It’s great to be healthy, especially as a senior, but simply because you are fit right now doesn’t mean you may not need long-term care when you get older. The worst mistake you could make is overlooking the need for Medi-Cal planning. You may not have health issues right now, but who can predict how healthy you will be in 50 years?
Not to mention the possibility of unexpected illnesses or injuries that could leave you with medical issues that require long-term care. According to some reports, more than 2/3 of the population over age 65 will require some form of long-term health care at some point. Clearly, Medi-Cal planning is a good idea for everyone.
You don’t have to be sick to 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.
Sadly, private health insurance is not always sufficient 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 more than $94,000. Many people believe they can afford those costs by simply relying on Medicare benefits and private health insurance. This is a mistake. The truth is, Medicare and private insurance rarely cover the cost of long-term care.
How the Medicare insurance program works
Medi-Cal 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 Medi-Cal, 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.
Forms 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 Medi-Cal different from Medicare?
One of the key differences between Medicare and Medi-Cal is that Medi-Cal 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, Medi-Cal recipients are only required to pay a minimal co-payment for covered medical expenses, if they are required to pay anything at all. Medi-Cal 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 Medicare is different from Medi-Cal
Medicare is different from Medi-Cal, first, because Medicare benefits are provided by private companies through contracts with Medicare. However, Medi-Cal is run by each state’s Medi-Cal agency. Because Medicare is a federal program, eligibility and benefits are the same all over the United States. Even though Medi-Cal 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
The purpose of the benefits Medi-Cal provides is to help low-income California residents to pay for their medical services. Because Medi-Cal 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 Medi-Cal applicant gives away property just before submitting an application for Medi-Cal 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 Medi-Cal planning, you can avoid the appearance of fraudulent transfers.
If you have questions regarding Medi-Cal or any other elder law needs, please contact the elder law attorneys at Schomer Law Group for a consultation, either online or by calling us at (310) 337-7696.
- Married Couples: Reciprocal vs. Joint Will - November 15, 2023
- Can I Still Access Assets Transferred into a Trust? - November 14, 2023
- Alternatives to Nursing Home Care in California - November 11, 2023
