As Orange County Medi-Cal lawyers, we recognize how fortunate our senior clients are to be healthy. But we encourage you to not overlook the need to still create a Medi-Cal plan. Simply being healthy right now doesn’t mean you will never have the need for long-term care as you get older. You may not have health issues right now, but who can predict how healthy you will be in 50 years?
Unexpected illness or injury can strike at any time
Our Orange County Medi-Cal lawyers also want to remind you of the very real possibility of unexpected illnesses or injuries that could leave you with medical issues that require long-term care. It has been reported that more than 2/3 of the population over age 65 will require some form of long-term health care at some point. For these reasons alone, Medi-Cal planning is a wise choice for everyone.
Being healthy doesn’t mean you won’t need long-term care
A common misconception is that you have to be sick to need long-term care. That is not always the case because serious injuries can also result in the need for long-term care in order to fully recover. In some cases, people are admitted to nursing homes or assisted living centers because of the need for help with daily activities like dressing and grooming. This could simply be the result of aging. There are many ways that a person’s situation could change making the need for long-term care an unexpected reality.
Private health insurance is usually insufficient to cover the costs
Many people underestimate the potential costs of long-term care, which can be rather expensive, even overwhelming for some. In California, the average yearly cost of long-term care is nearly $100,000. Assuming you can afford these costs by simply relying on Medicare benefits and private health insurance would be a mistake. In reality, Medicare and private insurance rarely cover the cost of long-term care.
Understanding the way Medicare works
Medicaid and Medicare are two very different health care benefits programs. Medicare is a health insurance program available for individuals who are age 65 and older, disabled, or dialysis patients. It is administered by the federal government. Unlike Medicaid, eligibility for Medicare is not based on income or need. Instead, Medicare recipients are required to pay a portion of their medical expenses through deductibles and small monthly premiums for non-hospital coverage.
Types of available Medicare coverage
Medicare is divided into two primary plans that provide different types of coverage. Medicare Part A is the insurance plan for health care services provided by hospitals, skilled nursing facilities, home health care and hospice care. While Medicare Part B is similar to basic health insurance which provides coverage for doctor visits, outpatient hospital care, and other medical services.
How is Medicaid different from Medicare?
One of the key differences between Medicare and Medicaid is that Medicaid is an income-based or needs-based health care assistance program. Federal, state and local tax funds are used to assist eligible individuals in paying their medical expenses. Generally, Medicaid recipients are only required to pay a minimal co-payment for covered medical expenses, if they are required to pay anything at all. Medicaid will generally pay for certain in-home services, but only when a physician certifies that home care services are actually needed for specific medical reasons.
How is Medicare different from Medicaid?
Medicare is different from Medicaid, first, because Medicare benefits are provided by private companies through contracts with Medicare. However, Medicaid is run by each state’s Medicaid agency. Because Medicare is a federal program, eligibility and benefits are the same all over the United States. Even though Medicaid is not uniform in every state, coverage is generally available for eligible adults with children who live below a certain income level, pregnant women, seniors and individuals with disabilities.
Why Medi-Cal planning is so important
As our Orange County Medi-Cal lawyers can explain, the purpose of the benefits Medicaid provides is to help low-income California residents to pay for their medical services. Because Medicaid is a needs-based program, its recipients must have less than $2,000 in assets. The goal of Medi-Cal planning is to prevent the need to exhaust all of your resources in order to become or remain eligible for benefits.
Furthermore, if a Medicaid applicant gives away property just before submitting an application for Medicaid benefits that transfer of property could be seen as fraudulent. That would result in your benefits being delayed or denied altogether. However, if you engage in careful Medicaid planning, you can avoid the appearance of fraudulent transfers.
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