Medicaid Crisis Planning … versus Long-Term Care Insurance?

Serving Clients and their Families throughout Franklin
and Nashville, Tennessee & the Surrounding Areas


Are you or a loved one faced with long-term care expenses? Are the costs of long-term care, nursing homes, assisted living, and home care getting to be too much?

If you are thinking about Medicaid, you should speak to an attorney who concentrates his practice in that area of law as soon as possible. There is really no time to waste—all you are wasting is money and adding stress. The sooner you address this, the sooner you may be eligible for Medicaid.

When we hear the word "crisis," we think of disasters or calamities of epic proportions. Well, that is where many Americans find themselves when they (or a family member) try to stay above water financially when dealing with the high costs involved with senior care—especially when care facilities are involved.

Accordingly, "crisis planning" in this context is planning for those who have an imminent need for Medicaid eligibility.

What if your husband or wife has been diagnosed with amyotrophic lateral sclerosis (ALS or "Lou Gehrig's Disease") … or Parkinson's, Huntington's, or some form of dementia like Alzheimer's?

Along with the devastating news, the neurologist recommends that your spouse be placed in a nursing home immediately. You have no idea what this will cost, let alone how you will pay for it. In short order, you learn that Medicare will not pay for long-term care. You may be familiar with Medicaid, but you have no idea whether your spouse qualifies or even how to apply.

If you are facing a similar situation, you need to discuss the Medicaid planning and application process with an experienced elder law attorney. An elder law attorney will have the necessary skills and contacts required to help you to address the important issues, create a strategy, engage and direct the required healthcare staff, and work with you to get the Medicaid application submitted and approved.

Does Medicare cover all of the nursing home bills?

Unfortunately, not, though many people are under the impression that Medicare will cover all of the expenses for nursing home care. Such is not the case. The most that TennCare will cover are the first 100 days, and even then, it does not pay the full amount.

Other people believe that Medicare is only for the needy, which is also not the case. Medicare can help pay for long-term care in certain circumstances, and eligibility is not income-dependent.

So Where Does Medicaid Come In?

For most people, Medicaid only becomes an option after Medicare benefits are exhausted. But what many people do not realize is that Medicaid benefits are not automatic. In fact, to receive Medicaid, a patient and the patient's spouse (if married) must first "spend down" their "countable" assets. In Tennessee, the spouse seeking benefits can have no more than $2,000 in total assets. The rules are more complex for married couples where the non-applicant spouse can retain significantly more assets. There also are categories of assets that will be automatically exempt for purposes of qualification.

It sounds pretty easy, right? Wrong!

Actually, things can get complicated quite quickly. What do I do to protect assets? What do I do to convert assets without getting in trouble? Do I apply before or after care begins, and what about the bills in the interim?

These are all valid questions, and you should seek professional advice from a qualified attorney who practices in Medicaid planning, understands the Medicaid system and can help you get organized for the future. If you qualify, Medicaid benefits can help pay for certain medical expenses such as:

  • Doctor and Hospital Bills;
  • Prescriptions;
  • Vision and Dental Care;
  • Medicare Premiums;
  • Nursing Home Care;
  • Personal Care Services (PCS), Medical Equipment, and Other Home Health Services;
  • In-Home Care under the Community Alternatives Program (CAP);
  • Mental Health Care; and
  • The majority of medically necessary services for children under age 21.

We are all most vulnerable in circumstances when we “don’t know what we don’t know.” Know your legal rights … before it is too late.

Have Questions?

Have Questions?

We’d Love to Talk with You

John Burns Law, PLC

John Burns Law, PLC

219 3rd Ave N #2000
Franklin, TN 37064

jburns@johnburnslawfirm.com
(615) 630-0122