITIES

Many of my clients are worried about long-term costs if they ever need a nursing home. Most do not have any type of long-term care insurance.

These clients typically ask: Will the nursing take my house? Or they say: I don’t want to give all my hard-earned money to a nursing home!

What they are really asking me is how to get on Medicaid! Medicaid is the government assistance program that pays for long-term care. It is meant for folks with low income and few assets.

But… the Medicaid rules are complicated and there are ways to become eligible and keep many of your assets. For example, in Florida, your primary residence does NOT count as an asset when computing eligibility. There are many other types of assets that do not count as well. And if your income is too high, there is a type of income Trust you can create and still become eligible for Medicaid.

However, there is another reality here. Not all facilities accept Medicaid. And you are not likely to get your own room in a Medicaid facility. Further, you will not be able to use your own doctors. For health care, Medicaid patients must be in a managed care plan. And not all treatments and therapies are paid for by Medicaid.

So, no, you don’t need to give your house to the state, but Medicaid is a needs-based program and doesn’t have all the bells and whistles you might want.

Do you have questions or need help with planning for your future?

Call the Law Offices of Debra G. Simms at 386.256.4882 to learn more.

Although the names sound similar, Medicaid and Medicare are very different government programs. Medicare is an “entitlement” health insurance program which makes health insurance available to all individuals over the age of 65 who have paid their Medicare taxes. It is also available to younger disabled persons who have a work history and have paid their Medicare taxes.

Medicaid is a “need-based” program which helps individuals with Long-term Care. Medicaid is available to those who can show a medical need for long-term care and who have limited financial resources.

It is important to understand that Medicare does not cover care in an Assisted Living Facility and covers care in a skilled nursing facility up to 100 days of residency. There are co-pay requirements after the first 20 days, but supplemental insurance can be purchased to cover deductibles and co-pays. Home care can be covered by Medicare, but only if ordered by a physician.

Medicaid provides very limited coverage for home health care and all Medicaid medical and financial requirements must be met.

Another difference between the two programs is that Medicare is administered totally by the federal government. Medicaid is a joint program between the federal government and the state. In Florida, the program is administered by the Florida Department of Children and Families in conjunction with the Florida Department of Elder Affairs. A Florida Bar Board Certified Elder Law Attorney can assist you in understanding the complex rules which apply to Medicaid eligibility.

Questions? The Law Office of Debra Simms is here to help. Call us today 386.256.4882

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