Frequently Asked Questions about Medi-Cal and Dementia
Medi-Cal and You
Your Home
Recovery and Estate Claims
Living Trusts
Picking a Nursing Home
Long-Term Care Insurance
Medicare
- What is Nursing Home Solutions? (NHS)
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NHS is among the oldest companies specializing in helping Middle Class Families obtain Federal Long-Term Care Nursing Home benefits. Nursing Home Solutions (NHS), is based in Glendale, California. NHS has led the way and is the pre-eminent, most knowledgeable and most established company in the arena of public Long-Term Care Benefits and Asset Protection. Since 1977, when our principal co-founded the non-profit Grey Law to meet the legal needs of senior citizens throughout Southern California, we have been pioneers in tackling difficult Long-Term Care issues in California and the Nation. Through the years, NHS has helped numerous Middle Class Families preserve their hard-earned Assets while obtaining Federal and State Benefits for which they are entitled. Our goal is to get your Long-Term Care benefits within a month of your first consultation.
In solving your Long-Term Care issues, NHS has the best and brightest minds at our disposal. We work with professionals such as Attorneys, Accountants, Financial Planners, Stockbrokers, Healthcare Professionals, Insurance Agents, Nursing Homes, Hospitals, Administrators and many others to provide the most comprehensive service each individual client needs to achieve his/her goals. We are experts at handling all matters related to Long-Term Care Benefits approval, filing government applications, protection and movement of Assets, and interaction with State and Federal agencies. We, at NHS, do all of this for you!
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Medi-Cal and You
For families that are currently receiving Long-Term Care Medi-Cal Benefits, it is imperative that they take steps to protect their home and savings from a potential Medi-Cal recovery claim. The home is not an exempt asset and is at risk for Medi-Cal Recovery claims.
- What is the difference between Medi-Cal and Medicare?
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Medicare is a federally funded and administered program that provides health insurance for older Americans and those who are disabled and who have contributed to the Social Security system for the requisite number of years. Since Medicare is a Federal program, eligibility guidelines and services are the same all over the country. Medicare will only pay for up to the first 100 days of a Nursing Home stay, and in most cases it pays for only the first 20 days.
Medi-Cal is a health insurance program financed and jointly run by Federal and State Governments. Medi-Cal runs two programs; one for low-income people of all ages and one for Long-Term Nursing Home Care.
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- Can I have an income and obtain Medi-Cal benefits?
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Married persons may retain most or all of their monthly income with proper advice and guidance, and still obtain benefits.
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- What assets can I keep and obtain Medi-Cal benefits?
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Fortunately, Medi-Cal rules exempt many assets from the countable asset base. With the proper advice and assistance, the average family can keep just about everything they own.
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- Can I have savings and a home?
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With the assistance of NHS, absolutely! It is not necessary to spend your life savings before you can qualify for Long-Term Care Medi-Cal.
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- What is “Share of Cost”?
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Share of cost is a monthly deductible that is payable to the nursing home, and other healthcare providers. It is used to reduce the total costs that Medi-Cal pays for healthcare. Under certain circumstances, NHS can help you take steps to reduce or eliminate your share of cost.
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- What does Medi-Cal cover?
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Medi-Cal covers nursing home costs, durable goods, necessary therapy and most prescriptions. Coupled with Medicare it is considered the “Gold Card” for Long-Term Nursing Home Care.
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- Is there a limit as to what I can have and still obtain Medi-Cal benefits?
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With the assistance of NHS, and with proper planning and proper asset protection there is no limit as to the amount of appropriate assets that you may have.
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- How quickly can I get Medi-Cal benefits?
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With the assistance of NHS, a person can become Medi-Cal pending in a few days. When approved, Medi-Cal will pay retroactively to the first day of the month in which the application was filed.
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- Is Medi-Cal a Bureaucracy?
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Medi-Cal rules and regulations are extremely complicated. If you have assets that you wish to protect it is imperative that you seek the advice and assistance of knowledgeable professionals in this narrow field of Public Benefits. NHS is the leader.
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- Can I transfer assets to protect myself?
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The "look back period" rule prevents you from giving away assets, and then qualifying you immediately for benefits. While there are ways to transfer assets, they must fit within the Medi-Cal guidelines. It is imperative that you not attempt to undertake the transfer of assets without competent and experienced professional advice.
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- What assets are counted by Medi-Cal?
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All non-exempt assets are counted by Medi-Cal. They include but are not limited to stocks, bonds, mutual funds, savings, insurance policies with a cash value, most annuities, the equity value in other real property, to name a few. Medi-Cal rules and regulations provide various ways of exempting all of these assets.
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Your Home
- Is my house counted as an asset?
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The home is exempt (not counted) for purposes of applying for Medi-Cal, but is really a deferred asset, which can be counted for re-imbursement to Medi-Cal. You need to take specific steps in order to protect the home from a future Medi-Cal Recovery claim. NHS understands the importance of the family home, and makes protecting that asset a priority from any future lien/claim a priority.
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- Are there problems with transferring my home?
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There may very well be. In addition, there are tax consequences to transfer’s as well, so all options should be reviewed in order to achieve the best possible solution for the individual.
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- Would I want to transfer the home to my husband or wife?
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Often, but not always. There are times when it is far better to consider other options.
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Recovery and Estate Claims
- Can I protect myself from the state placing a recovery claim against my home?
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Absolutely! But you must take steps to protect your home before the applicant dies. Ignorance of your rights could cost you your home.
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- Can I avoid an estate claim or recovery?
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Yes! There is no reason for anyone to lose their home to an estate claim/lien, if they take the proper steps in a timely manner. Let NHS help you.
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- Can a claim be made against my assets?
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Yes! If you have not properly protected your assets in compliance with Medi-Cal rules and regulations, the state will have a right to make a recovery claim against those assets. It is imperative however that this be done properly.
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Living Trusts
- Do Revocable Living Trusts work?
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Living Trusts avoid Probate, but they do not protect assets from creditors.
They are actually a creditor’s tool. Health care providers may well be the largest creditor that seniors will face.
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- Do Living Trusts work with Medi-Cal and Long-Term illness?
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Absolutely not!!! A Living Trust may preclude a person from qualifying for Medi-Cal in the first place and will insure the state a right to a recovery claim after the applicant has died.
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- Are there pitfalls to a living trust?
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There are some. Assets in a trust are "available" to the person who set up the trust. If they are available to the applicant, then the applicant may not qualify for the Long-Term Care benefits that would otherwise be available to them.
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- Are there ways to avoid or minimize problems with a living trust and still obtain Medi-Cal benefits?
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Yes! In most cases, although much depends on the language contained in your trust. If it can be accomplished, then a proper plan for converting countable assets to non-countable assets can be implemented, with the advice and guidance of knowledgeable professionals, like those at NHS.
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Picking a Nursing Home
- How can I determine if a nursing home is right for me or my loved one?
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You should consider a variety of factors:
- Location – identify facilities within reasonable driving radius of those who will be visiting most often.
- Payment options – make sure the facility accepts Medicare and/or Medi-Cal reimbursements. Some nursing homes are not certified by Medi-Cal.
- Waiting lists – ask if an opening exists. If not, ask how long the waiting list is and factor that into your needs.
- Condition – appearances can be deceptive. Make more than one visit at different times and days. View the entire facility, not just one wing or floor. Inspect rooms, common areas, baths and showers, and kitchen and dining areas.
- Residents – assess their level of satisfaction and care.
- Staff – check if staffing appears adequate and professional and if staff members enjoy working there.
- Food quality – older adults lose interest in unappetizing or ill-prepared food.
- Activities – find out what the facility provides for residents.
- Emotional care – use all your senses to get a feel for the emotional care provided and how the staff treats the residents.
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Long-Term Care Insurance
- Should I purchase Long-Term Care Insurance?
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No. If we qualify you for Long-Term Care Medi-Cal you will not need additional Long-Term Care Insurance.
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Medicare
- What is Medicare?
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Medicare is a federally funded and administered program that provides health insurance for older Americans and those who are disabled and who have contributed to the Social Security system for the requisite number of years. Since Medicare is a Federal program, eligibility guidelines and services are the same all over the country. Medicare will only pay for up to the first 100 days of a Nursing Home stay and only after a three day stay in a hospital, and in most cases it pays for only the first 20 days. Medicare does not pay for on going Long-Term Nursing Home Care.
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- How does Medicare work?
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Medicare is our country's health insurance program for people age 65 or older. In some cases, people younger than age 65 can qualify for Medicare. Those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig's disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most Long-Term Care.
Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.
The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program, which covers nearly 40 million Americans.
Medicare has four parts
Part A (Hospital Insurance)
Most people don't have to pay for Part A. It helps pay for inpatient care in a hospital or Skilled Nursing Facility (following a hospital stay), some home health care and hospice care. Part A Helps pay the costs when you're a patient in the hospital (In some circumstances, Part A may also help cover the costs of care in a Skilled Nursing Facility or hospice, or being treated at home by a home health care team for some limited period of time.) Helps Pay For:
If you aren't sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, "HOSPITAL (PART A)" is printed on your card.
Part B:
Medical insurance that helps pay for doctors' services and many other medical services and supplies that are not covered by hospital insurance (such as lab tests, screenings and medical equipment). Most people pay monthly for Part B. Part B Helps Pay For: Doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and rescription needs and switch to a different plan in the fall.
As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have the Original Traditional Medicare Plan or a Part C Medicare Advantage.
Traditional Medicare: This option works the way it has since Medicare began in 1966. When you use a Medicare service, you pay a share of the bill (your hospital deductible and typically 20 percent of the cost of outpatient services), and Medicare pays the remainder directly to the provider. This "fee-for-service" system of charges is the same for everybody in traditional Medicare. The important part is that you can go to any provider in the United States that accepts Medicare patients.
Part C:
Medicare Advantage plans are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organizations under Part C. (The fourth part, Part C, is not a type of coverage but a way of delivering benefits, as explained below.)
Medicare Advantage: provides several different alternatives to traditional Medicare, each offered through many private insurance plans that Medicare approves and regulates. Every year Medicare gives each plan a set amount of money toward the care of each person enrolled in the plan, regardless of how much health care he or she uses, and you pay what the plan requires for each service. Each plan must provide at least the same services as traditional Medicare but may offer extra benefits. Costs and benefits vary a great deal among plans. Overall, some enrollees pay less than they would in traditional Medicare and others pay more. You must be enrolled in both Medicare Part A and B to join an Medicare Advantage plan. Most plans charge a monthly premium (in addition to the Part B premium).
These are some of the differnet types of Medicare Advantage Plans and how they operate:
- (HMOs) Health Maintenance Organizations operate in local areas (counties and sometimes Zip Codes). You can typically go only to the doctors and hospitals within the plan's provider network (except in emergencies or for urgently needed care), and must go through a primary-care physician to see specialists.
- (PPOs) Preferred Provider Organizations may operate locally (in counties) or regionally (in part of a state or groups of adjacent states). They have provider networks but allow you to go to doctors and hospitals outside the network for a higher copayment and to see specialists without a referral.
- (PFFS) Private Fee-for-Service plans allow you to go to any providers that accept the plan's payment conditions anywhere in the nation, but it's not easy to know in advance which ones do. Doctors and hospitals can decide whether to accept or reject the plan each time you visit, even if they've treated you under the plan before.
- (MSAs) Medicare Medical Savings Accounts deposit a portion of the money they receive from Medicare into a personal health savings account for you. You pay for medical services (from any providers of your choice) out of this account. When the money is exhausted, you pay 100 percent out of pocket until you've met a deductible. After your expenses meet that limit, the plan pays 100 percent of your costs until the end of the year. You can roll over any money left in your savings account into the following year, and it's yours to keep if you don't re-enroll in the plan. You must file tax forms on your MSA withdrawals and pay tax on any that don't count as qualified medical expenses.
- (SNPs) Special Needs Plans are either HMOs or PPOs. Each SNP serves the needs of one special category of Medicare beneficiaries - people who receive both Medicare and Medicaid; or live in institutions (such as nursing homes); or have at least one chronic or disabling condition (such as diabetes, congestive heart failure, mental illness or HIV/AIDS). High-quality SNPs offer the services of care managers to coordinate enrollees' health care, financial and community needs. SNPs are not available in all areas of the country.
To compare the details of traditional Medicare and different private health plans available in your area you can visit Medicare's online comparison tool.
Part D: Prescription drug coverage helps pay for medications doctors prescribe for treatment.
Part D drug coverage also works through private plans, in two ways. You can choose a "stand-alone" plan that covers only prescription drugs. Or you can choose a Medicare Advantage private health plan that combines medical benefits and prescription drug coverage in one package.
You can choose a stand-alone drug plan if you're enrolled in:
- Traditional Medicare
- A Medicare medical savings account
- A private fee-for-service plan that does not cover drugs
- You can choose a Medicare private health plan (HMO, PPO, PFFS or SNP) that combines medical care and prescription drug coverage in its benefit package.
- You cannot be enrolled in a stand-alone drug plan at the same time as being in a Medicare HMO or PPO, even if it doesn't cover drugs.
To compare details of Part D drug plans available in your area (whether stand-alone or included in a health plan package), go to Medicare's online comparison tool at http://www.medicare.gov .
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- Who qualifies for Medicare?
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Most people age 65 or older who are citizens or permanent residents of the United States are eligible for free Medicare hospital insurance (Part A). You are eligible at age 65 if:
- You receive or are eligible to receive Social Security benefits
- You receive or are eligible to receive railroad retirement benefits
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid
- You are the dependent parent of someone who worked long enough in a government job where Medicare taxes were paid.
If you do not meet these requirements:
you may be able to get Medicare hospital insurance by paying a monthly premium. Usually, you can sign up for this hospital insurance only during designated enrollment periods.
Before age 65, you are eligible for free Medicare hospital insurance if:
- You have been entitled to Social Security disability benefits for 24 months
- You receive a disability pension from the railroad retirement board and meet certain conditions
- You have Lou Gehrig's disease (amyotrophic lateral sclerosis)
- You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program
- You are the child or widow(er) age 50 or older, including a divorced widow (er), of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.
- You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:
- You are eligible for or receive monthly benefits under Social Security or the railroad retirement system
- You have worked long enough in a Medicare-covered government job
- You are the child or spouse (including a divorced spouse) of a worker ( living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job. Medical insurance (Part B)
Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. For more information read Medicare Part B Premiums: New Rules For Beneficiaries With Higher Incomes (Publication No. 05-10161).
Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits.
If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don't qualify for premium-free Part A.
To learn more go to The Official U.S. Government Site for People with Medicare (www.medicare.gov)
You can get more detailed information about what Medicare covers from Medicare & You (Publication No. CMS-10050). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227), or go to www.medicare.gov. If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.
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