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The Rights and Benefits of Medicare and Medicaid.

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Presentation on theme: "The Rights and Benefits of Medicare and Medicaid."— Presentation transcript:

1 The Rights and Benefits of Medicare and Medicaid

2 Medicare 2012 Part - A (Hospital) `$1,156.00 Deductible $ 0. 00 1st Through 60th Day $289.00 per day 61st Through 90th Day $578.00 per Day 91st Through 150th Day

3 Medicare 2011 Part - B (Doctors) 80% of Medicare Approved Charges - Annual Deductible 162.00. Immunosuppressive Drugs for 1st Year After Organ Transplant. Injections for Broken Bones for Individuals Who Have a Diagnosis of Post-Menopausal Osteoporosis. Mammography Screening for Women over 65 Every 23 Months.

4 Medicare 2011 Skilled Nursing Home 100% of the Cost for First 20 Days. All but $141.50 Per Day from 21st - 100th Day. Three Day Prior Hospital Stay Required. Must Be a Medicare Approved Facility. Custodial Care NOT Included.

5 Medicare 2011 Home Health Care Medically Necessary Part Time or Intermittent * Physical Therapy * * Skilled Care * * No Hospital Stay Required * * Custodial Care NOT Included *

6 What is Long Term Care? The Assistance or Supervision given to a person who has a Physical or Mental Disorder which causes that person to no longer Function Independently. This can be due to Injury, Illness, or the Normal Aging Process.

7 Is Long Term Care Only Used in Nursing Facilities? NO! Long Term Care can be provided in the privacy of your own home, An Adult Day Care Facility, and other types of facilities.

8 Why Medicare Does Not Pay for Long Term Care F Care Provided in a Skilled Nursing Facility Only F Must be Medicare Approved F Three Day Prior Hospital Stay F “Restorative” in Nature

9 Questions To Ask Yourself F Do you know where the money will come from if You need care in a Nursing Facility or At Home? F How long will your money last? F Does it make sense to use your interest on principal to protect your assets to pay for Long Term Care? F Can You count on family to be able to help you? F Can you count on the Government to design a plan that is right for your needs?

10 Who Pays For Long Term Care Services? F Private Insurance 6.5% (and growing) F Medicare 11.8% F Medicaid37.9% F Self and Family43.8%

11 OBRA 1993 - RECOVER FROM YOUR ESTATE F Requires States to Recover Nursing Home Medicaid Expenses From the Estates of Deceased Recipients. F States can go against any real or personal property, including the home you held in your own name. F The State may even recover from assets you gave away or otherwise disposed of prior to death, property you held jointly with another. No recovery is made from Long Term Care Insurance Payments.

12 Spend Down Quick Reference (Welfare) F Home Regardless of income. Some States protect the home for a period of up to six months, if single. F Automobile Up to $4,500 value, no limit if used to go to work or used to receive medical care. F PersonalHousehold goods, personal items up to $2,000. F Wedding RingOne wedding ring and one engagement ring. F PropertyUp to $6,000 equity in personal and real property, if essential for support. F Life InsuranceCash Surrender value of $1,600. F AssetsApproximately $2,000. F Burial CostsFuneral and burial plots up to $2,500. F Personal NeedsAllowance is $35 to $70 per month, monies spent for personal expenses not covered by Medicaid. F Home Maintenance Allowance of approximately $2,000 per month.

13 N Y State Partnership Plan Protects Your Assets Does NOT Protect Your Income The Partnership Plan is a Covenant between YOU and the STATE OF NEW YORK.

14 N Y State Partnership Plan Protects Your Assets Does NOT Protect Your Income YOU promise to purchase Long Term Care with at least the following Minimum Benefits: F $208/Day Nursing Home Benefit F 50% Home Health Care Benefit F 3 Year Benefit Period F 5% Compound Inflation Rider F Plus Other Benefits

15 N Y State Partnership Plan Protects Your Assets Does NOT Protect Your Income The State of New York Promises: When Your Long Term Care Benefits are Exhausted. You will be able to Qualify for Medicaid and We Will Not Take Your Assets. You will however be required to contribute most of your Income.

16 N Y State Partnership Plan Protects Your Assets Does NOT Protect Your Income May Not Be Suitable: F If You are Planning to Leave New York F If You have a lot of Income F If You have Few Assets to Protect F If You Can Afford Longer Term Benefits

17 Why the Need for Long Term Care Six out of Seven Families would be financially devastated by the cost of Long Term Care

18 Why the Need for Long Term Care It is estimated that one third of the Nursing Home Population is under 65 years of age.

19 Why the Need for Long Term Care Every year, roughly half a million people deplete their life savings for Long Term Care and then have to go onto Medicaid.

20 Why the Need for Long Term Care More than 1/2 of the women and 1/3 of the men turning 65 this year will spend some time in a nursing home before they die.

21 Long Term Care Insurance It’s all about keeping you OUT of a Nursing Home

22 Do You really want to end up in a Nursing Home? With good reason we frequently hear: F I’ll put a bullet in my brain first! F I want my privacy, my dignity! F Nursing Homes are unsafe, smelly places with lousy food, filled with over-medicated zombies in diapers and wheelchairs receiving little or very poor care.

23 Why do so many end up in Nursing Homes? Crisis F An unexpected medical crisis such as a Fall from a Broken Hip, Stroke, Alzheimer's, or Over-Medication can be overwhelming. F It is just too easy to listen to well intended advice from health care professionals and wind up in a Nursing Home.

24 Why do so many end up in Nursing Homes? Burnout F Can you really expect your Spouse or Children to give up their lives to care for you? F Are they physically or financially up to It? F How long can they keep it up before their own health is jeopardized?

25 Why do so many end up in Nursing Homes? Savings Depletion No matter how much you are worth: F Long Term Care can wipe you out and quickly. F After your life’s savings are gone, you have to apply for Medicaid (Welfare), and Medicaid pays for very little outside of a Nursing Home.

26 If you should need Long Term Care Where would you like to be cared for: F A Nursing Home F An Assisted Living Facility F At Home Do nothing and you will be guaranteed to enter a Nursing Home in case of need!

27 Long Term Care Insurance is Expensive! of course it is but that’s only because Long Term Care is so very Costly.

28 The Most Expensive Mistake that you can make: To Need Long Term Care and not have Long Term Care Insurance

29 You Purchased Long Term Care Insurance Ten Years Ago. Now you Need the Benefits. How Long Before You Collect More in Benefits Than All of Your Premiums?

30 Answer: In Most Cases Less Than Four Months!

31 January 1, 1997 KENNEDY - KASSEBAUM Qualified Long Term Care Insurance Becomes Tax Deductible! If You Itemize and Exceed 7.5% of Adjusted Gross Income You May Deduct the Premiums Paid.

32 Amounts you may Deduct: Age 40 or Less $320 Ages 41 - 50 $600 Ages 51 - 60 $1,190 Ages 61 - 70 $3,180 Age 71 and older $3,980

33 Benefits Received from Qualified Long Term Care Insurance are largely Income Tax Free.

34 Your Long Term Care Choices: F Take Your Chances. F Give Away Your Assets. (But Don’t Get Caught) F Consider Long Term Care Insurance.

35 Most Important Reasons to Purchase Long Term Care F Choice and Remaining Independent F Protection of Assets F Avoid Emotional Burden on Family F Guarantee Affordability of Services F Avoid Physical Dependence on Family F Quality of Care F Peace of Mind

36 The Greatest Problem DENIAL

37 LONG TERM CARE F Living Benefits to Preserve Lifestyle F Total Protection F Choice and Independence

38 LONG TERM CARE The Choice is yours POVERTY OR PROSPERITY DIGNITY OR DESPAIR


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