The Regency Alliance on Senior Care has put together a fabulous selection of educational pamphlets on all aspects of senior care, which are empowering as they are enlightening.
Click on any image to open a beautiful interface with an option for printing the pamphlet of your choice!
I am often asked what this program is all about. There is a long (comprehensive) answer, with all of its ramifications. However, in a nutshell, this is what it is about.
The medically needy program provides states the option to extend Medicaid eligibility to individuals with high medical expenses whose income exceeds the maximum threshold, but who would otherwise be eligible for Medicaid. The program accounts for a small share of Medicaid enrollment, it is difficult for individuals to navigate, and it is cumbersome for states to administer. However, the medically needy program remains an important and consequential pathway to Medicaid eligibility, acting as a last-resort to Medicaid eligibility for those whose medical expenses overwhelm their income. Elderly living in nursing homes and children and adults with disabilities who live in the community and incur high health care costs comprise alarge portion of spending in the medically needy program.
For information specific to the State of New Jersey, click here.
The Medicaid program is one of the least understood of all State and Federal (funded) programs.
At Regency Nursing Centers, we are licensed to provide care for all Medicaid recipients and we invest a great deal of time and effort to educate our seniors and their families on the complex nuances of this program. We empower our families and arm them with the necessary tools to recognize their entitlements under Medicaid and we inform them of their benefits.
There are many articles written on this subject and some of them are more convoluted than helpful. A great tutorial which I’ve found to be very beneficial, is one published by the Kaiser Family Foundation.
THE MEDICAID PROGRAM AT A GLANCE
Medicaid, the nation’s main public health insurance program for low-income people, covers over 62 million Americans, or 1 in every 5. Medicaid beneficiaries include pregnant women, children and families, individuals with disabilities, and poor Medicare beneficiaries. Without Medicaid, most enrollees would be uninsured or lack coverage for services they need. As a major insurer, Medicaid provides essential funding to safety‐net hospitals and health centers that provide care to underserved communities and many of the uninsured. In addition, Medicaid is the main source of coverage and financing for long-term care, including both nursing home and community-based long-term services and supports. Altogether, Medicaid finances 16% of all personal health spending. The Medicaid program is administered by states within broad federal rules and is financed jointly by states and the federal government. Medicaid’s structure – extensive state flexibility in program design and guaranteed federal matching funds – have enabled the program to evolve, and to respond to economic and demographic changes and emergent needs. Its structure also facilitates state innovation. Under the Affordable Care Act (ACA), Medicaid will expand in 2014 to reach millions more poor Americans – mostly, uninsured adults. The Medicaid expansion is the foundation of the public-private system of coverage the ACA establishes to reach nearly all the uninsured. However, under the Supreme Court decision on the health reform law, each state will decide whether to implement the Medicaid expansion.
Who does Medicaid cover?
To qualify for Medicaid today, an individual must belong to one of the core eligibility groups under federal Medicaid law: pregnant women, children, adults with dependent children, people with disabilities, and seniors. State Medicaid programs must cover people in these groups up to federally defined income thresholds, but many states have expanded Medicaid beyond the minimum requirements, mostly for children. As of January 2013, 19 states covered children up to at least 150% of the federal poverty level (FPL) – $29,295 for a family of three in 2013 – including 11 states with eligibility thresholds between 200% and 300% FPL. All told, Medicaid and the smaller Children’s Health Insurance Program (CHIP) cover 1 in every 3 children. By contrast, adult eligibility for Medicaid is much more limited (Figure 2). In 33 states, the eligibility threshold for working parents is set below 100% FPL; in 16 of these states, parents with earnings equal to 50% FPL have too much to qualify for Medicaid. Historically, non-disabled adults without dependent children (“childless adults”) have been excluded from Medicaid by federal law, and states wishing to cover them have had to use state-only dollars or obtain a federal waiver to do so.
Joe Sanders never expected to wind up in the hospital for an extended stay. At age 68, he was in good health and leading an active life. So when a sudden heart attack on the golf course landed him in an emergency room, he was surprised to learn that his government health benefits weren’t going to see him through the long haul.
Unfortunately, like most of us, Joe never took a close look at his government entitlements and other options before an emergency struck. Had he fully understood his choices, he might have been better prepared to cope with the financial demands his care brought about. This article is designed to provide you with the basic information you’ll need to begin assessing your own health care coverage options.
Medicare Part A & B
Medicare is a two part program underwritten by the U.S Department of Health and Human Services that provides basic hospitalization and medical coverage for people age 65 and over. It also serves people under the age of 65 with certain disabilities. For example, if you have permanent kidney failure that is being treated with Dialysis or a transplant, or have been receiving Social Security or Railroad Retirement disability checks for at least 24 months, you are eligible for Medicare even if you’re under age 65.
Medicare Part A provides automatic hospital coverage, as long as you have worked at least 10 years in Medicare-covered employment. It also covers inpatient rehabilitation, sub-acute or skilled nursing care provided in a hospital or long term skilled nursing facility, as well as home health care and Hospice services. Part B helps cover medical and Doctors’ bills, and helps pay for rental or purchase of necessary medical equipment such as prostheses, wheelchairs and post surgical supplies. If you qualify for Medicare and have a non working spouse, he/she can also get Medicare parts A and B at age 65.
While part A is yours free of charge, Part B is considered elective coverage and requires monthly contributions. There are also several health care options available to Medicare beneficiaries, which come under the label of Medical Advantage. Most people receive a Medicare enrollment package just prior to their 65 birthday. At that point, they may choose whether or not to opt for Medicare Part B benefits and pay the required premiums for that coverage. If you have reached the age of 65 and have NOT received a Medicare Enrollment Package, you must call your local Social Security office in order to determine your eligibility.
The Medicare Part D: Prescription Drug Benefits
Introduced in January 2006, Medicare Part D is a prescription drug program available to all Medicare beneficiaries. Most people who qualify will pay reduced or no premiums and deductibles, and lower co-payments for their medication depending on their incomes and circumstances. Since private health insurance companies administer the program, monthly cost and coverage will also vary according to the company and plan you choose, as well as your state of residence. Premiums are in addition to the Part A and/or Part B premiums you may already be paying.
If you are currently taking prescription medication or thin you may in the future, you should explore your Part D options. Contact Social Security at 800-772-1213 or Centers for Medicare and Medicaid Services at 877-267-2323 or visit www.medicare.gov
Medicaid: Benefits for low income households
Medicaid is a combined federal-state program usually operated by state welfare or health departments and designed to furnish several basic services to low-income individuals. These include inpatient and outpatient hospital care, physicians’ services, nursing home care and laboratory and x-ray services. Under financial hardship, Medicaid may also be used to pay your Medicare premiums, deductibles and co-insurance.
MediGap: Benefits that take over where Medicare leaves off
MediGap refers to one of several supplemental health insurance policies that can be purchased to cover the costs Medicare often doesn’t cover, like prescription drugs, dental care, orthotics, hearing aids, or eyeglasses. For a complete list of recognized MediGap providers, contact the National Association of Sate Units on Aging, 1-202-898-2578 or visit www.nasua.org to locate the Office on Aging in your state.
Long-Term Care Insurance: Planning ahead for sudden continuing health care expenses.
Many people mistakenly believe that Medicare covers long-term care expenses such as nursing home and home health services. In fact, the program only pays short-term benefits for care in a skilled nursing facility and for part time skilled nursing visits at home. As for Medicaid, it does not generally pay for long-term care at home or for assisted living. As a result, if a person needs extended, non-nursing home health care, the only solution may rest with his or her ability to pay privately. That’s where long-term care insurance becomes a consideration.
Long-term care insurance is designed to pay for sudden, large, continuing healthcare expenses, whether care is provided in a nursing home, hospice, at home or elsewhere. Policies are sold through licensed insurance agents and brokers, and paid for from the policyholders’ private funds. It’s important to note that coverage is not limited to care for the elderly. As such, long-term care insurance may be a consideration for nearly every adult. As you would expect, premiums are significantly higher for older applicants who are at greater risk, therefore, the sooner you evaluate insurance options, the better.
Be An Educated Health Care Consumer: What you don’t know CAN hurt you.
Understand that most government entitlements are NOT automatic. You need to apply for them and meet all government requirements for coverage. Also, don’t assume that you’ll be covered for everything that comes along or you could be in for an expensive shock. Always familiarize yourself with the details of your medical coverage, and consider filling any gaps with an established supplementary plan. Consult an attorney or government counselor to help you make sense out of complex requirements or limitations in your coverage.
