If you are a senior who is facing the prospect of a stay in long-term care, you are likely worried about how you will pay for the cost of that care. After all, long-term care (LTC) is costly. Moreover, you will not likely be able to depend on your basic health insurance coverage nor on Medicare to help with those costs. The good news is that Medicaid may be able to help; however, you must first qualify for benefits. If you are unfamiliar with the Medicaid program, now is the time to learn more. Specifically, you need to learn how to qualify for Medicaid as a senior in order to ensure that help will be available to defray the high cost of LTC.
Why Will I Need to Qualify for Medicaid?
Across the country, long-term care costs are high; however, in the State of New York they are considerably higher than average. The average monthly cost of LTC in the State of New York is just over $12,000 – and expected to increase in the years to come. Unless you purchased a separate LTC policy or a rider to your basic health insurance policy, don’t expect any help from your health insurance provider. Medicare won’t cover your LTC costs either expect under very limited circumstances – and even then only for a short period of time. Without another alternative, that leaves you paying out of pocket for your LTC costs. The average person cannot afford to pay a $12,000 a month healthcare bill. This is why you may need to qualify for Medicaid.
What Are the Medicaid Eligibility Requirements for a Senior?
The two most important eligibility factors for Medicaid are your income and the value of your “countable resources” because Medicaid imposes a limit on both for eligibility purposes. The income limit is tied to the Federal Poverty Level (FPL). The FPL, in turn, is dependent on where you live and will change each year. As a senior on a fixed income, however, the income requirements may not be a problem for you. The “countable resources” limit is where most seniors run into a problem if they failed to plan ahead because the limit is extremely low.
Your “countable resources” are essentially all assets that are not specifically exempt by Medicaid. Assets that Medicaid does exempt in New York include:
- family residence, in some instances
- irrevocable pre-paid burial expenses
- personal and household property
- one automobile
- any life insurance policies with a face value of less than $1,500.
If you worked hard, saved prudently, and invested wisely, it is easy to see how your countable resources would exceed Medicaid’s eligibility limit. Before you start transferring assets out of your name in an effort to reduce the value of your countable resources, you need to know about the five-year look-back period imposed by Medicaid. In essence, Medicaid will review your finances for the five-year period prior to your application date. Any asset transfers for less than fair market value will be discounted and the value of the assets added back into your countable resources.
What Happens If My Countable Resources Exceed the Limit?
If the value of your countable resources exceeds the program limit, Medicaid will impose a waiting period during which time you will be expected to “spend-down” your assets. In effect, this means you are expected to sell assets to pay for your LTC costs during the waiting period. The length of the waiting period will depend on the value of your assets and the average monthly cost of LTC in your area.
Is There Anything I Can Do to Help Me Qualify for Medicaid If I Failed to Plan Ahead?
Before you resign yourself to the loss of assets, consult with an experienced New York Medicaid planning attorney. There may be some last-minute Medicaid planning strategies you can use to protect some of your assets. For example, you might be able to convert a non-exempt asset into an exempt asset.
Contact Us
If you have questions or concerns about how to qualify for Medicaid as a senior, contact an experienced Medicaid planning attorney at the Law Offices of Kobrick & Moccia by calling 800-295-1917 to schedule your appointment.
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