August 17, 2019










What Is Medicare Planning?

You plan for retirement, you plan for significant expenses, but what about Medicare planning? Most individuals under the age of 65 do not think of Medicare until it is too late. Ideally, you want to start planning for Medicare benefits long before you need them. Doing so can ensure you are not only approved but have access to the benefits you need quickly when you need them.

Medicare Planning Is Critical for Your Financial and Health Well-Being

One of the more significant decisions you will make while you near retirement is regarding your Medicare plans. You want to access all of the benefits and supplement options you can. Otherwise you will be paying out of your retirement fund for medical costs. Medicare planning means taking time to sit down with an estate planning attorney to look over your options and prepare for those unexpected costs.

What Is Medicare and Do I Need It?

Medicare is a government health insurance program managed by the federal government. When you reach age 65 or older, you are eligible for Medicare insurance benefits (some with qualifying disabilities or end-stage renal disease can receive Medicare before age 65).

Medicare has multiple parts, and when you go into a planning meeting with an attorney, they will go over each and help you understand which ones you’ll need for your healthcare in the future.

  • Part A: Part A is your hospital insurance plan, but it only covers admission into a hospital or skilled nursing care facility. You do not have a premium for this plan.
  • Part B: Part B is your actual medical insurance, which handles doctor’s office visits, laboratory tests, outpatient procedures, and more. You do have a monthly premium for this portion.
  • Part D: Part D is optional but highly recommended as it covers your prescription drug costs, and you do have a premium for this plan.

Why Medicare Planning Is an Important Step in Retirement

Healthcare is one of the most overlooked expenses when people plan for retirement. They think of their health situation right now rather than the likelihood that it will decline during their retirement. Medicare costs and the benefits you plan to use are critical parts of your retirement plan. In fact, they should be part of your estate plan.

When you start thinking about your future, your estate plan is one of those steps you are already taking to protect yourself and your loved ones. While estate plans are often thought of as a component for after death, they do protect you while you are still alive.

In fact, you can set up a trust today that will help you now and into the future when you hit retirement. Likewise, that trust is there to provide for your loved ones if you were to pass away.

Does My Income Affect Medicare?

Medicare is not the same as Medicaid. While Medicaid is asset and income-based, your Medicare benefits only require that you have a qualifying disability or that you are over the age of 65.

Creating Durable Powers of Attorney

While you are doing Medicare and retirement planning, one critical step to take is your durable powers of attorney. You could designate a friend or family member to make all legal and medical decisions on your behalf if you were to become incapacitated. They can also access your Medicare benefits so that you can use them while you receive medical treatment, and they can pay for your premiums to keep your Medicare coverage alive as well.

Make sure you pick a person that you can trust to handle all financial and healthcare-related decisions on your behalf. You will want someone who can think through critically, honor any wishes you might have about life-saving care, and who is responsible enough to handle your finances while you are unable to do so yourself.

Setting Up a Trust

You can create a trust to protect your assets while you perform retirement and Medicare planning with an attorney. A trust puts your assets into a single account and can include everything from bank accounts to property and even your life insurance policy. You are in charge of your trust’s assets while you are alive, including the ability to move them in and out of the trust, and use the assets in your trust for your living expenses. Once you pass away, the beneficiaries you name in the trust will receive their distributions per your allotment request. One benefit to setting up a trust is that, if you do pass away, your loved ones can skip the hassle, cost, and time consumption of going through probate court as well.

Do You Need an Attorney for Medicare Planning?

While you do not need a lawyer to plan for Medicare, you do need one who can help establish your estate plan, make your durable powers of attorney, and create a trust. Even if you do not plan to create a trust, you need a will drafted that will tell loved ones who inherits what and your wishes for burial.

Regardless, meeting with an attorney is beneficial if you need to plan for retirement and determine how you will care for your loved ones. One of the biggest advantages is that you can make sure you set aside funds in a trust to pay for medical costs not covered by Medicare, such as nursing home care. While you are covered for skilled nursing facilities and hospitalizations, your Medicare benefits will not cover long-term nursing home or in-home nursing home care.

By planning ahead, you can work your assets so that you will qualify for Medicaid, which helps pay for additional care as you get older.

To explore your options and make sure you and your family are protected, schedule a free case evaluation with the Law Office of Andrew M. Lamkin today. You can schedule your appointment at 516-605-0625 or request more information online about our estate planning and retirement planning options.

What Assets Disqualify You for Medicaid?

Medicaid’s application process is extensive, and it includes a detailed review of your assets. Certain assets can disqualify you from this federal and state program. But with the right planning, you might still qualify if you know which assets are countable and which are not.

Medicaid and Medicare of often used synonymously, but these are different programs entirely.

While both pay for medical and health care-related costs, Medicare is age-based; not income or asset-based. The only time income plays a role in Medicare is determining your premiums for certain coverage options. Instead, you can receive Medicare benefits if you are over 65 years, or if you have a qualifying disability. Medicaid, on the other hand, works more like public assistance; therefore, the program scrutinizes everything from income to assets to financial resources to determine if you qualify.

You are required to provide documentation when you apply for Medicaid, and omitting assets not only will guarantee that you are excluded, but it could also constitute fraud.

The Medicaid income assessment is straightforward, and it includes any income like Social Security, retirement, or actual wages from a job. However, the asset portion of qualifying is more complicated, and sometimes you might think that an asset doesn’t count when it does – affecting your chances of approval.

What Assets Count for Medicaid?

Assets eligible for Medicaid consideration include:

  • Checking and Savings Accounts – Any checking or savings account with your name or your spouse’s name count as an asset. Therefore, having a high amount of funds in those accounts could disqualify you. This includes long-term savings accounts or investments like CDs.
  • Stocks and Bonds – Any investment accounts you have, including bonds, stocks, or funds, count toward your eligibility. These are considered assets that you can withdraw and pay for medical expenses and long-term care. Therefore, the state will assume you have enough funds to pay for your care.
  • Real Estate Other Than Your Primary Residence – Your primary residence does not count. But if you own secondary property such as a rental home, vacation property, or even a co-owned property like a timeshare, these count.
  • Extra Cars – Your primary vehicle will not count, but any additional cars and recreational vehicles do count as assets.
  • Life Insurance – The cash value of a life insurance policy also counts. If the amount exceeds $1,500, then any excess is considered an asset to your estate and will be considered in your application.
  • Cash – While you can possess some cash, too much may disqualify you. For example, if you have $50,000 in a checking account, it would most likely disqualify you unless you could prove those funds were dedicated to something specific.

What Assets Do Not Count for Medicaid?

Medicaid doesn’t count certain assets that go toward your living, and those not considered liquid.

Some assets that are not counted include:

  • Your Primary Residence – Luckily, your primary residence doesn’t count against you for Medicaid. Even if you own your home in full, it is your home and primary residence where you live 90% of the time. Therefore, you do not have to worry about it disqualifying you. There are limits to your home equity, however.
  • Personal Property – Any personal property you own, especially that inside your primary residence, does not count.
  • Life Insurance – Any life insurance with a face value under $1,500 does not count.
  • Burial Expense Funds – You can still set aside funds for burial and funeral expenses, up to $1,500, without it counting against you when you apply.

Home Equity

When Medicaid looks at your home, regardless of the value, it is exempt. However, it will affect whether you get payments for long-term care and nursing homes from Medicaid, especially if the equity of your home exceeds a specific threshold. The equity of your home, which is the fair market value minus what you owe, does affect Medicaid qualifications.

What about Income?

Any income you receive from pensions, retirement accounts, and Social Security will count in your application. You can, however, keep up to $800 per month of your income, along with any costs associated with healthcare premiums, if you qualify for Community Based Medicaid. Any extra income, referred to as spenddown, must be used on your healthcare before Medicaid pays for the excess.

Your Options for Managing Assets When Applying for Medicaid Programs

Because your assets do play a heavy role in determining eligibility for Medicaid programs, you may want to look for other ways to protect family assets rather than selling or disposing of them to qualify for the healthcare coverage you need.

One of the best options is a Pooled Income Trust. A Pooled Income Trust is a unique trust that allows you to become eligible for Medicaid programs while still preserving your assets. Not everyone requires this type of trust, but when your assets exceed the qualifications for Medicaid, you may want to use a Pooled Income Trust.

How It Works

Pooled Income Trusts are allowed by federal law. You protect your public benefits, but you also receive pooled funds for expenses. You can then use your Pooled Income Trust for multiple expenses, such as:

  • Living costs, including food, clothing, and shelter
  • Housing costs, including rent or utilities
  • Private nursing care
  • Assisted living care
  • Medical procedures not covered by your government insurance plan
  • Entertainment
  • Travel
  • Attorney fees

Under the current laws in New York, your monthly income excess must be spent down to qualify for Medicaid, which is where your trust comes in. When you deposit into the Pooled Income Trust, you are no longer subjected to the ordinary rules for extra income and now you can protect the income benefit without selling your assets.

Speak with an Estate Planning Attorney to See How You Can Plan for Long-Term Care and More

If you are worried about how you will afford long-term care or how you will preserve assets while using government insurance, then you need to meet with an estate planning attorney.

Andrew M. Lamkin, P.C., has helped countless clients just like you figure out how to manage their assets, create estate plans, and ensure they can still qualify for Medicaid without throwing away everything they have earned.

Schedule your free consultation to discuss your Medicaid planning by calling us, or you can request more information about estate planning online.

How to Qualify for Medicare and Medicaid: A Planning Guide for Seniors

Retirement is around the corner. And while you have most of your retirement planning complete, the one area you put off is now knocking at the door.

Medicare and Medicaid become staples for retirees in New York. Without them, you do not have coverage for prescriptions, medical costs, and even nursing care. Therefore, it is time to pull out your paperwork and get ready to apply.

Being prepared, understanding how the process works, and ensuring you qualify are all critical when it comes to government insurance programs. These programs have strict requirements and deadlines. And when one misstep occurs, you experience lengthy delays.

It is best to consult with an attorney that has Medicare and Medicaid planning experience. Attorney Andrew M. Lamkin, P.C., can assist you with these steps, help allocate assets appropriately to qualify financially, and advise you on the process for both programs and which program you may be eligible for.

Medicare Planning for Plainview Residents

Medicare coverage in New York comes in various options; therefore, explore each and see which might work for you and your healthcare needs. New York uses the federal options of original Medicare (Part A and Part B), and the Medicare-approved insurance plans like Medicare Part D and Medicare Advantage.

Here is how each of these work:

  • Medicare Part A and B: This is primary insurance coverage. Part A focuses on hospitalization insurance, while Part B is general health insurance.
  • Medicare Advantage Part C: Plans for Part C come through private health insurance companies but must be approved as part of the Medicare program. These cover the same as Part A and B, but also give dental, vision, and prescription drug coverage benefits.
  • Medicare Supplements: Supplemental insurance plans help fulfill gaps between Advantage Part C, and original coverage. These come with up to ten various plans.
  • Medicare Part D: Prescription coverage under Advantage Part C may not be enough, depending on the number of prescriptions you take each year. Part D provides a stand-alone prescription coverage that works with Part A and Part B, saving you the hassle and cost of adding on Part C when you do not need the additional coverages it has.

When Do You Qualify for Medicare?

Applications for Medicare are accepted once you can show your legal residency in New York for a consistent five-year period and if you are 65 years or older. In some rare instances, you may qualify if you are under 65 if you have a qualifying disability or condition. Luckily, you automatically enroll in Medicare if a spouse or you already receive Social Security or Railroad Retirement Board Benefits or are diagnosed with Lou Gehrig’s Disease (ALS).

Medicaid Planning for Plainview Residents

Medicaid is more complicated than Medicare. Medicaid covers medical costs and insurance for residents of the state who cannot afford to do so themselves. You may qualify when you have high medical costs, receive Supplemental Security Income, and you meet the strict financial requirements.

Applications for Medicaid differ from Medicare. You do not automatically enroll. Instead, you must meet the Modified Adjusted Gross Income (MAGI) rules then apply through the NY State of Health or by using a Managed Care Organization (MCO).

Groups that qualify for Medicaid include:

  • Pregnant women;
  • Infants and children under the age of 19 years;
  • Childless adults between the ages of 19 and 64 whom certify as disabled and do not receive Medicare;
  • Parents and caretakers of sick relatives;
  • Family planning benefit recipients; and
  • Children in registered foster care programs.

What the Government Considers When Reviewing Applications for Medicaid

Medicaid is no cost to the recipient. Therefore, the government is strict about who can receive this medical benefit.

Medicaid is a joint insurance program through New York and the federal government. It pays for nursing homes and health aides for those who qualify. Unfortunately, too many qualified applicants assume they will not be accepted; so they do not try to receive benefits.

While the requirements are strict and hundreds of applications are denied each year, often, it is because the applicant did not go through the proper planning stages ahead of time. Working alongside an estate attorney with Medicaid planning experience is crucial here. An attorney establishes a plan that helps move assets and allows you to qualify under the financial requirements.

The Department of Social Services looks at three primary factors when considering qualification:

  1. The needs of the applicant and the care they seek in their application
  2. The income of the applicant and spouse, including pensions, retirement benefits, rental or investment dividends, and Social Security benefits received monthly
  3. Assets and resources of the applicant and their spouse, including home value, investments, cash, and insurance policies

Depending on the Medicaid program you apply for, one or more of these three will be heavily weighed in the decision-making process.

The Various Medicaid Programs and Options

You should only apply for the type of program you need and would likely qualify for. For example, the Community Based Medicaid program is for those who need a home health aide to assist with daily living. This plan has income requirements. And assets, including homes, are considered as part of the income cut-off.

The Benefit of Hiring a Medicaid and Medicare Planning Attorney

While you could plan yourself, an attorney is valuable in Medicaid and Medicare planning. Obtaining these state and federal insurance programs is complicated, and the process can be drawn out unnecessarily when things are not done right.

At the Law Office of Andrew M. Lamkin, P.C., you receive an advocate with years of experience in estate planning and Medicaid qualification requirements. He understands the complexities of these government programs, and he can ensure that you not only apply for the programs you qualify for, but prepare your estate so that you can receive your much needed benefits without unnecessary delays.

To get started, speak with attorney Andrew M. Lamkin, P.C., during a free case evaluation. Schedule your appointment now by calling 516-605-0625 or request more information online.

How Does Nursing Home Medicaid Work?

Medicaid is a government-funded program that takes many forms. Many New York residents are surprised to find out how many options they have for Medicaid coverage, including Nursing Home Medicaid.

Nursing Home Medicaid is one of the more comprehensive Medicaid programs, and it comes equipped with all Medicaid services from Community Medicaid and Community Medicaid with Long-Term Care. Also, you receive nursing home coverage as well as home care, adult day care, and assisted living care coverage.

Nursing home care in New York is costly – averaging more than $100,000 per year. Very few people have adequate resources, income, or even insurance to pay the costs of nursing homes. However, they need those long-term care services. Medicaid is the most common source for funding nursing homes and long-term care needs, but you need to apply for the proper coverage first.

How to Pay for Nursing Homes with Medicaid in Plainview, NY

A nursing home is a residential facility where you receive 24-hour nursing care and supportive services. Anyone who is 65 years or older, disabled, or legally blind qualifies for Medicaid, which handles nursing home fees. But you are only eligible based on income, resources, and if you require skilled nursing care.

Nursing Home Medicaid has stringent requirements. And unlike Community Medicare, Nursing Home Medicare does have a lookback period. Therefore, it is vital that you understand what these requirements are, and speak with an attorney to begin Medicaid planning sooner than later.

How to Qualify for Nursing Home Medicaid in New York

When you apply for Nursing Home Medicaid in New York, you are subject to substantial scrutiny. There are two primary areas that the state reviews when considering your eligibility: income and resources. Like other forms of Medicaid, you have strict monthly limits and maximum asset value amounts.

Your income is any money you receive per month or on a time-based schedule such as Social Security distributions, checks from a pension, or payouts from a retirement account. Your resources are assets. These assets include everything from investment accounts, stocks, bonds, savings accounts, or retirement accounts that you are not receiving a distribution from yet.

New York gives you a $50 per month income allowance if you are a nursing home resident. You cannot shelter income in a pooled income trust for Nursing Home Medicaid either.

Resource Limits for Nursing Home Medicaid

If you apply for Medicaid, you are subject to a nursing home resource maximum of $14,850. Any resources above this maximum must be spent down before you will qualify. If you exceed the resource value, speak with an elder law attorney to see how you can salvage your hard-earned assets while still qualifying for Medicaid.

The Five Year Lookback

Community Medicaid has no look-back period, but Nursing Home Medicaid does. If you want to gift or transfer assets to qualify for Medicaid without the hassles of spending down, you are subject to a look-back period of five years. Therefore, after you have completed all transfers, you must wait five years to apply or pay the penalty if the transfer was within the five year look-back.

The penalty rate is based on regional rates. For example, in 2017 the regional rate per month was $12,157 for New York City. Therefore, if you transferred assets, the value of those assets in the five year period would be divided by the regional rate to determine your penalty.

New York bases regional rates by the district. For example, New York City has a different rate than Northeastern New York (i.e., Albany, Greene, Hamilton, or Washington). You can see a full list of Medicaid Regional Rates online.

During your penalty months, you will not receive Medicaid payment. Instead, you pay privately for nursing home care until the penalty period is up. Then, Medicaid will take over payments.

For example, you transferred $100,000 in assets within the five year look-back. You live in Manhattan; therefore, as of 2017, the regional rate is $12,157. You would be subject to a penalty of 8.22 months for the transfer. If you lived in the Central New York District, the regional rate is $9,511, which means your penalty would be 10.5 months.

Intent to Return Home

Your home’s equity is exempt from resource considerations if you can prove that you intend to return home. Intent is subjective, but if there is a possibility that you will leave the nursing home and return home, you can request an exemption. The state could place a lien on your property if you are not reasonably expected to return home. Therefore, you must be cautious about claiming this exemption.

Other Exempt Income and Resources

You can also spend down your excess income to qualify for Nursing Home Medicaid. For example, if you are spending money on health insurance premiums, that money is not counted when the state reviews your income. Also, if you receive payments from specific resources, the state may allow for exemptions such as Holocaust restitution payments.

Contributing Your Income

If you are considering staying in a nursing home, the Nursing Home Medicaid program does require that you contribute your monthly income to the cost of your care. You are only allowed to retain $50 per month for yourself. You can pay your excess income to the Department of Social Services to keep eligibility, but it may be in your best interest to find a more useful way to spend the excess and reduce resources.

Speak with an Elder Law Attorney

Limiting your income and resources for Medicaid planning is a highly complicated process. The sooner you start it, the better the outcome might be and the less likely you are to face long-term Medicaid penalties.

If you plan to or suspect that you will need nursing home care at some point later in life, start the process of Medicaid planning now. Contact the Law Office of Andrew M. Lamkin, P.C. Attorney Lamkin can help you cover your bases when it comes to reducing resource value, limiting income, and qualifying for Medicaid.

Explore your options for long-term care planning by scheduling a free consultation at 516-605-0625 or request more information about elder care services online

What Is Community Medicaid and Who Qualifies for It?

New York offers various homecare and nursing home care solutions for aging residents. To determine which type of services you qualify for, you need to assess your budget. Depending on your income, age group, and disability status, you may be eligible for individual types of Medicaid coverage offered by the state.

Community Medicaid is one of those options. You may qualify for Community Medicaid or Community Medicaid with Long-Term Care if you are over the age of 65, blind, or certified disabled by the Social Security Administration or NY State.

What Does Community Medicaid Cover in Plainview, NY?

Community Medicaid is a health insurance program that handles most healthcare-related expenses such as doctor’s office visits, hospitalization, laboratory testing, and prescription medication.

If you are disabled, aged, or blind, you most likely have Medicare coverage and Medicare is your primary health insurance. However, Medicaid is a health insurance supplement. Community Medicaid helps bridge the gap between what Medicare covers and what you would otherwise pay for out-of-pocket. If you already have a supplement policy, such as Medigap, then Community Medicaid would cover anything after both policies are exhausted.

Another key coverage you receive with Community Medicaid is prescription drugs. Medicare does not cover prescriptions directly. Instead, Medicaid pays to Medicare under free Medicare Part D to cover your prescription drug costs.

What Is Community Medicaid with Long-Term Care

Community Medicaid with Long-Term Care works like Community Medicaid regarding prescription and health insurance coverage. However, it also offers additional coverage for long-term care services such as adult day care, assisted living, or in-home nursing care.

Do You Qualify for Community Medicaid?

Medicaid eligibility is based on income and resource limits. Therefore, you must pass a means-tested system. If you have low income and limited resources, then you may qualify for Community Medicaid.

The means-based system considers two financial categories:

  • Income – This is any money that you receive on a scheduled basis including pension payments, IRA distributions, and Social Security payments.
  • Resources – Resources involve your assets that could be used to pay for health expenses and in-home nursing care. These are assets such as your savings accounts, stocks and bonds, real estate, and an IRA that you are not currently receiving a distribution from.

Income and Resource Limitations for Community Medicaid to Know

Medicaid has income limits, which include:

  • $825 per month for an individual
  • $1,290 per month for a couple

Anyone that is aged, disabled, or blind qualifies for a $20 per month disregard. Therefore, if you are in one of those categories, you would have an income limit of $845 per month as an individual, and $1,310 per month for couples. Couples only receive a one person $20 disregard.

The resource limits are in addition to income limits, and they include:

  • $14,850 per individual
  • $21,750 per couple

If you are not looking for long-term care coverage, you can declare your assets and you are not required to document them for the application. If you do want long-term care coverage, you must record your resources. Resources are the primary determination of whether you qualify for Community Medicaid or Community Medicaid with Long-Term Care. Therefore, if you do not need long-term care, you will not have a heavy emphasis on your resources.

What If You Exceed the Limits?

Even if you exceed these limits, you could still qualify for Community Medicaid programs. There are  ways to help you qualify even when your income or resources go over the threshold. However, you should consult with a Medicaid planning attorney to explore these options. An attorney can review your expected income and current resource value, then help with a Medicaid or Medicare plan that legally assists you with qualifying for these forms of assistance.

Most options involve doing a spend down. This means that you spend to a specific threshold to help qualify for Medicare.

These are some options when you exceed the limits.

  • Paying Medical Bills – If you have monthly medical expenses that are more or equal to the amount of income over the threshold, Medicaid will ignore the excess income and allow you to qualify for Community Medicaid benefits.
  • Income Trust – New York is a state that realizes that $845 per month is not enough to cover someone’s cost of living let alone medical care. That is why they allow residents with excess income to establish a Pooled Income Trust. With an attorney’s help, you can set up the trust and then deposit the surplus income into the trust. Then, you submit your living expenses to the trust for reimbursement and the trust pays your bills. A Pooled Income Trust must meet specific state requirements, and you must provide monthly contribution records to show that it is active.
  • Paying Medicare Provider – If you do not want to use a Pooled Income Trust, you can spend down your excess income by paying your Home Care Medicaid Provider directly and contributing to the cost of care.

Earned Income

Some individuals that exceed the income amount may be able to claim for earned income.

For example, an applicant works part-time and earns $1,065 per month. All earned income qualifies for a $65 disregard, and the remaining income is divided by two. For Medicaid budgeting, that applicant can deduct $65 from earned income totals, leaving them with $1,000 per month. Once that amount is divided by two, they have a budgeted earned income of just $500 – qualifying them for Medicaid.

Considering the Look-Back Period

When your resources and income disqualify you from Medicaid, you may want to spend down so that you qualify. Spending down might include transferring assets to other family members so that you have fewer resources holding you back.

When applying for Community Medicaid, you can do this. Community Medicaid does not have the look-back period that other Medicaid programs do, which gives you more options for spending down before applying.

Need Assistance with Medicaid Planning?

If you need help with Medicaid or Medicare planning, speak with attorney Andrew M. Lamkin at the Law Office of Andrew M. Lamkin, P.C. Spending down resources and moving assets is complicated, and you want to ensure you follow the proper procedures so that you do not disqualify yourself from much-needed Medicaid coverage.

Schedule a free case evaluation at 516-605-0625 or request more information online.