Michigan Elder Law Today ©

Medicare Part A will pay for part of up to 100 days of skilled nursing care per spell of illness in a nursing home or inpatient rehabilitation center.  In addition to meeting the basic eligibility requirements for Medicare detailed in the earlier posts in this series, there are three other requirements that must be met in order to receive this nursing home coverage under Medicare:

When an elderly person is admitted to the hospital, it’s a stressful event.  A situation that can compound that stress is if the hospital wants to discharge your older parent or other loved one before you feel they are ready to be discharged.

Medicare Part A provides health care coverage for care in hospitals as well skilled care in nursing home or rehabilitation centers. Medicare Part A also provides coverage for care provided in hospice facilities and certain home health care services.

After practicing elder law for 15 years, I have found that my prospective clients and their families continue to be mystified by the Medicare program and what it does and does not cover.  As such, this is the first in a series of blog posts that I hope will be useful in explaining the Medicare program.

Medicare was first enacted into law in 1965 and it is the United States government's health care insurance program for people 65 years of age and over. In addition, the program includes coverage for individuals who are permanently disabled, regardless of their age.  Unlike Medicaid, Medicare is wholly a federal program, meaning that the states are not involved in its administration.

Medicare is an entitlement program, meaning it is not based on financial need.  Even though Medicare is an entitlement, older people who have Medicare coverage still will have health care costs they may need to pay themselves.  For instance, there is a monthly premium for Medicare’s coverage.  In addition, Medicare recipients may also have to pay for a portion of the costs of the health care services they receive in the form of deductibles or co-insurance amounts.  Many seniors purchase supplemental health insurance, or have it as a retirement benefit through their former employer, that may cover all or part of these deductibles and co-insurance amounts.  These supplemental health insurance policies are often referred to as “Medigap” policies.

There are some medical services and items that Medicare does not cover, which will be detailed in later blog posts.  Two important ones are long-term nursing home care and in-home care.  Medicare mainly pays for acute care, which are medical services necessary to treat or diagnosis an injury or illness.  This means that the program’s coverage does not include many preventive health care services.

Medicare has four different parts:  Medicare part A includes hospital coverage.  Medicare part B coverage includes outpatient care, including doctor office visits.  Medicare part C, which was intended to provide additional options for health care services.  Medicare part D includes prescription drug coverage.

Eligibility Requirements

The eligibility requirements for Medicare part A are:

• You must be a United States resident who is age 65 or older and you must be eligible for Social Security.  If you are not a U.S. citizen, you must be a legally admitted alien who has resided in the U.S. continuously for at least five years; or
• If you have not attained age 65, you must be a disabled person of any age who has been entitled to Social Security disability benefits for 25 months; or
• individuals who have end-stage renal disease will be eligible for Medicare Part A.

One is eligible for Medicare part B if they are age 65 or older, regardless of Social Security eligibility.

My next post will discuss in more detail the coverage provided under Medicare Part A.

The United States Department of Veterans Affairs (VA) Aid and Attendance program can be an excellent option for older wartime veterans and their widows. Among other requirements, there are four tests to qualify for Aid and Attendance, including military service, medical status, asset level, income level, and then documentation and proof of these requirements. The topic of this post will be the income requirement.

Long-term care is expensive.  Nursing homes in Michigan cost, an average, $227 per day or $6,816 per month for a semi-private room.  Assisted living in the metro-Detroit area cost, an average, $114 per day or $3,425 per month.  Home health aides cost, an average, $19 per hour. 

As an elder care attorney, I frequently meet with the adult children of a senior who has been hospitalized and is about to be discharged to a nursing home or has recently moved into a nursing home.  In these meetings, a common situation I see is that one of the adult children, frequently a daughter, has been providing  care to her mother or father for quite some time.  

In my last post, I wrote about what you do with the home of a nursing home resident in a crisis Medicaid plan.  A crisis Medicaid plan is planning that is done when an older person’s move to a nursing home is imminent or after they have already moved to a nursing home.  While I, as an elder care attorney, can help save money in a crisis situation, since it is often better and less stressful to avoid a crisis, in this post I will discuss the options and benefits of planning ahead for long-term care.

Many people are aware that an older person who is a nursing home resident can continue to own a home and qualify for Medicaid nursing home benefits.  Nevertheless, in assisting people in my elder care practice with paying for nursing home care, I have seen that the home is often the major asset at risk or that is lost, despite the protection provided to the home under Michigan’s Medicaid laws.

The VA Aid and Attendance benefit is one of the best options for older wartime veterans or their widows who need elder care assistance.

Long term care is expensive, and the receipt of these veterans services can help avoid the high costs of nursing home care, assisted living, or home care in depleting an older person’s assets.  That’s important because, once an older person is out of money, their only care option is to apply for Medicaid. 

As an elder law attorney who assists seniors and their families with Medicaid eligibility, I am frequently called on to review Medicaid nursing home applications that have been denied.  Since most people who need to move to a nursing home and apply for Medicaid are the frail elderly, often age 80 and over, these Medicaid applications were usually prepared by someone else for the nursing home resident, be it their spouse, who also may be quite elderly, or an adult child of the nursing home resident.