Before we explain the Medicaid waiver program, we have to provide some necessary background information about Medicare. A lot of people are under the impression that Medicare will pay for all medical expenses when they become eligible for coverage at the age of 65. This is not entirely true, and there is one absolutely gaping hole that will get your attention.
When it comes to covered treatment and services, there are deductibles, coinsurance, and premiums that must be paid by people that are enrolled in the Medicare program. For example, you have to pay 20% of expenses incurred for visits to doctors and outpatient care out of your own pocket.
Though these out-of-pocket expenses can add up for some people, if you have planned ahead for retirement diligently, they are generally not going to be overwhelming. That being said, the huge gap that we touched upon in the opening is the lack of coverage for long-term care.
That’s right, Medicare will not pay for living assistance, and seven out of 10 seniors will eventually need some help with their activities of daily living. Nursing homes and assisted living communities are very expensive, and professional in-home care is also quite costly.
The Widely Embraced Solution
Medicaid is a jointly administered federal/state government health insurance program that is intended for financially needy individuals. It will pay for the long-term care, but there is a low asset limit of just $2000, and there is an income limit.
To qualify for Medicaid as a person with some financial resources, you could engage in Medicaid planning. Sometimes this involves giving gifts or funding a trust, but the five-year look back is a key factor.
If you were to seek Medicaid eligibility, the administrators would examine your finances going back five years. Your eligibility could be delayed if they find that you have divested yourself of significant assets during this interim. For example, if you gave away enough to pay for three years of care, your eligibility would be delayed by three years.
Medicaid Waiver Programs
A lot of people that require living assistance would prefer to remain in their own homes, and this is often possible. However, in-home caregivers are expensive. Fortunately, there is an Ohio Medicaid PASSPORT waiver program that can potentially provide assistance.
The reason why it is called a “waiver” is because the standards are somewhat relaxed in certain ways as compared to the eligibility requirements for full-blown Medicaid coverage. If you can qualify for a waiver, you can remain in familiar surroundings while you receive the level of care that that you require.
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