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Horizon Elder Law & Estate Planning Blog

Thursday, April 29, 2021

Planning for Medicare

What will happen to you when you need long-term care? Are you in a financial position to afford the expense?

Very few have enough assets to cover extended nursing home stays, particularly in California, where monthly care costs can easily exceed $10,000.

At that rate, even those with sizable estates should consider all available options, including government benefits, when planning for long-term care.

A proactive approach to programs like Medicare can help you get benefits that will pay for your care. It's a good idea to work with a qualified California estate planning attorney when planning for Medicare.

What Is Medicare?

Medicare is government health insurance for people 65 or older and certain people under 65 with disabilities. Medicare has two parts, A and B.

Medicare A is generally premium-free to those who paid Medicare taxes while employed, and it helps cover various services, including:

  • Hospital care
  • Skilled nursing home care
  • Home health care
  • Hospice
  • The Medicare government program is extremely valuable in consideration of the expense of these services.

    Medicare B covers:

    • Outpatient care
    • Home health care
    • Medical equipment such as walkers, hospital beds, and wheelchairs
    • Preventative services such as vaccines and wellness visits

    Supplementing Medicare A with Medicare B will add reassurance that Medicare will cover the majority of your healthcare costs. However, while Medicare A and B pay for many services and supplies, they won’t cover all medical costs. Private, supplemental Medicare insurance may be needed to pay additional expenses.

    Medicare Eligibility Guidelines:

    Medicare has strict rules governing eligibility. To meet guideline requirements, you must:

    • be 65 or older, and
    • a U.S. citizen or permanent legal resident who has lived in the United States for at least five years, and
    • are receiving Social Security or railroad retirement benefits, or are eligible to receive them but are not yet collecting them, or
    • you or your spouse is a retiree or government employee who has not paid into Social Security yet has paid Medicare payroll taxes while employed.

    If you are under 65, you may be eligible for benefits under these criteria:

    • You receive a disability pension from the Railroad Retirement Board, with conditions, or
    • You have been entitled to Social Security disability benefits for at least 24 months, or
    • You suffer from Lou Gehrig’s disease, which qualifies you immediately; or
    • You have permanent kidney failure requiring a kidney transplant or regular dialysis, and you or your spouse has paid Social Security taxes for a period dependent on your age.

    If you do not qualify for Medicare under any of these terms, you may purchase Medicare through a premium plan.

    Medicare is not Medicaid

    Medicare is available to nearly everyone, either for free or through a monthly premium plan. It is a valuable benefit that supports short-term care and general medical expenses.

    Medicaid is a program oriented toward long-term care, but it is available only to people with meager income and assets. To qualify for Medicaid, it is best you work with an estate planning attorney to review and structure your estate to meet the qualifications.

    Advance planning in observation of Medicaid’s 5-year-lookback rule is critical to avoid penalties and preserve eligibility.

    Can a California Estate Planning Attorney Help You?

    An experienced California estate planning attorney can offer an objective review of your estate in consideration of your long-term care needs.

    It’s critical you discuss your ability to pay for long-term care with your lawyer and how to access additional resources.

    Government programs are available to help. With the guidance of your estate planning attorney, you can preserve your wealth and qualify for benefits with appropriate planning.

    Contact our law office today to discuss long-term care and estate plans.


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