Category: Medicare

Does Medicare Cover the Expenses of Long-Term Care in Florida?

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Are you finding that navigating the landscape of healthcare costs in senior years is not easy? In fact, as the population ages, there are more and more individuals requiring long-term care services. In addition, whether due to chronic illness, disability, or the natural progression of aging, long-term care needs can quickly become complicated and complex.

It is a fact that long-term care can be expensive. Often many of the seniors we meet with wonder if Medicare will help bear the brunt of these costs. Are you seeking answers to how to pay for the care you or a loved one may need? We have some important information to share on what Medicare covers and what it does not. We will also discuss why early planning with an experienced Florida elder law attorney is crucial.

We will begin with understanding Medicare basics. Medicare is a federal health insurance program primarily for individuals 65 and older and covers a broad range of healthcare services.  Medicare is divided into parts:

  • Part A (Hospital Insurance). This  covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Part B (Medical Insurance). Covers specific doctors’ services, outpatient care, medical supplies, and preventive services. Often you will hear of Part A and Part B referred to as Traditional Medicare. 
  • Part C (Medicare Advantage). A type of Medicare health plan offered by private companies that contract with Medicare. It provides all of Part A and Part B benefits.
  • Part D (Prescription Drug Coverage). This covers the cost of prescription drugs.

However when it comes to long-term care, Medicare’s coverage is limited. Even though Medicare Part A does provide coverage for care in a skilled nursing facility, it is important to note the limitations that apply to most situations:

  • Coverage is only for short-term stays (up to 100 days) in a skilled nursing facility, and only after a qualifying 3-day hospital stay.
  • It does not cover long-term stays or custodial care, which includes assistance with daily tasks like bathing, dressing, and eating.

If deemed medically necessary, Medicare can cover part-time or intermittent skilled nursing care and physical therapy. But again, it does not cover 24-hour care or purely custodial care as you would need in an assisted living facility or nursing home. Because of the limitations of Medicare when it comes to long-term care, it is vital for seniors to have an elder law financial strategy in place. Here are some concepts to consider:

  1. Research alternative options. Look into long-term care insurance, which is designed specifically to cover these costs. These policies can be tailored to your needs, but they are more affordable if purchased when you are younger and in good health.
  2. What about Medicaid? Unlike Medicare, Medicaid does cover long-term care services, but it is for individuals with limited income and assets. Proper planning can help seniors protect their assets while still qualifying for Medicaid.
  3. Find out about asset protection. Through trusts and other financial strategies, seniors can shield their assets from being completely depleted by long-term care costs.
  4. Meet now with an experienced Florida elder law attorney. Elder law attorneys specialize in helping seniors and their families navigate the complexities of long-term care, estate planning, and related financial matters. They can offer invaluable advice on protecting assets, qualifying for Medicaid, and ensuring that seniors receive the care they need.

The good news is that Medicare offers invaluable health coverage for seniors, but unfortunately its provisions for long-term care are limited. Because of the high costs of such care, seniors need to plan ahead as soon as possible and utilize the guidance of an experienced Florida elder law attorney who can help ensure that you or your loved one has access to the best care without the looming stress of exorbitant costs.

We know this article may raise more questions than it answers. Elder and Estate Planning Attorneys, PA, is a law office small enough to provide personal service but large enough to provide service in Jupiter, as well as Palm Beach, Martin, St. Lucie, and Indian River Counties in Florida. Our law firm will guide you through legal challenges involving elder law, estate planning, trusts, veterans benefits, real estate, and more. We encourage you to contact us and schedule a meeting with our attorneys.

Medicare Open Enrollment 2020: What You Need to Know

Medicare Open Enrollment 2020: What You Need to Know

Are you ready for Medicare Open Enrollment? Every year, Medicare health and drug plans make changes to costs, coverage, providers, and pharmacies in their networks. Have you considered that, between coverage changes and health condition changes, it may be wise to revisit health plans during the open enrollment period annually? This year, Medicare’s annual open enrollment period begins October 15th and ends December 7th.

For those already on Medicare, you should have received an “annual notice of change” from your Medicare plan in September. This letter explains all the changes coming in the new year, including coverage and costs such as premiums, deductibles, and copays. Review your medical expenses over the last six months, including a list of the doctors you see regularly and the medications you need.

Medicare beneficiaries without some sort of Medicare Supplement Insurance (Medigap) may face Medicare cost-sharing if they have health problems. Original Medicare pays for much, but not all of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.

If you are not able to purchase a Medigap policy, a Medicare Medical Savings Account (MSA) might be a good option. MSAs combine high-deductible insurance plans with a medical savings account that you can use to pay for your health care costs.

Medicare Advantage plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all of your Part A and Part B benefits. Most Medicare Advantage plans also offer prescription drug coverage. Before switching to a Medicare Advantage plan, be sure to examine it closely to see if it makes sense. While many have $0 premiums, the out-of-pocket costs can be high, or your hospital or your doctor may not be in-network.

The Medicare Plan Finder on is an online tool from the government to help you select a plan. After you enter your zip code and details about your medications and whether you receive them by mail, you can compare plans available in your area. You can also try the State Health Insurance Assistance Programs, which offer free local counseling to enrollees, or call 1-800-MEDICARE. 

For help evaluating your Medicare coverage options and which plan may work best for you, contact our office today to schedule a meeting time.

What Is Medicare Part D and What Options Apply?

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Tens of millions of American seniors rely on Medicare to help pay for their health care needs.

As long as someone is age 65 or older, a U.S. citizen or permanent resident living in the country for at least five straight years, and either they or their spouse paid Medicare taxes during their working years, they’re eligible for Medicare. The program offers government-funded health care coverage in a variety of areas, such as hospital care and outpatient medical services.

Another area of coverage is for prescription drugs. This is what’s known as Medicare Part D.

For most of its history, the Medicare program did not offer a prescription drug benefit. But that changed in 2006, when a bipartisan Congress added the coverage.

By 2017, more than 42 million Medicare beneficiaries had prescription drug coverage through Medicare Part D, which is optional. About 60 percent had a stand-alone prescription drug plan in conjunction with Original Medicare, also known as Medicare Part A (hospital insurance) and Part B (outpatient medical services). The other 40 percent had a Medicare Advantage prescription drug plan.

Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare as it allows program beneficiaries to receive their Medicare benefits through a private health insurance plan. Most Medicare Advantage plans include prescription drug coverage, although you may need to purchase a stand-alone drug plan if your specific Medicare Advantage plan doesn’t include prescription drugs.

For those enrolled in Original Medicare, the only source of prescription drug plans is through private insurance companies because Medicare A and B do not cover outpatient, or outside of a hospital, prescriptions. Medicare Part D, however, does pay for outpatient drug expenses. Each approved Part D plan covers different drugs and copays for covered drugs, which include both brand-name and generic products. It does not cover over-the-counter medications like cough syrups or antacids, prescription drugs like Viagra, or cosmetic treatments like hair growth elixirs or weight loss pills.

Here are several ways to get the Medicare Part D enrollment process started:

Call 1-800-MEDICARE to locate prescription drug plans in your area.
Log on to Medicare’s Prescription Drug Plan Enrollment Center.
Fill out the paperwork sent by mail from Medicare.
Call the private insurer with the specific prescription drug plan you want to join.
Call MedicareResources.org at 1-855-593-5633 and talk with a licensed agent.

Does this article raise more questions than it answers. We know that dealing with any elder law issue can be difficult. Do not wait to contact our office for support.