Medicare Versus Medicaid – A Big Difference for the Elderly

Despite the similarity in the words, Medicare and Medicaid are two very different health care programs.  Medicare and Medicaid affect the elderly in different ways.

Medicare vs. Medicaid

Medicare is a federal health care program for people over the age of 65 and those people with disabilities who qualify for Medicare insurance. There is no other qualification. Income level does not matter with Medicare. Medicaid, however, is run by each state (with assistance from the federal government) and is a health care program for lower income people. Each state creates its own Medicaid program based on federal guidelines. Unlike Medicare, where benefits are automatic at a certain age, you have to qualify for Medicaid benefits.

This difference becomes very obvious when you are moving a loved one into assisted living. Medicare, the federal health insurance program, does not cover assisted living. Medicaid does. However, Medicaid requires a person to have a certain income and asset level in order to qualify for Medicaid payments to assisted living centers. Each state is different. For example, in Michigan, the asset level is $2,000.00. Again, Medicaid is for people with little financial means.

Assisted Living and Medicaid

If assisted living is required with your loved one and they do not qualify for Medicaid, then payments to the assisted living center come from personal income and assets. Medicaid requires you to “spend down” these assets until they reach a certain level before Medicaid begins paying. There are certain exempt assets, such as a home, a car, etc., but if your loved one has an IRA, savings account, stocks or any other assets, payments to the assisted living center come from your loved one’s income and assets first. This can financially devastate a family. So, the more time you have to plan for a loved one’s move to assisted living, the better. There are ways that you can decrease the amount of assets, but Medicaid typically has a 60 month look-back period, meaning they will look at all of the asset movement for the past 60 months to determine whether it was a legitimate transfer or whether the asset should be included as part of your loved one’s assets. The Medicaid rules get very tricky, so if you think that the government is going to help pay for your loved one’s stay at a facility, you need to become familiar with Medicaid rules in your state and perhaps seek an attorney for some estate planning for your loved one.

Some individuals are eligible for both Medicare and Medicaid and they are called “dual eligible.” For those that receive both coverages, most of their health care costs are covered. Medicare pays first, then Medicaid will pick up most, if not all, of the balance.

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Shorts, Black Socks and Dress Shoes

Growing up in the 60’s and 70’s, the one dress style that I hated the most was when my dad or his male friends, or even our male neighbors, would mow the lawn or do yard work wearing shorts, black socks and black dress shoes. I could never understand the fashion statement and I would cringe when I saw my dad wearing such an outfit. He wasn’t a nerd or anything, but boy when I saw him dressed like that, I just wanted to hide from the embarrassment of it all. Well, fast forward to 2018. A few months ago, my husband comes out of the bedroom because he’s going to mow the lawn and do some yard work. What is he wearing? You guessed it. Shorts, black socks and black shoes. My first thought was “I married my dad.” I of course shrieked with disdain and said “You’re not going out in public dressed like that are you?” He said “Of course I am.” I was just as embarrassed a few months ago as I was years ago.
I’m sure everyone has that one fashion combination that, when seen, causes cringes. One only hopes that it is just a fad and it will go away. For me, what my father started, my husband carried forward. I’m doomed to either learn to like the style, ignore it or cherish it as a worthy characteristic in the two loves of my life.

The Different Levels of Elder Care Facilities

Whether you are thinking about moving to an elder care residential facility or worrying about moving a loved one to a facility, researching is the key. The research process can be long and stressful, so here are some helpful definitions to get you started.

  •  Independent Living

    This is a type of senior living where a person lives in an apartment-type complex. The complex has security and usually offers its residents transportation, group activities, and cafeteria style eating. Health care services are minimal. Laundry services can also be included.

  • Assisted Living

    This is also apartment-style living with group activities, food services and security. But this type of facility also provides basic health services. Skilled nursing (a level of care provided by trained persons such as RNs, physical therapists, etc.) is usually not included. Laundry services are usually included along with assistance in bathing and dressing.

  • Skilled Nursing Facility

    This is also known as a nursing home or a convalescent home where residents receive 24/7 care by licensed professionals. Housekeeping and laundry services are usually included, as well as bathing and dressing assistance.

One popular and emerging type of elder facility is the Continuing Care Retirement Community. A typical community of this type includes several residential complexes. A person in declining health can live in the independent living section of the complex, then as his/her health deteriorates, the elder can move to a different residence in the same complex that provides more and higher levels of health care assistance.

Medicaid for Parents Going Into Assisted Living

What is Medicaid?

Medicaid (not Medicare) is a federal/state health program for the needy and low-income. The rules are state-by-state and many of us are now looking at Medicaid for our parents that have little to no assets and who need to be in either assisted living or full time nursing care.

Each State has Different Medicaid Rules

The Medicaid rules in all states are very detailed and hard to follow. But, safe to say that there are two eligibility requirements – income and assets. There are assets that are counted by Medicaid and assets that are exempt. For instance, in Michigan, a person can own only $2,000.00 in assets to be eligible for Medicaid, and a person’s primary residence is exempt – not counted – in the total assets. If the assets exceed the minimum, a person must personally pay for the assisted living or nursing care until the assets reach that level.

Income levels are another eligibility requirement. Most, if not all of a person’s income, is paid directly to the assisted or nursing care facility. Again, the requirements go by state.
The cost of assisted living and nursing care facilities also vary by type and by state. The costs can be $4,000.00 per month and up, depending on where you live, the type of facility and the level of nursing care needed by the ailing person. The best thing to do is, when it is getting harder for a family to take care of an ailing person on their own, begin to check out some of the facilities for cleanliness, level of care, cost and waiting time. Some of the better facilities have a waiting list and, if you will need Medicaid, only a certain number of beds may be allocated to Medicaid patients. Don’t wait until the last minute, especially if you can do your research now.

Medicaid Recovery after Death

If you are able to qualify for Medicaid, there is another caveat that you must watch out for after death, and that is Medicaid recovery. States are required to seek recovery from a person’s estate for payments made by Medicaid. Some states seek repayment in an aggressive manner, but some states don’t make a big effort in the recovery process. In any case, remember that it is the person’s estate from which Medicaid can seek recovery. So, if there is nothing in the estate – nothing that needs to go to probate court – there is no recovery to seek. One of the main items of recovery is a person’s primary residence. If the spouse is no longer living, or if there is no spouse, and the house isn’t deeded to another person at the time of death of the Medicaid recipient, the house will most likely go to probate court and the state could file a claim to recoup its money. In these instances, it is best to put someone else’s name on the deed. Many states call the deed different names – transfer on death deed, beneficiary deed, ladybird deed, etc. With these types of transfers, upon death, then the house automatically goes to the other person listed on the deed. This avoids the house going into probate, and consequently, avoids a recovery claim by Medicaid.

I Love Pinterest Because I Can’t Visualize

I Don’t Have the Creativity Gene and Pinterest Helps

Pinterest is information overload and it intimidated me at first. But it is the greatest thing in the world if you can’t visualize, like me. If you know what you want, but can’t describe it or can’t draw it, Pinterest is wonderful. The best of the best ideas are on this website and it helps me find exactly what I am looking for. For instance, I had yellow in one of the bathrooms that couldn’t be changed. I didn’t know what colors worked with yellow, so I got onto Pinterest and searched yellow bathrooms. Low and behold, there were a ton of other colors that went well with the yellow, but when I saw the pictures of yellow and gray bathrooms, that was it! I was consumed by all the pictures and ideas by putting yellow and gray together. Those were the bathroom colors I wanted.  Yes, I could have gone through 10 or 12 magazines to find the right colors and ideas for the bathroom. But Pinterest made it so easy and there was so many more choices. Now, I’m not getting paid for saying this, and no one asked me to give a good rating to the website.  I honestly wanted to let people know that this is a great website for ideas, especially if you don’t quite know what you want, or can’t see what you want in your own mind.

Downsizing for Lifestyle – Don’t Become One Big Storage Bin

Moving to a Smaller Home

Downsizing is not the easiest decision to make. Many people consider the financial aspects of a smaller home. Not me. My motivation was that I just got tired of cleaning a big house where only two people lived.

Sorting Through Years of Storage

When we reached semi-retirement, we found a house about five hours away. The house was about half the size of our then-current house. I was responsible for packing everything up and sending it off to our new two bedroom house. What I realized when I was packing was that our house had turned into one giant storage facility. Every room was filled with furniture, clothes, paperwork, toys and dishes that we had not used in several years. Every closet was filled. Every cupboard was loaded to the max (I mean, why did I need 10 plastic beverage containers?) Everything was in “storage.” There was no need to hang onto those items, except for the sentimental value some of the items brought me when I looked at them and thought about the memories. But I had no choice. I was moving to a much smaller house which required less cleaning. (My biggest pet peeve is spending one day every weekend dusting and vacuuming and washing floors. When I was younger, this only took a couple of hours each week, but as I have gotten older, over time the couple of hours lengthened to a full day.

Half of Half is All You Need

In cleaning out the old house, I figured I could only take half my stuff to the new house. So, I muddled through and began pitching things, giving stuff to the neighbors and holding a couple of garage sales. I unloaded about half our old house and packed up the rest for the big move. Little did I know that I packed too much. The moving boxes filled our new basement from floor to ceiling. We didn’t have enough room to even begin unpacking. So, again, I had to throw things away, give stuff to the neighbors and hold garage sales. The expense of moving boxes only to have to give away the contents drove me crazy. But we did it and finally found the balance between our household items and our “storage.”

In the end, my recommendation when moving to a home half the size of your old home, you can only take about 1/4 of your stuff. So, downsize in the old home while you can. I will admit that we had about a dozen boxes that we put in the basement at the new house. Eight years later – we still haven’t looked in those boxes. That tells me that we really didn’t need all that stuff from our old house. We are just fine with what we have.

What Happened to Face to Face Talk?

Number 9 Number 9 Number 9 – Before the Internet

The Beatles, or the Fab Four as I so affectionately remember them, has their entire remastered catalog out in the public and it went on sale in 2009.  I remember playing Revolution 9 when the whole “Paul is dead” theory was rampant throughout the US. We played the song backward at “Number 9 Number 9 Number 9” and absolutely and positively thought we heard “turn me on dead man” and that this was a clue to Paul McCartney’s premature death. We sleuths were putting two and two together and were convinced between the Number 9 clue and the Abbey Road album, where Paul is walking across the street barefoot, that our idol was truly dead, and that an imposter was playing Paul. Conspiracy theories ran rampant back then. My friends and I would sit around camp fires, sit in our pajamas in each other’s basements at pj parties and just debate about the whole death theory (Why would someone make it up? How could they get the album to play backward? What about the license plate on Abbey Road? Didn’t you hear the car crash on that song?)

Wondering How We Would Debate it Now

That was before the internet. Face-to-face discussions about issues that affected our lives. I just wonder what it would be like if the whole “Paul McCartney is dead” theory happened now, with the internet, rather than back in the 1960’s.