Planning for Medicare

By Julie Fielder
Attorney

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:

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?

About the Author

Julie M. Fiedler, an Attorney at Law, has been a resident of San Ramon since 1988. With over 30 years of experience in healthcare and senior services as a Registered Nurse, she is recognized as a Certified Elder Law Attorney (CELA) by the National Elder Law Foundation. Julie is accredited by the Department of Veterans Affairs to assist individuals with VA benefits. Her extensive involvement includes serving on the Board of Directors for the National Academy of Elder Law Attorneys, Inc., and as the past President of the Northern California Chapter of the National Academy of Elder Law Attorneys. She is an active member of California Advocates for Nursing Home Reform and ElderCounsel. Additionally, Julie Fiedler has contributed her leadership skills as President of the Adult Day Services Network of Contra Costa.