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Medicaid Planning

Medicaid Planning & Medicaid Appeals

One of the greatest fears of older Americans is that they may end up in a nursing home. This not only means a great loss of personal autonomy, but also a tremendous financial price. Depending on location and level of care, nursing homes cost between $40,000 and $180,000 a year.

Most people end up paying for nursing home care out of their savings until they run out. Then they can qualify for Medicaid to pick up the cost. The advantages of paying privately are that you are more likely to gain entrance to a better quality facility and doing so eliminates or postpones dealing with your state’s welfare bureaucracy–an often demeaning and time-consuming process. The disadvantage is that it’s expensive.

Careful planning, whether in advance or in response to an unanticipated need for care, can help protect your estate, whether for your spouse or for your children. This can be done by purchasing long-term care insurance or by making sure you receive the benefits to which you are entitled under the Medicare and Medicaid programs. Veterans may also seek benefits from the Veterans Administration.

Those who are not in immediate need of long-term care may have the luxury of distributing or protecting their assets in advance. This way, when they do need long-term care, they will quickly qualify for Medicaid benefits. Giving general rules for so-called “Medicaid planning” is difficult because every client’s case is different. Some have more savings or income than others. Some are married, others are single. Some have family support, others do not. Some own their own homes, some rent. Still, a number of basic strategies and tools are typically used in Medicaid planning.

Medicaid Appeals

Patients with Medicare coverage have a guaranteed right to appeal decisions about their health care coverage. You can appeal a denial of coverage of a medical service or a refusal to reimburse your medical costs. Regardless of which type of Medicare you are appealing (Part A, B, C, or D), the appeal process starts out with a request for your Plan provider or Medicare administrator to reconsider the initial decision. Next you can ask a specific outside review body to review your claim. If you are still denied, you can request a hearing with an administrative law judge at the Office of Medicare Hearings and Appeals.

Medicaid appeals are much different, since Medicaid is a state-run program.

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