Medicare
Medicare is generally a non-need based federal program which is
available to most United States citizens who are 65 years of age and
older, and/or certain disabled persons. Medicare includes two
parts: Part A (Hospital Insurance) which is financed by payroll
taxes, and the optional Part B (Medical Insurance) which is paid for,
in part, by monthly premiums paid by the recipient.
If you are eligible for
Medicare, you should certainly inquire into whether you are
receiving your desired benefits. Also, if you are eligible for
Medicare, consider enrolling in the optional Part B coverage at the
earliest time allowable (unless, of course, you have carefully compared Part B
coverage to the coverage under your employer's plan).
Part A Benefits:
Enrollment in Part A is automatic. Generally, if you or your spouse paid
Medicare taxes while either of you were working, then you may not
have to pay a monthly premium for Part A. However, if you or your spouse
did not pay Medicare taxes while you worked and you are age 65 or
older, you may still be able to purchase Part A coverage.
Part A helps pay for care in hospitals as an inpatient, critical
access hospitals (these are small facilities that give limited outpatient and
inpatient services to people in rural areas), skilled nursing
facilities, hospice care, and some home health care.
Part B Benefits:
Part B covers medical and doctor services. If you enroll in
Part B benefits, the monthly premium
is deducted from your Social Security check, or you may pay for the
benefits quarterly in
advance. When you become eligible for Medicare, you will also
be enrolled in Part B unless you explicitly decline. With few exceptions,
when you become eligible for Medicare and you do not enroll in Part
B coverage, the premium on Part B coverage will rise 10% per year
for every year that you did not enroll. You may be able to enroll at no additional cost if you work beyond age 65, are covered
by your employer's plan and you enroll for Part B coverage within a specified time
after your work-related coverage ends. There are special rules
if you are receiving Medicare disability coverage or you currently
are purchasing Medicare Part A benefits.
Part B helps pay for doctors' services, outpatient hospital care,
clinical lab services, and some other medical services that Part A
does not cover, such as
outpatient physical therapy, occupational therapy, and speech
and/or language therapy
services, and preventive care (flu and pneumonia vaccinations,
mammograms, screenings for certain types of cancer).
MediGAP Insurance:
MediGAP or private Medicare supplemental insurance policies cover
some of the gaps in Medicare coverage.
Before you make any decisions regarding your current Medicare
benefits or whether any additional benefits are right for you, be
sure to speak with someone who is knowledgeable about Medicare
benefits.
For more information about the Medicare benefits which are available
to you, call the Social Security Administration at (800) 772-1213,
visit your local Social Security office,
or call us at (800) 501-3220
or
Email Us.
Medicaid
Medicaid is a need based program for certain low-income and needy
people, including children, the aged, individuals who are blind
and/or disabled, and people who are eligible to receive federally
assisted income maintenance payments.
New York Medicaid:
There are 2 types of Medicaid coverage: Medicaid home care
(also referred to as community-based home care), which includes such
services as doctor visits, prescriptions, home health care and some
hospital coverage; and Medicaid
nursing home care.
Under current Medicaid laws, the rules for getting Medicaid community-based care
are very different than the rules for getting Medicaid
nursing home care. For example, transfers of assets (gifts)
will not disqualify you from receiving Medicaid community-based
care, but will cause a penalty period for Medicaid nursing home
care.
All Medicaid recipients (community-based care and nursing home care)
are permitted to retain only a small amount of income and assets:
For 2002, a Medicaid recipient living alone may have no
more than $3,800 in non-exempt assets to be eligible for Medicaid
benefits (this amount increases depending on the number of family
members who live with the Medicaid recipient). In addition, an
applicant may prepay certain funeral expenses in advance. However
such funeral funds must be placed in an irrevocable-type trust fund
with the funeral home to ensure that any unused funds will be paid
to Medicaid after the Medicaid recipient's death. There are certain
additional exempt resources, including the contents of a home.
An individual not in a nursing home can retain income of no more than $634
per month (this amount also increases depending on the number of
family members who live with the Medicaid recipient) plus an
unearned income credit of $20 and receive Medicaid community-based
care. An individual in an institution such as a nursing home
is restricted to a personal needs allowance of $50 per month.
A non-Medicaid spouse (a spouse who is remaining in the community)
of a Medicaid recipient in a nursing home can retain significantly
higher amounts of assets and/or income and still not affect the
nursing home spouse's Medicaid eligibility. However, please
consider the possibility that in some
cases, if only one spouse needs Medicaid benefits it may be
beneficial for that spouse to apply on his or her own; the
non-Medicaid spouse must refuse to contribute his or her assets or
income to the applicant-spouse's medical needs. By doing this, and
if the Medicaid applicant-spouse is otherwise eligible for Medicaid benefits, the
Medicaid agency will grant benefits. But, the same Medicaid
agency may reserve the right to
pursue the non-contributing spouse for support in family court.
Transfer of Assets Rules
Medicaid generally will look at all asset transfers in the last 3
years, and in some instances relating to transfers to and from
trusts it will look back 5 years. A Medicaid applicant for
nursing home benefits (a person in a nursing home or receiving
equivalent services in a hospital) will be ineligible for Medicaid
nursing home benefits, or "penalized", for a period of time after he
or she, or his or her spouse, made a gift of resources. The
"penalty" period is equal to the value of the gifted asset(s) (other than
exempt assets) divided by the average cost of nursing home care to a private patient in the community. In New York
City, the average cost of nursing home care for 2002 is
presumed to be $7,894 per month; on Long Island it is $8,272 per
month; and in Westchester, Orange, Putnam and Rockland Counties it
is $7,138 per month.
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