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Benefits of Hiring an Elder Law Attorney for Medicaid Planning

Published: February 8, 2021

When an elderly loved one experiences a life-changing health episode, options for long-term care will be undoubtedly pricey. Applying for Medicaid benefits is most families’ first move when told by a doctor that their loved one will require long-term, full-time care. Unfortunately, too many people have not adequately prepared for these decisions and the experience can be overwhelming and stressful for all involved. Seeking counsel from an experienced, knowledgeable elder law attorney can save families money and provide peace of mind that their loved ones’ needs and wishes are being met. Below, after a brief summary of what Medicaid entails, are some of the benefits of hiring an elder law attorney for Medicaid planning.

What is Medicaid

Medicaid is a federal assistance program that is administered by the states. It is designed to help those who are financially eligible pay for the cost of long-term care and allows access to other medical and healthcare benefits. Because Medicaid is a needs-based program, there are strict financial requirements in order for someone to be eligible for Medicaid assistance.

Benefits of Retaining an Elder Law Attorney

Avoidance of conflicts of interest – Conflicts of interest can arise when a nursing home refers the family of a resident to a Medicaid specialist for assistance with the preparation of Medicaid documentation. Often this Medicaid specilaist has loyalties to both the facility that provided the referral and the client applying for benefits. When the facility and person preparing the documentation both want the Medicaid application to be successful, there is no conflict. However, it often benefits nursing homes when residents pay privately for as long as possible before going on Medicaid, and this can provide an incentive on the part of Medicaid specialists to ensure that Medicaid applications are delayed or denied. An elder law attorney hired to assist with Medicaid planning, however, only has a duty to his or her client, thereby eliminating conflict of interest concerns.
Experience and knowledge – Elder law attorneys, with their years of experience, have the knowledge necessary to successfully and compassionately advise their clients on how to achieve their legal goals, regardless of what they may be. And in the elder law arena, these goals are often related to Medicaid.
The availability of malpractice insurance – When an attorney or other professional makes an inadvertent error, malpractice insurance typically covers the loss. However, other advisers in the Medicaid arena often lack such coverage. Therefore, while mistakes by experienced elder law attorneys are rare, clients can rest easy with the assurance that unlikely errors will be covered.
Peace of mind – Finally, consultation with an experienced elder law attorney will provide you with the peace of mind that you have all your bases covered in regards to Medicaid planning. An experienced attorney will take legal issues into consideration during the process that other Medicaid advisers may miss, ensuring that you receive all of the benefits you are entitled to.

At Scott Bloom Law, we are a team of advocates who care, always fighting for what’s best for our clients and their families. With knowledge, experience, and compassion, we strive to find solutions that make the aging process as emotionally and financially easy as possible. Visit us at scottbloomlaw.com or call 215-364-1111, to talk to find out more.

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It can be quite confusing to determine which Medicare plan is best for you. There are several types of plans, and each has its own advantages and disadvantages. Understanding some basic features will help you decide how to maximize your healthcare dollars and choices. You should review your choice periodically, especially as elements of the Inflation Reduction Act of 2022 change prescription medication and vaccine policies. Coverage can also change from year to year..

There are three basic types of plans:

Original Medicare
Medicare Advantage
Medigap

Original Medicare

Medicare is a government health insurance plan for people 65 and older. Original Medicare, sometimes called traditional Medicare, comes in several parts. Each part covers different things and has various associated costs.

Most people do not pay for Part A as it was deducted from their taxes paid while working. It is primarily for hospital visits and nursing care. However, there are many fees associated with being in a hospital that Medicare does not cover, which you still might have to pay out of pocket.

Part B requires monthly premiums, which can be deducted from your social security. You can elect to enroll in part B through Original Medicare. It covers a portion of doctors' visits, durable medical goods, and more.

Part D covers the cost of many prescription medications. You can add it to Original Medicare or purchase it as part of a Medicare Advantage plan.

Medicare Advantage

Medicare Advantage is offered through private insurance companies that Medicare approves. Most plans include Parts A, B, and D of Original Medicare with some variations from the original. There are a wide variety of Medicare Advantage plans, including Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO). PPOs tend to have higher premiums and offer more choices than HMOs. Medicare Advantage HMOs and PPOs often have higher premiums than traditional Medicare because they usually cover more expenses, including prescription drug costs, vision, hearing, and dental.

However, the overall costs, premiums, plus out-of-pocket expenses for Advantage plans can be lower than Original Medicare because the private insurers manage patient care and limit choices. They assemble networks of hospitals and physicians to control their costs and reduce their customer's premiums. They also restrict access to certain providers and increase the cost of care obtained out-of-network.

Traditional Medicare allows people to seek care from any provider participating in Medicare, which includes virtually all hospitals and physicians.

Medigap

Medigap is a co-insurance or supplement to Original Medicare. You can enroll when you first enroll in Part B. It is also available through Medicaid, a union, or a former employer when you qualify for both programs. You can’t have both Medicare Advantage and Medigap plans. Medigap helps cover expenses that Original Medicare does not cover, such as co-pays and deductibles. Due to the enrollment restrictions, you should strongly consider Medigap when you first become eligible.

The Right Choice for You

With all the different plans, parts, choices, and restrictions, it is crucial to consider your priorities for care. Limited access to doctors and hospitals may become important if you need specialized medical care, such as cancer treatment. Before enrolling, consider what specialty hospitals are included in Advantage plans. Likewise, Advantage plans can make it difficult to see a specialist for ongoing and chronic conditions due to limitations in long-term care services. An estate planning lawyer or elder law attorney can help address long-term care planning and the potential to qualify for Medicaid when necessary.

The Kaiser Family Foundation has put together a cost analysis to help you determine when Medicare Advantage would save you money. As you can see, the longer you stay in the hospital, the less advantageous an Advantage plan becomes.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

A Guide in Choices after 65

Enrolling in the right Medicare coverage is one of many decisions that will affect your quality of life in your senior years. We are here to help you navigate a wide variety of choices.

If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

- Medigap, Medicare Advantage, and Traditional Medicare

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This question is asked all the time: “Wouldn't it be easier to get a will off the internet, transfer my land when I die, and put my children on my bank account?” It’s just not a good idea. For the plan to work as you would want it to, it should account for plenty of complications. A good plan should protect your spouse and your children from the loss of valuable government benefits if anybody is or becomes disabled. The plan should avoid the delay and expense of probate court. The plan should protect money from children’s creditors or divorce or remarriage. It should be crafted to serve family harmony and to avoid disputes between children as joint owners. Even a relatively simple situation is made up of many moving parts. Internet documents and joint-ownership devices just won’t do the job.

Also, assembling the moving parts so they work smoothly is just the first step. Your estate plan needs maintenance too, just like your car has a “check engine” light. Major family events like serious illness or death, marriage, birth, or financial reversals are alerts that you should tune up your plan to reflect those changes. Your plan shouldn’t be “one and done.”

It takes expertise to coordinate the various strategies available. Don’t risk a result that will cause your family problems and unnecessary expense. Call us to create a plan that harmonizes the moving parts, so the gears will work together and you will leave the legacy you intended. We hope you found this article helpful. If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

- Creating an Estate Plan On Your Own: Think Twice

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Call Today: 215-364-1111
Toll Free: 855-992-6337