Paying for custodial and medical care can be difficult. Medical costs can add up even if your loved one has Medicare with Medicare supplemental insurance or a Medicare Advantage plan. (In addition to the original Medicare "fee-for-service" program, Medicare offers beneficiaries the option to receive care through private insurance plans. These private insurance options are called Medicare Advantage.) Prescription drugs alone can be several thousand dollars a year. Add other costs, such as help around the home, and it all adds up to a large bill.

Medicaid

Medicaid will help pay the medical and long-term care bills if there is no other way to do so. Medicaid is a program run by both the federal government and your state. To qualify for Medicaid, your loved one must exhaust almost all of his or her assets first. If he or she is in a nursing home and on Medicaid, virtually all income has to be used for paying medical and long-term care costs. Once your loved one is accepted into the program, Medicaid will pay for most custodial and medical care.

What Medicaid Will Let Your Loved One Keep:

• The home (if your loved one or the spouse is living in it)
• A car
• Some jewelry
• Some money for a burial plot and a funeral
• Clothing and some furnishings
• A small personal needs allowance each month
• If there is a spouse that will not be in a nursing home: Extra income each month (The amount is subject to change annually and depends on the state your loved one lives in.)
• Some assets (The amount is subject to change annually and depends on the state your loved one lives in.)

Special Rules Regarding Medicaid

There are some difficult rules regarding Medicaid that you should understand:

• You Cannot Give Away Assets in Anticipation of Applying for Medicaid—Medicaid tries to prevent a transfer of assets in order to apply for coverage under a financial hardship. Medicaid looks at transfers within the last five years. If gifts were made during the 60-month look-back period, coverage can be denied for a period of time. For example, you transfer $75,000 to qualify for Medicaid and it costs an average of $5,000 a month for nursing home care in your area; under current rules, you would not be eligible to receive Medicaid for 25 months ($75,000÷$5,000).
• Medicaid's Strict Definition of Income—Unlike the IRS, Medicaid counts almost all money that an applicant receives as income. This includes proceeds on the sale of assets, inheritances and gifts, life insurance payouts and Social Security checks.
• Forced Sale Of The House—Medicaid allows the applicant to keep his or her house if a spouse or other dependent lives in the home (strict rules apply here as well). Otherwise, Medicaid will force a sale if it can prove that there is no chance the applicant will ever leave a nursing home. The actual time constraints differ from state to state.
• Medicaid Liens—Even if Medicaid lets the house remain in the hands of the spouse that stays out of a nursing home, when that spouse enters a nursing home or dies, Medicaid can use the house to get back the costs it paid on behalf of the applicant. This is called a Medicaid lien.

IMPORTANT NOTE: There are ways people try to plan in advance for Medicaid. These strategies require a skilled lawyer who specializes in this area (commonly called elder law). Keep in mind that Congress has changed the Medicaid qualification rules many times to stop these techniques. In some cases, these changes have been retroactive. PROCEED VERY CAREFULLY AND UNDERSTAND THE RISKS INVOLVED!!!

If a loved one is on Medicaid, alert anyone who is planning to give or leave something in a will to him or her. When that person makes a gift or dies, Medicaid will force him or her to spend down the gift or inheritance. If the person writing the will wants to leave something to your loved one, consider having his or her lawyer set up a trust (called a Medicaid Trust). These rules are very complicated, so you or your loved one should talk to an experienced elder law attorney. If you're aware of any life insurance policies or retirement plans that name your loved one as a beneficiary, change the beneficiary to someone else or to one of these special trusts.

More about Medicare

Medicare is a program that every senior should be participating in. There are some points of caution you should know:

Doctor Charges to A Fee-For-Service Medicare Patient—Medicare sets a maximum amount that the doctor can charge Medicare for each type of service provided.

The Child and Dependent Care Credit can get you 20% to 35% of up to $3,000 of child care and similar costs for a child under 13, an incapacitated spouse or parent, or another dependent so that you can work (and up to $6,000 of expenses for two or more dependents).

In 2020, Medicare Part B has a $198 deductible each year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. What if the doctor wants to charge more than the maximum amount he or she bills to Medicare? The doctor can charge the patient directly for the surplus. (Medicare sets limits as to how much the doctor can charge you over the Medicare maximum.) With the private fee-for-service plan under Medicare Advantage, the Medicare patient is responsible for the difference between the doctor's full fee (not limited by Medicare) and the amount reimbursed by Medicare, up to Medicare's fee schedule.

Paying for Custodial Care out of Savings

Those who have lots of available money may choose self-funding (also known as self-insurance) to pay for custodial care. They may prefer to use their life savings rather than paying monthly premiums on an insurance policy they may never use. This strategy requires your loved one to have set aside invested financial assets that keep up yearly with the cost of inflation and can then be used later on to pay for nursing home care.

IMPORTANT NOTE: We only suggest the self-funding strategy if your loved one has the financial resources to afford this care on his or her own without reducing the retirement income that your loved one and spouse will need.