June 16, 2019










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.