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Long-term care is expensive, costing thousands of dollars a month. For most people, it’s an impossible expense without assistance. It’s important to start planning for your elder years, or for the possibility of earlier disability, while you are still able and working. There are a few different options for long-term care coverage in Florida, which we discuss below. Call an expert West Palm Beach Medicaid planning and elder law attorney for assistance.
If you anticipate the need for long-term care, it’s important to understand how to get coverage. Medicare covers long-term care benefits only if you need skilled services or rehabilitative care. For nursing home care, Medicare covers up to 100 days, but in practice the average Medicare-covered stay is much shorter. Medicare will also cover at-home skilled nursing care for a short period of time. Normal care for Activities of Daily Living (ADL), which makes up the lion’s share of long-term care services, is not covered.
Employer-sponsored insurance and private health insurance typically have similar long-term care coverage to Medicare. If you need coverage for the daily costs of long-term care throughout retirement, you’ll likely need to look elsewhere.
Higher-income individuals can purchase long-term care insurance in advance of needing care. There are a number of pros and cons to long-term care insurance. Typically, you cannot buy long-term care insurance once you are already in need of long-term care insurance. Applicants must pass a physical to qualify, which is why as many as 20 percent of applicants fail. The policies are cheaper the younger and healthier you are, but that also means you’ll be paying premiums for much longer before relying on the benefits.
Once you need long-term care, however, that insurance law can save you hundreds of thousands of dollars. Your disability benefits and elder planning attorney can help you understand your options and work with you to determine whether long-term care insurance is right for you.
Residents of Florida over the age of 65, or under 65 with a disability, may qualify for long-term care benefits through Medicaid. To be eligible for Medicaid, the applicant’s income and total assets must be below a certain threshold and they must meet other state-specific requirements. Medicaid coverage is a lifesaving, vital program for Florida residents who qualify. With planning, applicants may be able to protect assets and income before applying with the help of an Elder Law Attorney.
Florida’s Medicaid program is known as the Statewide Medicaid Managed Care (SMMC) program. The program for long-term care is known as the Long-Term Care (LTC) program. Other services outside of LTC are provided through the Managed Medical Assistance (MMA) program.
SMMC LTC recipients can obtain coverage for a wide range of long-term care benefits, depending upon their needs, including:
To be eligible for long-term care through Florida Medicaid, applicants must either be over the age of 65 and eligible for Medicaid, or over the age of 18 and eligible for Medicaid by way of disability.
To be eligible for Medicaid, the applicant’s income and assets must be under a certain threshold. For a single individual applying in 2023, the applicant’s income must be under $2,742 per month, and they must possess under $2,000 in assets. Married couples applying together can double the income limits and have a higher asset limit. If only one spouse is applying, the other spouse is permitted a much higher asset limit.
Additionally, the applicant must demonstrate that they require the level of care provided in a nursing care facility and meet one or more established clinical criteria. Applicants will go through the Comprehensive Assessment and Review for Long-Term Care Services (CARES), a federally mandated pre-admission screening program. The screening will determine the level of care the applicant requires. Your Elder Law Medicaid attorney can evaluate your condition to determine which criteria may apply and how best to strengthen your application for benefits.
A skilled West Palm Beach Medicaid planning attorney can help you and your family plan appropriately to maximize your chances to qualify for Medicaid and other needs-based governmental programs. If you are in need of a thorough, comprehensive Florida Medicaid planning and elder law attorney, contact the stellar West Palm Beach trust & estates attorneys of Shalloway & Shalloway at 561-686-6200.