Medicaid Planning

[wdwfan16]

It's $10,000 a MONTH, not a year. That was upstate New York. It's my understanding that nursing homes here on Long Island are over $12,000 a month. That's $144,000 a year.

As for long-term insurance policies, most would never have come close to paying for the time my husband's great aunt spent in a nursing home.

As for me and my family, we have multiple life insurance policies, pay for our own health insurance (we are self-employed), pay for our employees' health insurance, disability insurance, etc.

Long-term care policies have caps and are, for the most part, a bandaid, when considering the astronomical costs of nursing home or in-home nursing care. I have yet to seen one that would cover more than half the daily cost of a nursing home in our area. I have yet to see one that didn't have a cap that was substantially more than one year of nursing care. Until then, they are, in my opinion, a waste of money.

Until there are better remedies, more equity and fairness in the system and real solutions, we will utilize the services of our attorney and financial planner to safeguard and protect our family's assets, within the scope and intent of the law.

This is definitely a situation where one must walk in the shoes to fully understand. It's very easy to sit on a high horse and declare people to be "thieves" - when you know how hard someone has worked, what they sacrificed to save, what their intent was for those they love and to see a lifetime - 70 years of savings - gone in three short years is mindboggling and heartbreaking.

You are VERY misinformed. DH and I bought LTC insurance a few years ago. Being in our early 30s the payments are about $3K/year for the two of us.

We got:

UNLIMITED payout
Flat payments
5% inflation increase each year.
Today it would pay us $375/day ($137K/year).
Both in home and in facility payments.
Since we do not claim it on our taxes the payment is tax free.


The number we picked is based on the costs in our area. We can almost pay your LI costs (if we lived on LI we would have gone a little higher) and can pay way more than we would need here.


You are wrong in your last sentence. We say now for our older years not to pad the pockets of our children. We do not want to be a burdon to our kids. If we have money left over then they get a windfall.

 

[golfgal]

We have planned and saved and played by the rules all along. I have paid into that system, more than most. I will protect my family's interests, our business interests (which also includes multiple employees and their families).

We will pay for our own care, but we will not allow it to bankrupt us. If such catastrophic care is needed that will completely drain our family's resources, we will be prepared for that.

If either of us need nursing home care, we will pay for that so we have choice of facility, which one does not have with Medicaid - in fact, if a patient is in a nursing home and is hospitalized during their stay, they can be placed into a completely different nursing facility without any choice. We've worked too hard all our lives to lose our right of choice and we will pay for that.

However, our assets will be protected if long-term or unforeseen events take place. While we plan to pay our way until the day we die, we will plan for the absolute worst case scenario - and if that means that some of the hundreds of thousands of tax dollars I've paid over the years come back in my direction, then so be it. I'm only 45 years old - I can't even begin to imagine what costs will be, what the law will be, what programs will be in place.

My point is - the law is set up to allow people to plan for their futures, to have these discussions with their children and children's children. I think it's disgraceful that in a country such as ours, where we are told to work hard, pay taxes, invest in the American dream, that a lifetime can be swallowed up in three years because those who screwed up get a free ride and those who did the right thing pay through the nose.

The law is set up to help those of us who do the right thing protect that for which we have worked so hard. I intend to pay my way, and, I'm sure, the ways of others, for the rest of my life. But, if something unforeseen happens, I will not allow my lifetime of hardwork disappear in the blink of an eye.

I am really only repeating myself at this point. I think those that have actually lived through a real life situation and watched how the system works have a much different viewpoint than those who have not. It's just unbelievable to see how completley idiotic and illogical the entire system is.

Again, repeating myself-GET LTC INSURANCE if you can. It is a SIMPLE solution to your problem, period. Your life insurance and health insurance will NOT help you and WHY pay the cost of the nursing home if you don't have to? As someone told me when we were buying our LTC ins, which side of the check do you want to sign, the front or the back? I don't understand why you want your hard earned savings to go to the nursing home and not your kids or grandkids???

The other factor of this equation you are not considering is the fact that the baby boomers are retiring and there may not be ROOM in a nursing home so if you are planning on using medicaid at some point you might not have that option at all. At least with LTC ins you can live in an assisted living home, medicaid you can't. BTW, my mom is in a nursing home which is WHY we bought LTC ins.

 

[FinallyBoughtDVC]

Again, repeating myself-GET LTC INSURANCE if you can. It is a SIMPLE solution to your problem, period. Your life insurance and health insurance will NOT help you and WHY pay the cost of the nursing home if you don't have to? As someone told me when we were buying our LTC ins, which side of the check do you want to sign, the front or the back? I don't understand why you want your hard earned savings to go to the nursing home and not your kids or grandkids???

The other factor of this equation you are not considering is the fact that the baby boomers are retiring and there may not be ROOM in a nursing home so if you are planning on using medicaid at some point you might not have that option at all. At least with LTC ins you can live in an assisted living home, medicaid you can't. BTW, my mom is in a nursing home which is WHY we bought LTC ins.

We have looked into LTC insurance and the policies offered to us were basically useless. We will look into it again. However, be aware, that states can change regulation on these policies, so for those of us in our 30s and 40s buying into something we may not need for another 40 years...a lot can happen in that time and render these policies useless, expensive, etc.

I think, honestly, the best solution for everyone is to plan for everything and keep talking about it. People never want to talk about death, what happens if, etc.

We just switched insurance agents when writing our new health insurance policies...currently, we spend more in insurance every month than on any other expense. It's ridiculous. I don't want to get political - but something has to be done.

I spend enough on insurance every month to own at least another four homes - I could be housing homeless people every month with the money we spend on all our insurance policies.

Anyway, I'm starting to ramble. My point has been and will always be - plan ahead, talk to people - I would never have considered looking into LTC programs again if I hadn't stumbled on this topic the other day. Consult with and elderlaw attorney - understand that these laws are set up for those of us that do prepare and play by the rules. Cover all your bases. At 30 years old, having a LTC policy that looks solid as a rock is not enough.

And, I'm not trying to line the pockets of my children - but I will say this...children of business owners sacrifice a lot. We work weekends and holidays and they get stuck sitting around with us while we wait to close. From the time my daughter was 5 years old, she could batch out the register. When your family business is so closely tied to your children's childhood, you feel as though they have a stake in it and sacrificed for it, just as we adults have. Your business becomes another baby, another child you raise, and you will do anything to protect it. Our home is the place we loved our children, and hope to love our children's children. We'll do anything to protect it.

Anyway, I think I've said enough and there's no sense saying anymore. Thanks for the suggestions from those of you who offered advice. It's much appreciated.

 

[allison443]

That doesn't sound like much fun at all, and I'm glad that the US has something to catch old and sick people when they fall. (and that's super-hard for me to say, b/c I'm a wanna be expatriate and have been for over a decade!)

Just curious-for over ten years? What is stopping you?

 

[allison443]

I want a level playing field. I feel the same way about college financial aid.

Case two: Our friends...they live in our neighborhood in a home valued the same as ours. Our family incomes are nearly identical. We each have three children. We saved and played by the rules and set up accounts, etc. They traveled the world, spent every nickel they had.

When it came time for our oldest children to go to college (they were born 5 days apart), we both filled out FAFSA. We were told we had enough money to pay $46,000 a year out of pocket. They were told they basically could get a free ride for their daughter. I can tell you, I really wished I had taken those extra trips every year and redid my kitchen twice, etc.

I have two kids in college and some familiarity with FAFSA. For someone to get a "free ride" based on FAFSA you have to have a very low level income. So either they lied to you or FAFSA. Also a free ride very rarely doesn't include loans. Loans can be obtained by anyone without regard to financial need. Is it possible she got a full ride (merit based) from a particular college, nothing to do with financial need?


I honestly am not picking on you, we also did not even bother filling out FAFSA for one of our kids after running the online calculator. Like you we played by the rules, saved, sacrificed, with our goal being to get the three kids through four years of college. Since we are full pay, we did have to put some limits on how expensive the school could be. That is reality for our kids. I do sometimes wonder about things when I see other people getting financial aid (not loans) and wondering if we did something wrong.



I just think it isn't good to make generalizations, etc. based on anecdotal evidence that may not be true, or maybe they exaggerated, kwim?

 

[PaddingtonBear]

My dad became very sick a few years ago. He had a bowel blockage - very likely cancer- and had to have emergency surgery. He was in the hospital for a month, then moved to a rehab center. Once in rehab he continued to deteriorate and they sent him to the ER. After lots of confrence with his doctors, and given my dad's other issues, we decided not to do a centeral line or any additional intervention. The hospital wouldn't admit him so the sent him back to the nursing home where he'd been doing rehab. That's where my nightmare started.

The nursing home called me and said that my dad had to leave within 24 hrs- he wasn't able to do rehab so his care wouldn't be covered any longer by Medicare.

I asked what my options were, and there weren't any acceptable options. I was working full time, and living in a small one bedroom apartment. My mom had some severe memory issues and there was no way she could be responsible to care for him- even if she could her house was a retirement cottage and after measuring with the facility social worker we confirmed that we couldn't get a hosptial bed, etc., in there. I had to find a place for him. I started calling around. Only three nursing homes in a 20 mile radius accept patients starting out on medicare. Most facilities in our are will only accept private paying patients who eventually spend down into medicare. My parents had not planned on nursing home care and had no resources saved for that eventuality. I calculated and the cost to private pay would have completely wiped out all cash reserves for my parents- including my mom's utility and grocery money, all her savings for emergencies like home repairs, etc., within about 9 days. The facilities that did take medicare patients were all horrible, the horror story type nursing homes were people are left in chairs in the hallways moaning. I visited all three and there was just no way I could do that to my dad. I was in a total panic attack. My dad had 12 hrs to vacate his facility, and we had no where for him to go.

I remember I was in the car, sobbing, crying out to the Lord (wow is this dramatic, I'm not normally this drama filled, but true story) in dispair. My cell phone rang. One of the social workers at the nursing home is friends with a hospice charge nurse. She said she's heard about my dad and about me - I was 26 and taking care of both my parents who needed a LOT of care- and she could dispatch an ambulance to pick him up right then if I could come and sign the paperwork. Honestly, it was a miracle.
Anyway, so we admit him to hospice. Luckily my dad had a secondary medical insurance plan, which covered hopsice care. If he hadn't, we would have had to go into spend down for medicaid.
Its all well and good to call preparing for medicaid "thievery", but I'd do it in a heartbeat. If we'd had to go on medicaid, my mom would have lost everything. Often there's a spouse left who will allowed to keep a house, but not a car, not a savings account, not even money for daily living expenses.
After dad died, I looked into a LTC policy for mom, but none were willing to insure a 60 year old woman with health problems. So the " you should have planned for that" ship had sailed.

Pointing fingers is very easy. Telling a person that the 'should have' prepared for thier long term care is easy. The system is broken. Long term care is not affordable for many, or most, people. Many times there is a spouse that has to live with the concequences of spend down that will put the spouse on public assistance and into poverty for the rest of his or her life.

My grandparents divorced after 50 years of marriage due to medicaid spend down rules. My grandmother's nursing home care would have drained everything that my grandfather lived on.

 

[barkley]

Being poor doesn't mean anything for having Medicaid. Yes the reason you go Medicaid is because you have no money left but that doesn't mean you are poor. No one in this day and age has any money let alone when you get older have any money set aside. You could have all the money in the world and then spend it in a nursing home and then have to go on Medicaid. So what. Alot of people including the elderly are on Medicaid whether in the community or in a nursing home. It just means you need help with your healthcare and costs.

And just because you buy a long term care insurance does not mean it covers everything. Just like an insurance premium you have - you have to really read the fine print. Yeah some are better than others but that doesnt mean it covers everything. I have yet to see one that does. I mean yes its a good investment if you can afford it for now but eventually no its not. I try to tell people just read the fine print on everything. Just because it looks good doesnt mean it is. Always compare plans.

For my parents (my dad is retiring soon) i have already told them - Use Medicare - everyone takes it - no referrals no nothing. Just get a secondary in which they have AARP which is usually good. Right now they have PC - which has copays. I should know - I have it too. But in different situations those copays are high and some are low. Hence why I say use Medicare.

But anyway -- its not up to anyone but the people making the decisions. They have to make the smartest decision they feel they can make at that time and thats it. Good Luck.

just to clarify-not everyone takes medicare. unless you are in a state that makes it a requirement that a doctor accept medicare in order to get licensed it's an individual providers choice. and even in those states that have the requirement, their doctors can cap the number of medicare patients they have in their patient base at any given time. so you can call and try to get in with a doctor but they ask before they schedual who your insurance carrier is and when they find out it's medicare you can be told the doctor has no availability for new medicare patients and you'll be put on "the list" (my doctor's practice has about a 2 year wait)

that said-referals are still required. i receive medicare and i can't just choose to go get tests and see specialists-i have to get a referral and then i have to make sure i get one for a medicare accepting specialist.

if a person has JUST medicare they can still be paying allot out of pocket (a recent medicare bill i got w/ a medicare accepting provider had me paying 50% of the cost). thats for what medicare covers-allot is not covered.

so if a person is FORTUNATE they can get a secondary plan. some can't because if their former employer's retiree plan is less than what medicare offers even though it would help cover part of the co-pays and help cover what medicare does'nt-the employer is'nt obligated to offer it at retirement. some get injured or ill absent of insurance during a period of no insurance/pre medicare eligible and they don't qualify for secondary coverage. so in my case i've got medicare and a secondary (considered "great") policy. i still look at paying for 25-30% of my medical bills. may not seem like allot but when you consider a recent trip to the e/r ran me almost $10,000 and not all of the staff/services were medicare accepting i'm looking at several thousands in bills.


for those who are agasht at people who pre plan for mediCAID, i just want to point out that there were reasons that the feds put provisions into the program to provide for some sheltering of assetts. they were'nt looking at elderly parents who wanted to leave money to their adult kids, they were looking at catastrophic situations that can occur in any family and trying to put something into place for TAXPAYER cost containment. the theory was if a younger parent had a catastrophic illness or injury and their insurance did'nt cover it or they had no insurance, rather than that person going through every assetts they had and being left with nothing (or going w/o medical care and becoming totaly and permanantly disabled) which would leave them AND their young dependant children reliant on MULTIPLE forms of public assistance for however long it took them to recover/return to gainful employment-if that person could shelter some of their assetts to provide for their kids and still be able to qualify for mediCAID (which would also link them to the much lower government negotiated payment rates for services) it would cost the taxpayers less in the long run. likewise with 2 elderly spouses-one ends up in a nursing home. if the other had to spend every penny, every assett to pay for it who do you think would ultimatly end up paying the bill for their ENTIRE subsistance plus still footing the nursing home care costs? the taxpayers.

with sheltering plans at least an older adult can shelter some assetts for their spouse to be able to survive, and in many cases shelter some assetts to be able to continue to pay for their secondary insurance so their non mediCAID spouse can try to keep their health care costs such that they don't end up still running through all their remaining assetts and having to go on mediCAID themselves.

may not work in practice-but that's the theory behind it.

 

[golfgal]

My dad became very sick a few years ago. He had a bowel blockage - very likely cancer- and had to have emergency surgery. He was in the hospital for a month, then moved to a rehab center. Once in rehab he continued to deteriorate and they sent him to the ER. After lots of confrence with his doctors, and given my dad's other issues, we decided not to do a centeral line or any additional intervention. The hospital wouldn't admit him so the sent him back to the nursing home where he'd been doing rehab. That's where my nightmare started.

The nursing home called me and said that my dad had to leave within 24 hrs- he wasn't able to do rehab so his care wouldn't be covered any longer by Medicare.

I asked what my options were, and there weren't any acceptable options. I was working full time, and living in a small one bedroom apartment. My mom had some severe memory issues and there was no way she could be responsible to care for him- even if she could her house was a retirement cottage and after measuring with the facility social worker we confirmed that we couldn't get a hosptial bed, etc., in there. I had to find a place for him. I started calling around. Only three nursing homes in a 20 mile radius accept patients starting out on medicare. Most facilities in our are will only accept private paying patients who eventually spend down into medicare. My parents had not planned on nursing home care and had no resources saved for that eventuality. I calculated and the cost to private pay would have completely wiped out all cash reserves for my parents- including my mom's utility and grocery money, all her savings for emergencies like home repairs, etc., within about 9 days. The facilities that did take medicare patients were all horrible, the horror story type nursing homes were people are left in chairs in the hallways moaning. I visited all three and there was just no way I could do that to my dad. I was in a total panic attack. My dad had 12 hrs to vacate his facility, and we had no where for him to go.

I remember I was in the car, sobbing, crying out to the Lord (wow is this dramatic, I'm not normally this drama filled, but true story) in dispair. My cell phone rang. One of the social workers at the nursing home is friends with a hospice charge nurse. She said she's heard about my dad and about me - I was 26 and taking care of both my parents who needed a LOT of care- and she could dispatch an ambulance to pick him up right then if I could come and sign the paperwork. Honestly, it was a miracle.
Anyway, so we admit him to hospice. Luckily my dad had a secondary medical insurance plan, which covered hopsice care. If he hadn't, we would have had to go into spend down for medicaid.
Its all well and good to call preparing for medicaid "thievery", but I'd do it in a heartbeat. If we'd had to go on medicaid, my mom would have lost everything. Often there's a spouse left who will allowed to keep a house, but not a car, not a savings account, not even money for daily living expenses.
After dad died, I looked into a LTC policy for mom, but none were willing to insure a 60 year old woman with health problems. So the " you should have planned for that" ship had sailed.

Pointing fingers is very easy. Telling a person that the 'should have' prepared for thier long term care is easy. The system is broken. Long term care is not affordable for many, or most, people. Many times there is a spouse that has to live with the concequences of spend down that will put the spouse on public assistance and into poverty for the rest of his or her life.

My grandparents divorced after 50 years of marriage due to medicaid spend down rules. My grandmother's nursing home care would have drained everything that my grandfather lived on.

Just to correct some information: Medicaid spend down DOES have provisions for surviving spouses. Your mom would have been able to keep the house, a car and 1/2 of the assets as well as an income-social security or a pension or whatever they have to live on. If she passed away before your Dad the rest would have had to go to his care. It isn't much, but it is something. These cases are WHY you want to get LTC insurance when you can-it's too late to buy it when you NEED it because you won't qualify.

 

[CPT Tripss]

Just to correct some information: Medicaid spend down DOES have provisions for surviving spouses. Your mom would have been able to keep the house, a car and 1/2 of the assets as well as an income-social security or a pension or whatever they have to live on. If she passed away before your Dad the rest would have had to go to his care. It isn't much, but it is something. These cases are WHY you want to get LTC insurance when you can-it's too late to buy it when you NEED it because you won't qualify.

There is a ton of mis-information floating around about government healthcare programs and the scare tactics are ramping up daily.

Thanks for putting this out there.

 

[claudia]

There is a ton of mis-information floating around about government healthcare programs and the scare tactics are ramping up daily.

Thanks for putting this out there.

Here is a link if you want to know how the system works:
http://www.cms.hhs.gov/MedicaidEligibility/09_SpousalImpoverishment.asp#TopOfPage

 

[claudia]

OT but, IMO, the government has no place in long term elderly care unless daily medical assistance is required. Families should be caring for their elderly. When we stopped caring enough about our elderly to keep them until they passed, our society began to crumble.

Nursing home care is not loving care, though many who work in the industry try to make it so. I cannot imagine doing this to my mother. Take care of your elderly and the money can all stay in the family...

Not only is this extremely simplistic, but for myself I find it very offensive. I took care of my grandmother for as long as I could. After her second stroke she was also diagnosed with dementia. She was unable to walk, unable to understand and reason and would refuse to eat and drink. There was no way I could properly care for her. I needed help and found it at a nursing home close to me. They were able to keep her on IV's to keep her hydrated (which made her feel better so that she actually would eat), able to bathe her and kept her from getting bed sores. I came to know all of her CNA's and floor nurses and I can tell you that she was given loving care....they were wonderful....and I was there almost every day watching over her.....that is what loving family does, they consider what is in the best interest of their loved one, not keep them at home suffering. So by putting my beloved grandmother in a nursing home I was able to improve her quality of life....doing what is best for another person is what love is all about. Please save the holier than thou speeches for after you have cared for someone with these problems.

 

[Pixie Dust for Me!]

Amen!