Did you know Medicare provides financial assistance by paying a portion of the current cost of health care for persons 65 years of age or older who are entitled to Social Security retirement insurance or Railroad Retirement cash benefits? A person who has received Social Security disability benefits or Railroad Retirement Disability Income for 24 months or longer is also entitled to receive Medicare assistance regardless of his or her age. Persons of any age who have end-stage renal disease or amyotrophic lateral sclerosis can also obtain this Medicare coverage. 

Let us share the three basic threshold criteria for Medicare coverage:

1. The care and supplies to be provided must be medically reasonable and necessary for diagnosis or treatment of illness or injury or to improve the functioning of a malformed body part.

2. The care and supplies must be prescribed by a doctor.

3. The services and supplies must be obtained through a Medicare-certified provider.

It is important for you to know that in many areas of coverage, the patient is required to pay a specified deductible amount each year or during each illness. In addition, the patient may have to pay for a portion of the cost.

Medicare calls this a co-insurance payment or co-payment.

Medicare seldom pays all the costs of healthcare and this holds especially true with regard to the need of a senior for long-term care. A nursing home patient may be eligible for assistance from Medicaid, as opposed to Medicare, in paying a portion of his or her skilled or custodial nursing home cost through the state of Florida’s institutional care program. 

There is, however, a maximum amount of countable assets that a person applying for assistance and his or her spouse can own and still receive assistance. The institutionalized spouse entering a nursing home cannot own more than $2,000 in countable assets. In the year 2019, the community spouse who is not residing in the nursing home cannot own more than $126,420 in countable assets. A person who has no spouse can only retain $2,000 in countable assets. However, a person with an income of less than $891per month can have assets of $5,000.

There is also a maximum amount of monthly income that the institutionalized spouse can receive and still be eligible for nursing home assistance. The monthly gross income available to the institutionalized spouse cannot exceed the state monthly income cap of $2,313 in 2019.

We know this article may raise more questions than it answers. It is not easy to plan for any health care costs, and this becomes even more complicated when we factor long-term care concerns into the equation as well. Do not wait to let us know how you may plan forward for this, or any, elder care issue right here in Florida.