Posts Tagged ‘MaineCare’

Long Term Care Insurance in Maine: What you don’t know just might lose you a few hundred thousand dollars.

Wednesday, February 22nd, 2012

By Nova Ewers, Beach Glass Transitions, LLC

Patricia Nelson-Reade, R.N., CELA, recently gave a presentation on Long Term Care planning to  the Cumberland County Networking Group for Senior Service Providers at Sedgewood Commons in Falmouth, Maine.

Today Patty told the group about  The Long Term Care Partnership Act. The gist: this act can help you save hundreds of thousands of dollars potentially.  Yet, most people are unaware of its existence – including quite a few insurance professionals.

Here are the details:

The Long Term Care Partnership Act “permits purchasers of ‘approved’ long term care insurance policies to protect from Medicaid an amount of assets equal to the amount of the long term care insurance if the purchaser relies on Medicaid after exhaustion of the long term care insurance.”  (quoted from Patty’s blog).  So in other words, if you purchased an LTCI policy with a $300,000 payout, and you have activated a claim on your policy, you may access MaineCare when your assets are equal to or below $310,000 as opposed to the normal asset limit of $10,000 for a single person without an approved LTCI policy.

Sounds great, right?  But the problem is that with the passing of this Act in 2009, it only covered policies sold after the enactment date, which does little for the vast majority of policy holders out there.  And insurance companies were refusing to reissue older policies with new policies that could be endorsed in the Partnership Program, even if the old policies met the eligibility criteria because the insurance companies had no incentive to do so and were not required by the Act to do so.  So in 2011, Maine added a statute to the Act that said insurance companies must reissue all policies that qualify for the Partnership Program as long as the policy holder submits a request by the determined deadline – September 28, 2012. Read More…

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LePage’s MaineCare cuts would hit Maine seniors hardest.

Friday, December 9th, 2011

MaineCare now helps many pay for medicine and a place to live in Maine.

By Susan M. Cover scover@mainetoday.com
MaineToday Media State House Writer

Through its MaineCare program, the state now covers a portion of the $600 monthly cost for drugs including insulin, which she needs for her diabetes. LePage is proposing to reduce or eliminate two programs that pay for prescription drugs as part of a plan to eliminate a projected $221 million budget deficit in the Department of Health and Human Services over the next 18 months.

While LePage’s plan would end MaineCare coverage for 65,000 Mainers and hit nearly all age groups, advocates for the elderly say senior citizens in Maine will be especially hard hit if lawmakers approve the cuts.

Read the rest of this Portland Press Herald Article here.

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Maine nursing home care: Maine’s elderly will lose as Congress gambles on Medicare cuts

Thursday, October 6th, 2011

Richard Erb, president of the Maine Health Care Association, writes about balancing the budget on the backs of our nation’s elders in today’s editorial section of the Portland Press Herald.

Although we think of Medicaid as a program supporting the poor, about 75% of seniors in Maine nursing care communities depend on Medicaid (MaineCare) for payment. Maine is the oldest state in the nation, so this figure is not likely to go down, and if Medicaid and MediCare budgets are slashed, a primary payment source for  Maine’s needy elders will be drastically reduced.

Sometimes the newspaper doesn’t keep articles on-line long, so you can read Maine’s elderly will lose as Congress gambles on Medicare cuts here. 

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Ask Lynn

Thursday, March 24th, 2011

Q: I’m a social worker trying to help a friend who lives in Maine. I understand all you have said (referring to a recent blog on Medicaid), but am wondering, if a spouse who will remain in the community, partially retired, with a 401K he still hasn’t touched, will his 401K have to be spent down?

A: Kerry Peabody, our expert blogger on LTC insurance, says that the 401K is considered. “If they’re married,” says Kerry, “the community spouse’s 401k is still considered a “countable resource.” So it would be included in determining eligibility, and subject to the spend down requirements.”

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Maine Medicaid: What’s Your Plan Part II

Thursday, March 24th, 2011

In my last blog, (Maine Medicaid: What’s Your Plan?) we talked about Medicaid/MaineCare financial qualification. It boils down to this – you can ask the state for help, but before they’ll help you, you need to spend down to the required asset levels. You can keep a few things, and a little bit of money, but if you have resources, you’re going to need to use them to pay for care before the state will help you. And, really, isn’t that the way it should be?

Fortunately, if you plan now, before you find yourself in the middle of a crisis, you do have options. There are many steps that you can take that will help you prepare for potential care needs and expenses.  

First, you need to stop hiding from it. Talk to your kids, your siblings, your spouse, and even your parents about this. You can’t have a plan if you don’t acknowledge the need for one, so have the discussion. Practice this line: “We need to talk about what I’d like to happen if I need help with things around here for some reason, or if I can’t make decisions for myself.” That’s not so hard, is it? I’ve had that discussion with my wife (she’s pretty sure that I can’t take care of myself now). Once you open the door for discussion, everyone will slowly become more comfortable with the topic, and then you can make some progress on discussing your wishes.

Once you’ve talked about what your wishes are, you can move to “If this gets to the point where I need regular help with things, it’s going to be expensive. How can we pay for this?”

Here’s where you need to think long and hard about how much LTC costs, and what your resources really are. You may feel that you have enough savings to cover a need, but if you don’t accept the real costs involved with LTC, you could come up far short. Most people say to themselves “I’m never going in a nursing home, so it’s not that expensive.” Think about this. Unskilled care costs, on average, $22 per hour in Maine. If you need someone in the house for eight hours a day, five days a week, that’s $880 per week, or $45,760 per year in today’s dollars. What if you need 24-hour care? Basic care services at home would cost $192,720 per year. That’s a lot of money. Perhaps you can spend that much on your own needs, but what if your spouse needs that money? Or what if you’d planned to leave it to the kids?

At that point, you may choose to find a quality assisted living facility as a less-expensive option. Private assisted living facilities cost anywhere from $3,000 to $6,000 per month, so you’re paying less than you would to get round-the-clock coverage at home. If you look at long term care insurance claims experience, most clients are managing to stay out of the nursing home, simply because they have the financial resources to pay for care in these other settings. So, having a plan will help to keep you out of the nursing home, not force you into one!

So, what’s your plan? Next time, we’ll talk about the most common ways to pay for care.  

Kerry L. Peabody, CSA, CLTC, a Long Term Care Insurance Specialist with Clark Insurance

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Maine Medicaid: What’s Your Plan?

Thursday, March 17th, 2011

by Kerry L. Peabody, CSA, CLTC, a Long Term Care Insurance Specialist with Clark Insurance

“I don’t want the state to take everything I have.” I often hear this when I begin discussing Medicaid with my clients. Medicaid is a good program, but it’s designed to help people who have very limited assets. If you’ve managed to build a decent nest egg, and you don’t want to be forced to spend it to qualify for Medicaid, then there may be better options. Let’s discuss “I don’t want the state to take everything.”

(Remember, I’m NOT an attorney, so I’m not qualified to give legal advice. I’m simply providing some very basic interpretations of generally accepted guidelines here. Consult a qualified professional for legal advice on this topic.)

So, let’s say you’ve worked for the past 40 years, and now you’ve retired. You’ve managed to pay off your mortgage, you’ve got a decent car, and you have $400,000 in retirement savings. But, your husband just had a stroke, and you want to get some help to pay the nursing home bill, so you apply for Medicaid benefits for him.

The state will say something like this: “Gee, Mary, we’d love to help, but first we need to take a look at your assets, to see if you qualify financially.” So, you provide all of your financial documentation for them to review. In general, they’re going to let you keep:

1)    your primary home

2)    your primary vehicle

3)    $110,000 for a couple. A single person can keep about $2,000.

But you have more than that, right? Don’t panic (yet), they’re not going to take the extra stuff or money you have when you apply. But… they won’t provide you with any financial help while you still have it. 

This is where “spend down” comes in. If you have a camp on the lake, a vacation home, the RV, or that extra retirement money, then you’ll have to get rid of them and spend the excess money. The “cash” you can keep would be capped at the $110,000. So, if you end up with $400,000 in “excess,” you’ll have to “spend down” $290,000 of that before you’d qualify financially.

This is where people generally say “Well, I’ll just give it to the kids.” Nice try. The state will “look back” five years from the date you apply for help, and they’ll want to see everything you did with your money that counts as a “transfer.” This is giving anything away, selling it for less than fair market value, paying for something for someone else, etc.

So, if you gave your grandson $50,000 for college, that counts against you. If you’ve been “gifting” $13,000 per year to your children, that counts against you. If you sign the camp over to the kids, or put everything into an irrevocable trust within the last five years, that all counts against you, and makes you ineligible for a certain period of time.

Let’s face it – the state doesn’t want your house, or your car, your clothes, your dog, or anything else. People seem to have this impression that someone from the state is going to kick down the front door and start carrying out your furniture if you apply for Medicaid, but that’s not so. What the state will do is refuse to help you financially while you still have assets above and beyond what they say you can keep. You’ll be forced to “spend down” to acceptable levels before you can get any help. The questions then become “Is this really what I wanted to do with my money, and what will this mean for my spouse and family?” This is why you need to plan ahead, before you find yourself in a crisis.

How do you plan ahead? That’s for the next installment! Thanks!

Kerry Peabody, CSA, CLTC

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