Top Ten Long-Term Care Planning Myths

I. I Can Care For My Spouse Indefinitely On My Own

Too often a primary caregiver ends up in the hospital or even predeceasing the unhealthy spouse because she failed to acknowledge the limits of her ability to provide 24/7 care. It is imperative that all involved recognize an illness impacts both spouses.  In the end, keeping an unhealthy spouse at home can actually do more harm than good.

II. Medicare and Medicaid Are Terms To Be Used Interchangeably

Eligibility for Medicare is determined based solely on whether a worker or their spouse paid adequately into the system during their lifetime. Medicare eligibility does not depend on assets or income.  On the other hand, eligibility for Medicaid is determined based upon the assets and income of the applicant.  Whereas the rules governing Medicare eligibility are identical in all states, the rules governing eligibility for Medicaid differ depending on the state.

III. Medicare Will Pay For A Nursing Home if I Ever Need One

Medicare will pay for just 20 days in full following a hospitalization. It can potentially assist for an additional eighty days, but only after the resident covers a daily co-payment of $164.00.  Under no scenario will Medicare provide assistance with long term care beyond 100 days.

IV. Medicaid Will Cover Home Health Care And Assisted Living Care

Although there are limited Medicaid programs designed to help with home health care or assisted living care, these programs are grossly underfunded and maintain long waiting lists. Moreover, under no circumstances will Medicaid pay for 24/7 home care.  For the most part, home health care and assisted living care must be paid for privately.

V. The Quality Of Care Will Suffer If I Go On Medicaid

While it is certainly true that some nursing homes offer better care than others, virtually every nursing home in Georgia accepts Medicaid. The key is gaining admission to one of the better homes as a Medicare or private pay resident before Medicaid ever becomes necessary.  If a resident converts to Medicaid following admission, the facility cannot involuntarily discharge the resident or reduce care provided.

VI. I Have To Be Totally Indigent Before I Can Get Help From Medicaid

Medicaid allows recipients to own assets of great value so long as those assets are considered exempt under the eligibility rules. In addition to exempt property, a married couple can own non-exempt property valued as high as $122,900 (2017).  Non-exempt property for a single person is limited to $2,000.

VII. I Must Sell My Home To Pay For Private Nursing Care.

Your home is the most sacred asset in the medicaid world with equity of $552,000 being exempt when eligibility is determined. So long as your equity is at or below this amount, ownership of the home should not complicate Medicaid eligibility.  The limit does not apply if a spouse still lives in the home.

VIII. I Would Never Qualify For Medicaid Because My Assets Are Too Great

Even if your non-exempt assets are currently over the resource limit, it is often possible to achieve eligibility before exhaustion of savings with the help of a qualified attorney. Although planning for eligibility can take five years for those who have time to spare, there are definitely still planning options for those who are closer to needing care.

IX. Medicaid Planning Primarily Involves Giving All My Property To My Children

Due to recent changes affecting how Medicaid penalizes gifts, gifting now plays a smaller role in Medicaid planning. While careful gifting can still be helpful, Medicaid planning has never really focused on gifting.  Rather, Medicaid planning really focuses on the process of reinvesting savings in assets that Medicaid considers exempt.

X. The Government Will Take Everything From Me If I Go On Medicaid

In May 2007, Georgia finally initiated an estate recovery program whereby certain sums paid on behalf of a Medicaid recipient will be recovered from their estate after death. Although many of the program’s rules remain ambiguous, it appears that estates valued at less than $25000 will avoid recovery.  Moreover, recovery against a home is generally postposed if the spouse still resides there.  Although recovery may occur, the estate still enjoys significant benefit in that repayment takes place at the Medicaid rate instead of the private pay rate – usually about a 20% discount.