Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease. As a social insurance program, Medicare spreads the financial risk associated with illness across society to protect everyone, and thus has a somewhat different social role from for-profit private insurers, which manage their risk portfolio to maximize profitability by denying claims.
Medicare offers all enrollees a defined benefit. Hospital care is covered under Part A and outpatient medical services are covered under Part B. To cover the Part A and Part B benefits, Medicare offers a choice between an open-network single payer health care plan (traditional Medicare) and a network plan (Medicare Advantage, or Medicare Part C), where the federal government pays for private health coverage. A majority of Medicare enrollees have traditional Medicare (76 percent) over a Medicare Advantage plan (24 percent). Medicare Part D covers outpatient prescription drugs exclusively through private plans, either standalone prescription drug plans or through Medicare Advantage plans that offer prescription drugs
In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. Medicare serves a large population of old, sick, and low-income people, many of whom would be unable to afford health care otherwise. On average, Medicare covers about half (48 percent) of health care costs for enrollees. Medicare enrollees must cover the rest of the cost. These out-of-pocket costs vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and supplemental insurance.
If you have questions about Medicare and supplemental Medicare health insurance, consult with an attorney at Pirsch & Associates, PLLC.
Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care. Medicaid was created to help low-asset people who fall into one of these eligibility categories ?pay for some or all of their medical bills.?
There are two general types of Medicaid coverage. ?Community Medicaid? helps people who have little or no medical insurance. Medicaid nursing home coverage pays all of the costs of nursing homes for those who are eligible except that the recipient pays most of his/her income toward the nursing home costs, usually keeping only $66.00 a month for expenses other than the nursing home.
While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the general rules under which Medicaid operates, each state runs its own program. Under certain circumstances, an applicant may be denied coverage. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.
If your net worth exceeds, say, $8 million, you don’t need to protect your Medicaid eligibility because you’ll be be able to afford whatever you might evantually require in terms of long term care if you are too disable to care for yourself. If you are in the middle class, however, worth several million dollars or less, you might later find yourself in the awkward situation of ineligibility for Medicaid while facing annual care expenses of $150,000 or more, probably more than you can comfortably afford. If you will be facing a long term disability, Mediciad is a benefit that is well worth planning for. See also Elder Law Attorneys for the District of Columbia, Maryland and Virginia.
If you are worried about paying for long term care due to a disability, you should plan to qualify for Medicaid now while you?re still in good health or as soon as possible while you still have assets. As eligibility for Medicaid in based on your assets and income, we can help you transfer your assets, either outright or into a trust, which will then qualify you for Medicaid after the five-year look back period. Some assets are exempt so we can help you invest in them.
Sound Medicaid planning can help most families take full advantage of the success they achieved during their working years. Contact Pirsch & Associates, PLLC for advice on whether you may need Medicaid and how to qualify for it in the jurisdiction in which you live.
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