4 - Explaining Medicare vs. Medicaid

Posted on

Mar 20, 2023

Book/Edition

Pennsylvania - South Central PA

Share This

Episode Summary

In this episode, we walk through a very important topic: Medicare vs. Medicaid. We explain Medicare first and what Medicare’s relevancy is in terms of estate planning and elder law. Following that, we dive into Medicaid. We cover what it is and how it functions in our society. We also touch on filial responsibility law and Medicaid estate recovery. The goal of this episode is to clear up any confusion with Medicare and Medicaid and provide you the information you need to plan out the rest of your life. We will dive into some new topics on the next episode, so stay tuned!

Key Takeaways 

Takeaway 1: Medicare

01:01 - 00:05:36)

  • Medicare is not what many people think it is. It is not a widely-applied health insurance.

  • In terms of long-term care, it only applies to an individual when they are admitted to a hospital for 3 consecutive nights, leaves the hospital, and then goes to a skilled facility for rehabilitation. 

  • Must be admitted to the hospital, not just be under observation.

  • Medicare will pay for up to 100 nights in the skilled facility, but only if you show signs of improvement and progress in your rehabilitation. It’s not 100 guaranteed nights of coverage.

  • You could go from paying almost nothing, maybe just a copay, to paying $12,500 per month if you do not rehabilitate.

Takeaway 2: Medicaid

05:37 - 09:30

  • Medicaid is a federal program, with the most common laws that people recognize being OBRA 96 and DRA 05. These laws set the rules for Medicaid.

  • There is federal law, but each state interprets the federal Medicaid rules as they see fit.

  • Research the nuances in your state and talk to the local county office.

  • Pennsylvania has a long-term care handbook that can be found online.

    • Every county interprets the handbook in their own way, and within each county, every case worker may look at an issue slightly differently.

  • We offer weekly workshops, one of those being the Medicaid workshop. We talk about what to expect, what you can do ahead of time, and what you can do to make things easier down the road.

  • Medicaid essentially will pay for the long-term care for an individual in a skilled facility, or there is the waiver program or Community HealthChoices in Pennsylvania that will pay for care in a person’s home if they meet the requirements.

    • There is an income cap limit in PA with the waiver program, but with a nursing home, whatever the income is, we can preserve and protect the assets.

  • In PA, if a spouse enters a nursing home, we are able to protect 100% of the assets of the spouse still living at home.

  • We can take everything else and put it in the community spouse’s name, but the community spouse can only take half as long as half of the money falls between $135 thousand and $30 thousand.

    • Any excess money can be turned into an income stream that will pay back to the community spouse in as short of a term as possible. It must be Medicaid-compliant under the law.

  • For unmarried individuals, we can protect at least 50 percent of their assets. We can gift half the money they own.

    • This is called the Half and Half plan 

  • If someone is about to enter a nursing home, it is not too late. We can still help with crises and prevent asset loss. 

Takeaway 3: Filial responsibility law and Medicaid estate recovery

19:32 - 24:32

  • Filial responsibility law is the proposition that children, spouses and parents can be responsible for the nursing home debt of the child, spouse, or parent. 

  • The Pittas case was a bad facts case that made bad law. The judge in the case used filial responsibility law to hold Mr. Pittas responsible for taking his mother’s money. He was liable for nearly $93,000 in nursing home costs incurred.

  • Medicaid estate recovery is once you’ve already been receiving benefits, when you die, the state is allowed to go after the probate assets of the individual to cover the amount of care that was provided.

  • We just want to make sure the assets are under $2400 and/or they do not go through probate. 

    • This is why you want to use a professional.

  • Estate recovery is the last thing we worry about, because when we do a plan correctly, we do not have to worry about it.

Links and Resources Mentioned

Bellomo & Associates workshops including our Medicaid workshop: https://bellomoassociates.com/workshops/ 


For more information, call us at (717) 845-5390   

Connect with Bellomo & Associates on Social Media

Twitter: https://twitter.com/bellomoassoc 

YouTube:  https://www.youtube.com/user/BellomoAssociates 

Facebook: https://www.facebook.com/bellomoassociates 

Instagram: https://www.instagram.com/bellomoassociates/  


LinkedIn: https://www.linkedin.com/in/bellomoandassociates 

Ways to work with Jeff Bellomo


Contact Us: https://bellomoassociates.com/contact/ 


Practice areas: https://bellomoassociates.com/practice-areas/ 


Other Videos You May Like

Episode 55. The Smart Move: Protect Your Biggest Asset by Placing Your Home in a Trust

Episode 55. The Smart Move: Protect Your Biggest Asset by Placing Your Home in a TrustRegardless of your financial situation, putting your home in an asset protection trust provides unparalleled benefitsit safeguards the wealth in your home, anticipates future healthcare needs, and minimizes taxation. Placing your home in a trust is not just a smart financial move, it provides you with the sense of security that comes with continued control and ownership of your home.Estate tax planning trusts were used more when tax rates were much higher. But today, it makes more sense to use an asset protection trust. An asset protection trust that satisfies the look-back period ensures you wont lose the home to creditors, reduces capital gains tax, and provides your children and grandchildren with greater inherited wealth.Don't forget to Follow, Like, and Subscribe for upcoming podcast episodes: Apple: https://podcasts.apple.com/us/podcast/the-smart-move-protect-your-biggest-asset-by-placing/id1634278675?i=1000624726087 YouTube: https://youtu.be/rxD-hiL1dVo Spotify: https://open.spotify.com/episode/4LKIZs6vpCr5J0UECEMPLb?si=4davi1pgQY6KbRg6oWzjXg

Episode 54: Our Revolutionary Estate Planning Process: Protect Your Future with Bellomo & Associates

Episode 54: Our Revolutionary Estate Planning Process: Protect Your Future with Bellomo & AssociatesThe team at Bellomo & Associates is passionate about providing education and empowering your family with the knowledge you need to make informed estate planning and elder care decisions. Our educational workshops and updated service model are revolutionizing estate planning practices all across the country.The Three Secrets Workshop explains how to protect your family's legacy and why planning for health care costs and long-term care is essential. Our Red Wagon Club offers ongoing support and assistance. And, using our combined estate planning and tax management expertise, we can set up an innovative Roth Alike Trust to protect your retirement assets while promoting tax-free growth. With these programs and others, youll enjoy the assurance that your plans align with changing laws, family dynamics, and individual needsultimately giving you greater peace of mind that your assets are protected now and into the future. Don't forget to Follow, Like, and Subscribe for upcoming podcast episodes: Apple: https://podcasts.apple.com/us/podcast/our-revolutionary-estate-planning-process-protect-your/id1634278675?i=1000624001620 YouTube: https://youtu.be/CfnuYaUFmKg Spotify: https://open.spotify.com/episode/6UL2EaUh4Ju9gPM5AuzBpb?si=UJ0iJ-M7Q9q0JKF1FY5QXw

Episode 53: Benefits Unlocked: Mastering Medicare and Medicaid for Your Future

Episode 53:  Benefits Unlocked: Mastering Medicare and Medicaid for Your Future Weve been getting a lot of questions about the differences between Medicare and Medicaid. Its important to understand the distinctions so that you can make the most of the benefits that are available to you. Our free workshops provide in-depth educational opportunities, and we encourage you to sign up at our websiteboth in-person and online learning are offered. Until then, take advantage of Jeffs easy-to-understand explanations of Medicare and Medicaid as he clarifies misconceptions about these programs and describes how to protect your assets while also ensuring essential health care.Don't forget to Follow, Like, and Subscribe for upcoming podcast episodes: Apple: https://podcasts.apple.com/us/podcast/benefits-unlocked-mastering-medicare-and-medicaid-for/id1634278675?i=1000623269652 YouTube: https://youtu.be/vff3d039A18 Spotify: https://open.spotify.com/episode/3jxsDXULALcXoxrzXKXF5O?si=QRbmbQZoSHyAv_gVDhgAzQ