Navigating Nursing Home Expenses: Understanding Medicare Coverage

Whether it’s for ourselves, our parents, or our loved ones, the prospect of long-term care can be daunting, both emotionally and financially. Nursing home expenses add up whether you need assistance with activities of daily living (ADL) or a range of medical care. The federal health insurance coverage offered under Medicare pays only certain medical nursing home expenses under very strict guidelines. On top of this, we recognize that planning for long-term care involves more than just understanding insurance policies. It requires comprehensive estate planning to ensure that your assets are protected and utilized effectively. At SCC Legal in Fairfield, NJ, our team of experienced attorneys specializes in crafting tailored estate plans that encompass provisions for long-term care coverage. In this article, we’ll take a closer look at these expenses against Medicare and how an estate plan ties into all of it. 

Deciphering New Jersey-Specific Nursing Home Expenses: A Guide to Medicare Coverage

As you probably gathered, Medicare doesn’t cover all nursing home expenses. If you need long-term care (LTC) in a nursing home, Medicare will only pay for a limited number of services and under strict circumstances. Nationwide, Medicare pays approximately 5% of all LTC expenses if it is for a restricted period and a post-hospitalization requirement. It does cover full-time skilled nursing facility care and intermittent home health care only if you need nursing or therapy care that can only be performed by medical professionals or technical personnel. 

Navigating Medicare Coverage for Nursing Home Expenses: Eligibility Insights 

To be eligible for Medicare coverage in a nursing home, you must be admitted to a nursing home following at least a 3-day hospital stay, and your nursing home admission should be within 30 days of being discharged from the hospital. You must require skilled or rehabilitative care as certified by a physician and receive it in a Medicare-approved facility.

However, you can qualify for Medicaid long-term care in a nursing home if you have income and asset limits (financial requirements) and need nursing home level care (functional requirements). Frank Campisano and the team at SCC Legal can help you navigate the enormously complex Medicaid eligibility application process in full.  

Understanding New Jersey-Specific Medicare Coverage: A Closer Look into Nursing Home Expenses

What kind of skilled nursing facility expenses will be covered by New Jersey Medicare? It will pay for you to stay in a semi-private room with meals included and the skilled nursing care you need. Also included are medications, dietary counseling, medical social services, and the medical supplies and equipment used on your behalf in the facility. Medicare will pay for physical, occupational, and speech-language pathology services if they are needed to meet your health goal.

Mastering Nursing Home Expenses: An In-Depth Guide to Medicare Coverage 

Medicare does not cover the non-medical care (custodial care) costs associated with someone helping you with activities of daily living such as using the bathroom, bathing, dressing or eating. According to Medicare, most nursing home care is custodial care. 

However, Medicare Part A (Hospital Insurance) may cover care in a certified skilled nursing facility (SNF) if it is medically necessary that you receive skilled nursing care, it is on a short-term basis, and if all the following conditions apply:

  • You have Part A and have days left to use in your benefit period.
  • You have a qualifying inpatient hospital stay.  
  • Your doctor decides you need daily skilled care from skilled nursing or therapy staff.
  • You get these skilled services in a Medicare-certified SNF.
  • Skilled services are necessary for a hospital-related medical condition. 

Do you need help with your Medicaid application? Or are you trying to plan ahead and incorporate long-term care costs into your estate plan? Either way, Frank Campisano at SCC Legal in New Jersey understands all the costs and options, and will try to get you assistance with nursing home expenses not covered by Medicare. Contact SCC Legal today for more information or visit us at: https://www.scclegal.com/

The Challenges of Applying for Medicaid

Medicaid planning

Millions of people use Medicaid to pay for costs related to assisted living, in-home care, and other associated medical costs. While you may not associate Medicaid planning with estate planning, we recommend preparing your Medicaid application the same as you would prepare traditional estate planning documents. Anyone who has been through the Medicaid application process will tell you that it’s arduous, complicated, lengthy, and any errors may cause your application to be rejected. It’s best to work with an experienced legal team who can help you navigate the application process.

What are the top reasons Medicaid applications are rejected?

  • Your application is incomplete and doesn’t contain all the required documents. Unfortunately, incomplete applications are often rejected immediately, meaning you’ve lost valuable time and you’ll have to start over with a new application.
  • Failing to reply to questions about your application. Once your local Medicaid office receives your application, they will contact you if they need further clarification. You only have 10 days to reply to their queries, and if they don’t receive a response from you, you may have to start again from the beginning. 
  • Your income is too high. Every state has different income thresholds that will disqualify you from Medicaid, and we recommend working with an elder law attorney who knows the New Jersey Medicaid Eligibility requirements to increase the chance that your application is accepted.
  • Filing too early or too late. There is a window of time in which you’re eligible to apply for Medicaid, and if your application is submitted too early or too late it will probably be rejected.

Why SCC Legal Recommends Medicaid Application Help 

Working with an experienced Medicaid attorney will save you time, frustration, and money, and can increase the chances that your application is successful. Having a Medicaid application denied can cause emotional and financial stress and you don’t want to go through the application process multiple times.

For more information about Medicaid application assistance, or if you have any questions for us at SCC Legal, please contact us today. Discover why so many people in New Jersey choose us as their trusted elder law attorneys and estate planning specialists. 

Medicare vs Medicaid: What you NEED to know

There are many things to think about as we get older, and health care may be one of the most important things. Having affordable access to doctors, any specialists you may need to see, medications, and other healthcare services is crucial, and it’s best to know your options about how to access them. Medicare and Medicaid are two major American healthcare systems that people often get mixed up, but they’re quite different, and here’s how.

Medicare

Medicare is a government-run medical insurance program for American citizens of all income levels who are 65+ years old. For older adults there are certain work history requirements that must be met in order to qualify for Medicare, while people of all ages with certain disabilities may also be qualified. 

Medicare coverage is made up of several parts:

  • Hospitalization coverage. As we get older we’re more susceptible to falls, injuries, and certain illnesses. Hospitalization coverage can also include assisted living facilities and other types of care homes. 
  • Medical insurance. Things like routine doctor visits and preventative care, and other outpatient visits are covered by medical insurance. 
  • Prescription medications.
  • Medicare Advantage plans. These plans consist of additional services purchased as supplemental parts of your existing coverage, and they’re often a combination of hospitalization coverage, medical insurance, and prescription medications.

Medicaid

Unlike Medicare, Medicaid is only for people who are below a certain income level. Medicaid is for people of all ages and it covers both routine medical care and long term care, including assisted living facilities. Run by both federal and state governments, Medicaid has strict guidelines and you must provide extensive documentation about their income and financial resources when submitting an application. 

Health care guidance from elder law attorneys 

Planning for your health care may feel overwhelming and confusing, especially when you aren’t clear about your options. In addition to enrolling in Medicare or Medicaid, there are other legal documents you should have in place as you get older, such as Health Care Proxy, that give your family clear instructions on what to do in case you become unable to make medical decisions for yourself. An elder law attorney can help you determine your eligibility for either Medicare or Medicaid and can support you through the often-complex application process. They can also help you get all the recommended documents in order to secure your future.

At SCC Legal we specialize in many areas of elder law, including Health Care Proxy, Power of Attorney, Last Will and Testament, Medical Directive, and more. For more information about how we can help, please contact us today. Discover why so many people in New Jersey have chosen us as their trusted elder law attorneys. We look forward to hearing from you.

Why Hire a Certified Elder Law Attorney for Medicaid Applications?

medicaid

People often hesitate to hire an elder law attorney to assist them with their Medicaid Application. For some, they think an attorney will be too expensive, and for others, they think the application process is straightforward and doesn’t require legal help. But Medicaid Applications are notoriously complex and they can be very time consuming, often taking months, and there’s no guarantee that your application will be approved. Whether the application is for yourself or a loved one, you obviously want to get the best care possible for them, which is why we recommend hiring an elder law attorney to help with the process. 

How an elder law attorney can help:

  • There’s no conflict of interest. Sometimes nursing homes and other care facilities will refer families to non-lawyers to help with Medicaid applications. While these people may be helpful, unfortunately they aren’t always impartial due to their existing relationship with the facility who referred them. Attorneys are neutral and can act in your best interest.
  • Elder law attorneys can save you money. As mentioned earlier, the Medicaid application process often takes months with no guarantee you’ll be approved. While you’re waiting for the results of your application, you may be racking up thousands of dollars in medical bills, nursing home bills, and other related costs.
  • They can identify any potential red flags that could hinder or jeopardize your application. An attorney will review your entire application and make sure everything, including your financial documentation, is correct before submission.
  • They can help you plan your finances while your application is pending. You may need to create a budget if you’re paying out of pocket for certain expenses, and elder law attorneys have decades of experience helping people in similar situations as you.

With an elder law attorney, you’re not alone

Applying for Medicaid is daunting. Eligibility rules can be confusing, producing the required paperwork can be stressful, and understanding the application itself can be overwhelming. Worse, your application can be denied due to a tiny error, meaning you have to go through the entire process again later. Due to budget cuts, many county Medicaid offices have huge backlogs of applications and you need a plan in place to get you through the waiting period. An elder law attorney can help you with the process from beginning to end, including what to do if your application is rejected.

For more information about Medicaid assistance and Medicaid planning in New Jersey, or if you have any questions, please contact SCC Legal today. Discover why so many people have chosen us as their trusted elder law attorneys. We look forward to hearing from you.

What are Medicaid Transfer Penalties?

medicaid

Medicaid can be a complicated system, and you may benefit from speaking with an elder law attorney who can help clear up any confusion you might have. It’s normal to want to complete all the Medicaid enrollment paperwork yourself, however, in order to avoid a Medicaid transfer penalty, we recommend speaking with an attorney who specializes in elder law.

To understand what a Medicaid transfer penalty is, let’s go back a few steps. In order to be eligible for Medicaid, you cannot have recently transferred assets, because the government wants to prevent seniors from simply giving away all their assets to family and friends, then enrolling in long-term care paid for by Medicaid. 

When a new application is submitted, Medicaid’s system reviews the applicant’s past financial information within a specific frame of time, known as the look-back period. Each state has slightly varying look-back periods, and in New Jersey it’s five years, meaning all the applicant’s financial information dating back five years will be thoroughly examined. 

What exactly are they looking for? They’re looking for any gifts the applicant gave, or any assets the applicant transferred, for less than what is called fair market value. If any assets or money changed hands for less than the fair market value during the five-year look-back period, the applicant will be ineligible for Medicaid for a certain period of time, known as the penalty period.

For example, if you give your adult daughter a car worth $100,000 and in return your daughter pays you $200, Medicaid will delay covering the cost of any of your expenses, because if you had received a fair market value price for the car you could have used that money to pay for your care instead of enrolling in Medicaid. The delay in covering your care is the Medicaid transfer penalty, and the length of the penalty period depends on the total amount of assets transferred and gifts given. 

Incurring a Medicaid transfer penalty means you are responsible for the full cost of your care until the delay is over. For seniors on a budget this can be difficult and stressful, especially those with more complex medical needs.

Advice from New Jersey elder law attorneys 

The Medicaid transfer penalty system does have exceptions and exemptions, and if you’re unsure about how it works, we are happy to talk through your specific situation step by step. We are proud to be trusted attorneys in many areas of elder law, including healthcare proxy, power of attorney, medical directive, and Medicaid, so please contact us today and let us know how we can help. 

NJ Medicaid Penalties You Need to Be Aware Of

Medicaid is health insurance that the government offers to people who may have low income or certain health conditions. This means it’s paid for with public funds that are collected through income taxes. Eligibility can vary by income, household size, and citizenship status, depending on your state. While Medicaid is a great option for many there are some penalties you should be aware of. 

The Medicaid Look-Back Period and transfer penalties

The Medicaid look-back period and transfer family rules is a scary thing for most applicants applying for Medicaid. There is a question on the Medicaid application that asks whether you have given away or transferred any assets for less than fair market value within five years before the application. The five years before the form is called the look-back period. If you answered yes to this question on the application, then you won’t face what’s known as a transfer penalty unless you have resolved it before you apply. A Transfer penalty is a temporary delay in eligibility starting from the time of application how long that delay depends on which state you’re in.

Medicaid fraud penalties

Medicaid fraud happens when a health provider misrepresents the services rendered and thereby increases the reimbursement from Medicaid. A provider can be any individual or company that provides services to Medicaid participants.

Examples of Medicaid fraud?

  • Phantom billing: Billing for any services not performed, 
  • Upcoding: Billing for a more expensive service than was rendered
  • Unbundling: Billing for several services that should be combined into one billing
  • Billing twice for the same medical service;
  • Dispensing generic drugs and billing for brand-name drugs;
  • Giving or accepting something in return for medical services, known as a kickback;
  • Bribery;
  • Billing for unnecessary services;
  • Submitting false cost reports; and
  • Falsifying timesheets or signatures in connection with the provision of personal care or consumer-directed home health services.

The legal consequences for this type of fraud conviction can vary depending upon the circumstances of each case but are generally very strict. A person convicted can face up to five years in prison per count, even for a first-time offense. A company or corporation that is convicted of felony Medicare or Medicaid fraud can be fined up to five hundred thousand dollars per count. A misdemeanor conviction can bring up to two hundred and fifty thousand dollars for a corporation, and a person found guilty of misdemeanor Medicare fraud can face a fine up to one hundred thousand dollars. 

Law attorney New Jersey can help with Medicaid legal services

SCC legal will provide you with the highest quality legal expertise and guidance you need from Frank R. Campisano. In addition to Medicaid legal services, we can also prepare additional estate planning documents, such as your Last Will and Testament, Health Care Proxy/Medical Directive, Power of Attorney documents and trusts. For more compassionate legal guidance and a free consultation, please contact us or visit our website at https://www.scclegal.com/

Your Guide to Proactive Medicaid Planning in 2020

Elderly woman touching face of young female nurse

The senior population is growing, with over 47 million people in the USA aged 65 and above. Obviously, as we age, our need for high-quality, accessible healthcare becomes critical. Medicaid plays an important role in providing seniors with quality long-term care. But, accessing this care can be a complex process. Your elder law and estate planning attorney can assist you in not only understanding your options, but also proactively implementing a strategy to ensure that you can access these options when the time comes that you need them.


Why Being Proactive About Medicaid Planning Matters

Medicaid is a federal program that provides coverage for the costs associated with long term care and healthcare for seniors. However, it is incredibly complex. Each year, Medicaid is tweaked and changed, all to help define the limits of who as well as what services are eligible for these benefits. Even the simplest errors or oversights in your application can mean you get denied benefits, which can be devastating.

As a result, legal specialists are often the most valuable resource in not only understanding this system, but for putting Medicaid planning strategies in place to ensure that when you need the benefits offered by Medicaid, you have the best possible chance of being positioned correctly to meet their very strict and complicated criteria.

Medicaid Planning Needs to be Customized

There is no one-size-fits-all Medicaid planning solution, and your estate planning attorney should tailor your strategy to you or your loved one’s financial position and needs. For example, if you are married, your strategy needs to include the possibility of one spouse being able to live independently at home while the other requires long-term care. You also need to consider how to manage assets to ensure that they are passed on to your children and grandchildren, rather than them being absorbed by costly penalties when you apply for Medicaid.

Being proactive about Medicaid planning is not about waiting until you or a loved one needs to access these benefits. Rather, it is about taking an active role to ensure peace of mind about your health and assets when that time comes.

Find Out More About Medicaid Planning – Book a Free Consultation with Your Estate Planning Attorney Today

At Sedita, Campisano and Campisano in New Jersey, otherwise known as SCC Legal, estate planning attorney Frank Campisano is ready to assist you with all your Medicaid and estate planning needs, including planning for Medicaid eligibility, business succession planning, personal estate plans, your Last Will and Testament, Power of Attorney, trusts or minimizing inheritance tax on your estate.

Contact us today and let us deliver expert estate planning advice to take care of all your Medicaid and estate planning needs. For more information, please visit our website at:https://www.scclegal.com/

Should You Have a Medicaid-Qualified Annuity for Your Spouse?

Medicaid planning

A Medicaid-qualified annuity is a useful tool for protecting your assets for a spouse when the other spouse is applying for Medicaid. As with all Medicaid planning, it’s best to consult with your elder law attorney in New Jersey to see if it’s right for you.

  • Excess Resources in the Medicaid Application Process

Your estate is made up of a range of assets, all of which will be considered in the Medicaid application process, which covers a lookback period of 5 years from the date of the application. This means that any Medicaid planning strategy has to begin well before any benefits are required.

In order to qualify for Medicaid, you’ll need to be below their threshold, so any assets over this threshold are excessive resources. Essentially, these need to be removed from the household for more than 5 years before you make a Medicaid application. A Medicaid-qualified annuity can do this.

  • What are the Benefits of a Medicaid-Qualified Annuity?

A Medicaid-qualified annuity is a good option for spouses where only one spouse requires Medicaid, as it can be used to provide income for them. Without this type of measure in place, a household’s excess resources would be used for nursing home or long-term care instead.

This annuity is a single premium immediate annuity, which means that you pay in a lump sum (your excess resources) in return for a stream of income in the form of monthly payments until the lump sum runs out.

  • What are the Requirements of a Medicaid-Qualified Annuity?

There are legal requirements that define whether or not an annuity product is Medicaid-qualified. This includes:

  • That it has to be an immediate annuity,
  • That it pays income in equal installments (usually monthly),
  • That it has no balloon payments at the end,
  • That the terms of the annuity do not extend beyond the receiving spouse’s 

life expectancy, and

  • That it is irrevocable and non-assignable.

This means that if the spouse receiving the income dies during the period before the annuity is fully paid out, any remaining money will be used to pay the other’s spouse’s Medicaid bills first before it will go to a beneficiary.

Is This the Right Medicaid Planning Option for You? Speak to an Elder Law Attorney in New Jersey

Frank R. Campisano is a highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to Medicaid planning, he is also able to assist with applications, appeals, and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Health Care Proxy, Power of Attorney documents, and trusts.

For a free consultation with an NJ elder law specialist for Medicaid assistance, please contact us today, and speak to Frank R. Campisano or visit our website at https://www.scclegal.com/.

Everything You Need to Know About Medicare Advantage Open Enrolment in 2019

Medicaid planning

Medicare Advantage open enrolment is running from January to March 2019, with the traditional open enrolment period running from mid-October to early December. Here’s a guide to what this means, from your elder law attorney in New Jersey.

Changing Your Coverage – Medicare Advantage Open Enrolment in 2019 

If you are currently enrolled in a Medicare Advantage program, you are able to leave your current plan during this period. You can also move onto an alternative plan, like Original Medicare with a Part D prescription plan for medication, or onto a different Medicare Advantage plan – something that has not been allowed in previous years.

You are only allowed to switch once a year and it must happen within this period. If you signed up for a Medicare Advantage plan during the October-December enrolment period and it didn’t work for you, you can change during the January-March period. Once this change is made, however, you will have to stick with it until the next January-March period.

Important Things to do Before You Switch Medicare Plans 

If you are planning to change your Medicare plan, check to make sure that your preferred medical providers (doctor, local hospital, etc.) are part of the network for that plan in 2019. Also, confirm with them that any medications you are taking are also covered by the plan you want to take.

Be Aware of Fraud 

From April 2019, Medicare will be sending out new ID cards. This is a measure designed to protect beneficiaries from identity theft and fraud. You will receive this new card during the year and you’ll notice it does not have your social security number on it. Instead, it will have a unique but randomly generated ID number. You can use your old card until the new one arrives, and it is important to properly destroy the old card once the new one is in use. When destroying the cars, make sure that your social security number is made unreadable.

Need Help Applying for Medicaid or Qualifying for Coverage? Speak to Your Elder Law Attorney in New Jersey 

Frank R. Campisano is highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to planning ahead financially for Medicaid eligibility, he is also able to assist with applications, appeals and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts.

For a free consultation and Medicaid assistance or NJ estate planning, please contact us today and speak to Frank R. Campisano.

What to do When You’ve Been Denied Medicaid for Excess Resources

Medicaid planning

There are many reasons someone can be denied access to Medicaid, from missing documentation to incorrectly filled in forms, but one of the most common issues is for having excess resources. Here is some helpful advice on what to do in this situation, from a Medicaid eligibility specialist and elder law attorney in New Jersey.

What are Excess Resources? 

Part of the Medicaid application process includes listing all the assets that you own, including those of your spouse if you are married. This means bank accounts, property, savings bonds, investments and more. Some assets are exempt from this list, like your home, household goods, one vehicle per home and pension. You may also keep up to $8,000 of non-exempt assets, and your spouse can keep a certain amount of assets under the terms of the Community Spouse Resource Allowance, or CSRA.

All of your assets that are non-exempt after this are considered excess resources. If this is above a certain amount (this differs from state to state and may change from year to year depending on legislation), then you will be denied Medicaid as the state feels that you are essentially too wealthy for this type of support.

Why Were You Denied Medicaid? 

There are several reasons why this denial may occur.

  • An error: The agency may have made a mistake when calculating your assets, by classifying an exempt asset as non-exempt, for example. You can appeal an error of this kind within 30 days of the mailing date of your denial.
  • Calculations were correct, but your excess resources are not very high: This means that you just missed qualifying for Medicaid, but that your application can be approved if you reduce your excess resources (by buying an irrevocable burial reserve or spending on nursing care), you should qualify with ease.
  • You applied too far in advance: This often happens to people who apply too soon and simply have too many assets to be considered eligible, especially in circumstances where a nursing home has insisted on an application. This will require the implementation of a well-considered spend-down strategy, where the best choices are outlined to ensure that you achieve Medicaid eligibility upon reapplication at a later point. There are several legal avenues to achieve this while still utilizing your assets to the benefit of yourself and loved ones, and your elder law attorney is critical to developing a reliable strategy for you to follow.

Work with a Qualified and Experienced Elder Law Attorney in NJ to Develop Your Medicaid Strategy 

 

 

Frank R. Campisano is highly experienced and compassionate elder law attorney with considerable knowledge of Medicaid issues. In addition to planning ahead financially for Medicaid eligibility, he is also able to assist with applications, appeals and other Medicaid issues. If you or a family member needs assistance with their Medicaid planning or protecting their assets effectively, don’t hesitate to get help today.

In addition, you can also prepare additional estate planning documents, such as your Last Will and Testament, Healthcare Proxy, Power of Attorney documents and trusts.

For a free consultation and Medicaid assistance, please contact us today and speak to Frank R. Campisano or visit our website at https://www.scclegal.com/

 

 

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