Sunday, February 12, 2017

2017 Med-CalResource Limits by Kevin Staker

2017 Medi-Cal Limits for Long Term Care by Kevin Staker

The Community Spouse Resource Allowance ("CSRA") for 2017, the amount at home spouse can have in countable assets is $120,900 in assets.

The maximum amount of income the at home spouse is guaranteed to receive is $3,023.  This amount is called the Minimum Monthly Maintenance Needs Allowance ("MMMNA"). The MMMNA can be increased by going to Court and requesting additional support for the at home spouse from the income of the ill spouse.

For 2016 and early 2017 the Average Private Pay Rate ("APPR") for nursing homes is $8,189.  The APPR is used in calculating the term of ineligibility if an individual gives non-exempt assets to other individuals.

Kevin Staker has stated:

Medi-Cal will release a new APPR usually in April 2017.  This figure is used for calculating a period of ineligibility if an individual makes improperly large gifts

By Kevin Staker


Medicare Versus Medi-Cal by Kevin Staker

Medicare

Medicare

Medicare is the federal medical insurance program.  Its funds come primarily for payroll deductions out of the paychecks of American workers.  All individuals 65 or older who have contributed to Social Security receive its benefits.  Also, individuals under age 65 who have been eligible for Social Security disability benefits for at least two years, or persons of any age with end-stage kidney disease are eligible.

Medicare has two parts.  Hospital Insurance is Part A, and Medical Insurance is Part B. Those persons eligible for Social Security or Railroad Retirement benefits as workers, dependents or survivors, All individuals are eligible for Part A when they turn 65. If an individual has failed to work enough calendar quarters to qualify for benefits, he or she may pay a monthly premium and qualify. If an individual purchases Part A, Medicare Hospital Insurance, he or she must also enroll in Part B, Medical Insurance.  Participants in the Medicare are liable for co-payments and deductibles along with monthly payments for Part B coverage. Medicare is not based on financial need. Any individual is eligible who meets the age, disability or coverage requirements of Medicare.

Medicare does not cover all medical expenses.  It must be supplemented with private insurance, also called "medigap" insurance, such as Anthem, or consumers can enroll in an HMO plan that contracts with Medicare, such as Kaiser Permanente. After three days in the hospital, Medicare will pay up to 100 percent for the first 20 days of skilled nursing care. For days 21 through 100 days, the individual pays a typically large co-payment. The premiums and copayments increase every year. After day 100,  Medicare coverage for nursing home care ends.

Please note that Medicare only pays for “skilled nursing care.”  It does not pay for “custodial care”, such as in a board and care home.  The average stay in a nursing home under Medicare is usually less than 24 days; people simply do not want to pay the large co-payment. Thus, Medicare fails to cover long term care in a nursing home.

Medi-Cal

Medi-Cal is a California State program largely paid for with federal tax dollars.  It pays for medical care for individuals with low income. Some Medi-Cal recipients may receive Medicare, but the two programs are separate. Medi-Cal is a needs based. In California it is now called "Covered California".  It is part of the Affordable Care Act - Obamacare. 

Kevin Staker has stated the following:

You cannot rely on Medicare to pay for long term care.  Long term care insurance is very expensive.  Older folks must consider what must be done if they need to qualify.  In a future blog post, I will talk about the keys: a good financial power of attorney that allows gifts, including to the agent, and a living trust if you own a home.

By Kevin Staker