Medicaid planning is important because you may need Medicaid to pay for care that you require if you become sick or if you get older. It is important to understand the rules for what your Medicare or other private insurance will cover so you can determine if you need to make a Medicaid plan. One of the key things that you need to understand is the definition of skilled nursing care.
Zimmer Law Firm can provide information on what skilled nursing care is, why this definition matters, and what you need to do in order to make sure you are able to get the care you need paid for without spending your entire life savings. It is best to act well before the time when you need care and get plans in place now to get covered, so you should give us a call as soon as possible.
What is Skilled Nursing Care and Why Does it Matter?
Medicare defines skilled nursing care to include care that must be provided by a person who has some kind of medical training. If a layperson without experience or credentials could provide the care, then it is not considered skilled nursing care.
For example, physical therapy, speech therapy, intravenous injections and changing bandages after surgery are all tasks that must be performed by someone who has medical training. By contrast, helping someone to use the bathroom or eat or dress or shower would not require any medical training. When assistance is providing with basic activities of daily living, such as getting dressed or showering, the care is called custodial care by Medicare rather than skilled nursing care.
The distinction between skilled nursing care and custodial care matters a great deal because skilled nursing care is covered by Medicare. As Medicare explains, in appropriate circumstances such as after a qualifying hospital stay when skilled nursing care is medical necessary, Medicare will pay for a semi-private room in a skilled nursing facility. Medicare will also pay for meals, physical and occupational therapy, medications, and medical supplies and equipment that need to be used to provide treatment and support while a patient is living in a skilled nursing facility.
Although Medicare pays for skilled nursing care provided in a skilled nursing facility, or pays for skilled nursing care provided at home by medical professionals under appropriate circumstances, Medicare does not pay anything at all for custodial care. Private insurers, Medicare Advantage Plans, and Medigap plans will also pay nothing for custodial care and will cover skilled nursing care only.
Unfortunately, this means if a senior or a disabled person needs unskilled nursing care or custodial care, getting the costs of this care covered can be very difficult. One option for getting custodial care paid for would be to buy a long-term care insurance policy but this is often very expensive for people who are getting older. Long-term care policies also typically have coverage limitations that make such policies an imperfect and impractical way to get care expenditures paid for. These limits may include limits on the number of days of coverage, a long waiting period, or a low daily maximum payment limit which is far below what the actual costs of care are.
If you cannot get Medicare or private insurance to cover you and long-term care policies are inadequate, your only option may be to try to make a Medicaid plan and get Medicaid to pay for the costs of custodial care or long-term care provided at home. Medicaid can offer coverage for custodial care in a nursing care facility or offered by home health aides, but Medicaid is a means-tested program and you will not qualify to get covered if you have too many assets. This is why working with an experienced attorney is so important.
Getting Help from Medicaid Planning Attorneys
The attorneys at Zimmer Law Firm can provide personalized advice on making a Medicaid plan that will provide you with the protections and peace-of-mind you need as you get older. You can work with an experienced attorney at our firm to make a Medicaid plan so you can qualify for Medicaid when you need coverage without first having to spend all that you have earned over your lifetime.
To find out more about how our legal team can help, join us for a free seminar. You can also give us a call at 513.721.1513 to talk with an attorney who you can trust to help you make your plans to protect your assets in case you need custodial care in the future.