Today we’re going to talk about something that confuses most people: the difference between Medicare and Medicaid.

They sound similar, right? Well, unfortunately many people fail to realize the differences between the two, which makes for big problems in the future. Surprisingly, most people think Medicare will “care” for them forever. Unfortunately, that’s not the case.

When a friend of mine began his career as an elder law attorney, he was surprised at how few people knew the truth about Medicare and nursing home benefits. In fact, his own mother asked him one day, “Why are you focusing in the area of Medicare and Medicaid? There can’t be any money to be made helping people with those issues.” His mother is a very bright person, but even she did not understand the limitations of Medicare and what it would and would not pay for if you need to live in a nursing home.

Medicare and Medicaid sound similar, but are totally different programs. And for ANY senior, it’s vital to know the difference. Your future depends on it!

Medicare provides healthcare benefits for the over 65, blind, and disabled; while Medicaid provides medical benefits for the impoverished.

Medicare is primarily a type of public health insurance for those age 65 and older. In essence, it is their primary health insurance coverage. Many seniors are unaware that Medicare does not pay for long term care – it’s excluded! The confusion is easy to understand, because Medicare does pay for rehabilitation. So, if a senior citizen is enrolled in the traditional Medicare plan and is hospitalized for a stay of at least three days, and is then admitted into a skilled nursing facility, Medicare may pay – for a while. But once those Medicare benefits hit 100 consecutive days, you’ve hit the maximum.

And while we’re being frank, Medicare may not even cover you for the full 100 days – it’s based on the patient’s response to the rehabilitation. There must be some actual improvement, otherwise Medicare will decide that the condition is a long term care need and they’ll cut you off. Medicare really only cares about you if you can get better. Since diseases like Alzheimer’s and Parkinson’s have no known cure today, rehabilitation is not possible – and Medicare isn’t going to pay for nursing home care for you if you have Alzheimer’s or Parkinson’s or a similar disease.

Unlike Medicare, few of us have any experience in dealing with Medicaid rules and guidelines. Medicaid is paid for by both federal and state funds but is “administered” on a state level. That means the federal government covers between 50-80% of the program costs within the state, and the state pays the rest. Therefore, rules can vary from state to state (even county to county) rather dramatically.

EVERY reader of this report should understand the differences between Medicare and Medicaid. The information below is designed to contrast the two programs:

***Medicare***
-Health insurance for seniors age 65+
-Federally controlled, uniform application across the country
-Pays for no more than 100 days of nursing home care
-Pays for primary hospital care and related medically necessary services
-Must have contributed to Medicare system to be eligible and generally be over age 65

***Medicaid***
-Needs-based health care program
-Controlled state by state, which created different regulations in each state of application
-Pays for long term care
-Pays for medications
-Must meet income and asset limits to be eligible and be over 65, disabled, or blind

So, as you can see, Medicare is health insurance, and Medicaid is public long term care coverage – but often there are stages in between that require examination and discussion. Don’t get caught off guard by the surprising differences in these two programs. The people in charge don’t seem to be able to keep it simple.

To learn more about your options, call us at (913) 338-5713. You need to be informed about your particular situation – and whether you’ll need to put in place some honest, legal strategies to protect your hard-earned assets and keep you safe for the future. Call to speak to one of my expert (and friendly) intake personnel to see if you need to take steps to safeguard your savings.

If you have a loved one in a nursing home, or about to go into a nursing home, the thought of paying $5,000 to $9,000 per month or more can be utterly terrifying. Many folks find that their life savings is drained in a matter of months. That’s where the Medicaid program can help.

Medicaid pays nursing home costs for certain “qualified individuals,” once a person has run out of money and out of other options. The federal government provides a grant to each state to cover approximately 50-80% of the program costs within the state; the state pays the rest. And as we all know, both the federal government and our state are upside down and spending more than they take in, so one of the places that they always try to cut is in the area of Medicaid. After all, it’s easy to make cuts to Medicaid because rich folks do not consider it a “necessary benefit.” Unfortunately, for most senior citizens and their families, it is very necessary.

The truth is that Medicaid covers 50% of the nursing home expenses in this country, because few families can afford to pay thousands per month for nursing home care.

Medicare does not cover most nursing home expenses, so Medicaid fills the void.

The Medicaid rules are a lot more complicated than the tax laws – and there are very few advisors who know the rules. When you calculate your income taxes, you probably hire someone who knows where to find the deductions – because as we all know, the tax rules are filled with both potholes and pots of gold. When you send your tax return in, the IRS does not call you on the phone and say, “Hello, I was looking over your return and I noticed that you could have saved money by taking a deduction.” The truth is that only a tax expert knows how to keep your taxes as low as possible. Similarly my law practice is focused on estate planning, Medicaid, VA benefits, and disability laws. We know the rules for keeping our clients from spending more money than necessary when applying for Medicaid nursing home benefits. We help you avoid those potholes, so you can keep more gold.

Don’t make BIG MONEY Medicaid mistakes! In this special report, you will learn how to avoid some of the common traps that cause big money losses.

BIG MONEY MISTAKE NUMBER ONE: Don’t let a nursing home social worker or the state Medicaid department complete your Medicaid application. The Medicaid rules are even more complicated and less understood than the tax rules. People need a trained guide who has experience with qualifying clients for Medicaid while at the same time, saving more money for the families. Quite frankly, those who need to qualify for Medicaid are at the mercy of the state government. It’s not uncommon in my practice to have families come to see me after they have been to see the Medicaid Agency to quickly fill out a Medicaid application. They know that when you don’t know the rules AND you quickly fill out a Medicaid application, then you wind up spending most of your money on long term care before you ever qualify for Medicaid benefits.

BIG MONEY MISTAKE NUMBER TWO: Someone may have told you, “It’s too late to do anything, because there is now a five-year look-back penalty!” That is technically right. Everybody seems to know that there’s a five-year audit by the state Medicaid department of every one of your financial documents, whenever you apply for Medicaid. And those same people who know about this rule assume that there’s nothing that you can do to help the family to save money if you’re within five years of applying for Medicaid. But ask those folks, “How many Medicaid applications have you ever completed?” The answer is usually… ZERO! You need help from an elder law firm that knows the Medicaid rules and works every day to represent clients who apply for Medicaid.

That’s right – often the people giving bad Medicaid advice include well-meaning lawyers, accountants, nursing home staff, and even the Medicaid case workers themselves. But the hidden truth is this: A good elder law attorney has learned the state, federal, and even the county rules governing Medicaid. He or she will then apply the specific facts of your own family situation to the Medicaid rules and figure out what options you may have. That’s what we do.

Every month, people hire my firm to help them. We deal with the State so they don’t have to. We show them sound legal solutions that help them protect more of their money. Don’t get me wrong, we cannot promise you a rose garden, but we can show you how our legal services will save you money. And if they won’t, we’ll tell you that too. That’s because our services are designed to save you money, not cost you. You will be far better off when we guide you.

BIG MONEY MISTAKE NUMBER 3: Dealing with the State can be frightening and intimidating. It’s important that you let an elder law attorney take that worry away from you and help you make your life better today. Let us sit down with the Medicaid department so that you don’t have to. We know the rules and the right answers. We tell the truth and we never hide anything! If we give you money-saving advice, we highlight our advice when we talk to the Medicaid caseworkers. To schedule a no-obligation phone consultation, please call us now at (913) 338-5713. Or, to learn more about the strategies that may help you, take a look at my Action Guide in my Alzheimer’s Resource Center at http://alzheimersresourcekit.com/hammond/pdf/alzheimers_legal_survival_guide.pdf.

The cost of Alzheimer’s care has been rising rapidly for the past 10 years… and it shows no sign of stopping. Not only that, the percentage of seniors with Alzheimer’s is on the climb. An epidemic of Alzheimer’s disease is upon us, as Baby Boomers have begun to hit age 65 in 2010. Between 2010 and 2050, the number of people with Alzheimer’s is expected to jump from 5.5 million to 14 million.

In a study by The Lewin Group, it was revealed that within 10 years, Medicare’s costs of treating Alzheimer’s patients will soar well above 49.3 billion dollars. There’s a similar outlook on the spending in the Medicaid department… but the important thing for seniors to know is which of these is going to pay for your loved one’s care.

The fact of the matter is, Medicare only cares about your loved one if they’re going to get better. If they suffer a heart attack or a stroke, and rehab can help, they’ll continue to pay… but only up to 100 days. In reality, very few people know the difference between Medicare and Medicaid. Medicare simply doesn’t pay for long-term, chronic care. If your loved one has Alzheimer’s, that means that they’ll have to rely on Medicaid if they are out of money to pay privately for care.

According to the Alzheimer’s Association, “Most people who get Alzheimer’s and related dementias are Medicare beneficiaries. Even though Medicare does not pay for what they need most — long term care and prescription drugs, it spends a lot on their basic health care. Alzheimer-related health care costs are not limited to those with the disease. Caregivers—one-third of whom are Medicare beneficiaries themselves—have more health problems than others their age.

Medicaid expenditures for people with Alzheimer’s disease are high because of the uninsured cost of long-term care. Nearly half of Medicare beneficiaries with Alzheimer’s disease also qualify for Medicaid, because they have exhausted their own resources paying for long term care. At least half of all nursing home residents have dementia. They are the residents with the longest stays and the ones most likely to spend down to Medicaid.”

As we continue on with these blog posts, you’re going to discover what protections you may be able to use so that even if your loved one does need to rely on Medicaid to pay for their care, you’ll still be able to give them the quality of life they’re accustomed to. When someone is on Medicaid, they often can only keep about $2000 in savings and $30 per month… just $1 a day. What can you buy for $1 a day? It’s not enough to pay for the basic essentials your loved one will need when they enter a nursing home, let alone to provide for those little extras that make life sweeter.

If you’d like to know what you may be able to do to protect your loved one’s well-being, give my office a call at (913) 338-5713. Or, to read more, just visit my Alzheimer’s Resource Center and read my Legal Action Survival guide at http://alzheimersresourcekit.com/hammond/pdf/how_to_find_the_right_nursing_home.pdf.

People often confuse the Medicare program with the Medicaid program. There are major differences between these separate and distinct programs.

Medicare is the federally-funded health insurance program designed to provide health care services primarily to individuals over the age of 65. Recent changes to the program have expanded benefits through Medicare managed plans. However, long-term custodial nursing home benefits have never been part of either managed care or traditional Medicare plans.

For example, suppose that your loved one is enrolled in traditional Medicare. What is available? In most cases, Medicare will cover the first 20 days in a skilled nursing facility. In some circumstances, Medicare may cover the next 80 days of nursing home care, but with a deductible that is over $114/day. If your loved one is enrolled in a managed Medicare plan, days 21-100 are covered without a deductible, but only if your loved one meets strict qualification criteria.

We strongly recommend a complete review of your health benefits so that you can be prepared and understand the qualifying factors to receive services. If your loved one receives treatment and recovers, he or she may again be eligible for additional Medicare skilled nursing benefits.

It is difficult to predict how many days of skilled nursing care Medicare will cover. From our experience, we have found that our Alzheimer’s clients rarely receive benefits that extend to the 100-day maximum. But even if you do receive the full 100 days, what happens when Medicare discontinues coverage and your loved one still requires around-the-clock care? As stated above, the options available are either: long-term care insurance, payment from one’s own limited assets, or possibly coverage through the Medicaid program or through certain programs available through the Veteran’s Administration.

There are Health Maintenance Organizations (HMOs) that offer a Medicare +Choice program instead of traditional Medicare. These insurance companies use the Medicare reimbursement to provide additional services over what traditional Medicare provides. These are voluntary and are chosen by the Medicare recipient. There are strict enrollment rules. If a Medicare +Choice program is covering your family member with a condition that requires long-term care, it is very important to know the benefits offered and what the qualifiers are for the services. These programs are required to follow Medicare regulations, but can offer more services. Remember that the Medicare +Choice programs are the “gatekeepers” instead of the physicians and, therefore, dictate when, where, and if services are authorized.