At What Age Can You Get Medicare If You're Still Working?

Many people keep working well beyond age 65 — the age when most people become eligible for Medicare. If your employer offers health coverage, do you need to enroll in Medicare? What about Medicare’s prescription drug benefit?

Should I Enroll in Medicare Part A?

Most workers probably should enroll in Medicare Part A.

Part A is free for most people and covers institutional care in hospitals and skilled nursing facilities. It also pays for certain care given by home health agencies and care provided in hospices. But ask your employer (or your spouse’s employer, if that’s where you get your coverage) whether your current coverage will change in any way if you enroll in Medicare, even just Part A. 

Enroll in Medicare Part B? It Depends.

Medicare Part B, which covers outpatient and preventative care like doctor visits and tests, has a monthly premium that changes each year (it is $174.70 a month in 2024). Individuals who don’t sign up for Part B when they first become eligible can pay a 10 percent premium penalty for each year that enrollment is delayed. However, there is an exception to this.

Whether you should enroll in Part B while you are still working depends on how many people work for your employer. If your employer has 20 or more employees, you do not need to sign up for Part B right away. This is because your employer’s group health plan will be the primary insurer. When you retire, you will have a special enrollment period of eight months to sign up for Part B, without penalty.

If your employer has fewer than 20 employees, however, you should enroll in Medicare Part B when you are first eligible. Medicare is the primary insurer, which means it pays before your employer’s insurance pays. If you don't enroll, your employer’s plan can refuse to cover you for services that Medicare would have covered. That means that you may have to pay for those services out of your own pocket.

Before making a decision about Medicare Part B, you should always contact the Social Security Administration (SSA). Call 800-772-1213 or visit your local Social Security office. The Medicare Rights Center has a handy list of Questions to Ask Social Security During Medicare Enrollment.

Medicare Part D: Prescription Drug Coverage

Medicare Part D covers most prescription medications. Even if you choose not to enroll in Medicare Part B, you can still enroll in Part D. Doing so may be advisable to avoid a late-enrollment penalty similar to the one for Part B.

If you already have prescription drug coverage through your employer, your insurance plan should send you a letter telling you whether or not the company’s coverage is “creditable” — meaning it is equal to or better than what Medicare is offering. If it is creditable, then you won’t have to pay a late-enrollment penalty if you decide to switch to Medicare Part D later.

Also, if you are already covered by your company’s drug plan, a Medicare plan may not be right for you. Don’t sign up until you compare your current plan with the Medicare plans available in your area. Finally, before you sign up for a drug plan, ask your employer if you can drop your drug coverage without losing your other supplemental insurance. Once that insurance is gone, you may not be able to get it back.

Automatic Enrollment

If you are currently receiving Social Security benefits, you don’t need to do anything to enroll in Medicare. You will be automatically enrolled in Medicare Parts A and B effective the month you turn 65.

If you do not receive Social Security benefits, then you will need to sign up for Medicare. Call the Social Security Administration at 800-772-1213 or visit the SSA site. If you decide not to enroll in Part B, fill in the box on the back of your Medicare card declining Part B coverage and mail it back to the address listed. The SSA will mail you a new card.

~ Elder Law Answers

Medicare Open Enrollment October 15 - December 7: Is It Time to Change Plans?

Medicare's Open Enrollment Period, during which you can freely enroll in or switch plans, runs from October 15 to December 7. Now is the time to start shopping around to see whether your current choices are still the best ones for you.  

During this period you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during the seven-week period you can return to traditional Medicare (Parts A and B) from a Medicare Advantage (Part C, managed care) plan, enroll in a Medicare Advantage plan, or change Advantage plans. Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.

According to the New York Times, few Medicare beneficiaries take advantage of Open Enrollment, but of those who do, nearly half cut their premiums by at least 5 percent. Even beneficiaries who have been satisfied with their plans in 2020 should review their choices for 2021, as both premiums and plan coverage can fluctuate from year to year. Are the doctors you use still part of your Medicare Advantage plan’s provider network? Have any of the prescriptions you take been dropped from your prescription plan’s list of covered drugs (the “formulary”)? Could you save money with the same coverage by switching to a different plan?

For answers to questions like these, carefully look over the plan's "Annual Notice of Change" letter to you. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions, and appeals. Medicare Advantage plans can change their benefit packages, as well as their provider networks. For more about entering and leaving Medicare Advantage plans, read this related article.  

Remember that fraud perpetrators will inevitably use the Open Enrollment Period to try to gain access to individuals' personal financial information. Medicare beneficiaries should never give their personal information out to anyone making unsolicited phone calls selling Medicare-related products or services or showing up on their doorstep uninvited. If you think you've been a victim of fraud or identity theft, contact Medicare. Get more information about Medicare fraud.

Here are more resources for navigating the Open Enrollment Period:

• Medicare coverage options

• The Medicare & You handbook, which all Medicare beneficiaries should have received. 

• The Medicare Rights Center

• Your State Health Insurance Assistance Program, which offers independent counseling

Elder Law Answers

Medicare Coverage Basics: What You Need to Know

Introduction: What Is Medicare?

Medicare is a federally run health insurance program that serves seniors (age 65 and up). The program also covers people of any age who are permanently disabled or who have end-stage renal disease (people with kidney ailments requiring dialysis or a kidney transplant) or Lou Gehrig’s disease (ALS).

Medicare insures about 69 million Americans and, as of 2023, spent more than $1 trillion a year on their care. Medicare is an entitlement program, meaning it is not based on financial need.

Each year, Medicare issues a comprehensive handbook detailing all aspects of the program.

Is Medicare Free?

Many believe Medicare is provided at no cost, but this is not accurate. Although Medicare was originally conceived as a program that would relieve seniors of the burden of paying for health care, Medicare beneficiaries now pay a greater percentage of their incomes for out-of-pocket health care expenses than they did before Medicare was enacted in 1965.

In addition to paying a monthly premium, Medicare recipients often must pay a portion of the cost of the services they receive in the form of a deductible or coinsurance amounts. Deductibles, coinsurance, and premiums typically increase each January.

Many services and items, such as long-term unskilled nursing home or in-home care, are not covered by Medicare. To help with this cost-sharing and the items that Medicare does not cover, Medicare beneficiaries often purchase private insurance policies called Medigap policies.

Generally, Medicare pays only for “acute” care – care that the program views as reasonable and necessary to diagnose or treat an illness or injury. It does not pay for most preventive care or unskilled care to treat chronic conditions.

What Are the Different Parts of Medicare?

Medicare consists of four major programs:

• Part A, which covers hospital stays;

• Part B, covering physician fees;

• Part C, which permits Medicare beneficiaries to receive their medical care from among a number of delivery options; and

• Part D, which covers prescription medications.

Medicare Part A

Sometimes referred to as hospital care or hospital insurance, Medicare Part A covers inpatient health care costs. This includes inpatient hospitalization, rehabilitation services, skilled nursing facility services, and aspects of home hospice care. (Together, Part A and Part B comprise what is often called Traditional, or Original, Medicare.)

Eligibility for Part A begins at age 65. If you currently receive Social Security retirement or disability benefits, your enrollment in Part A is automatic.

The costs for Medicare Part A in 2026 are as follows:

• Monthly Part A premium = $0 for most people (those who have paid into Social Security during their employment for at least 10 years)
   

• Annual inpatient hospital deductible = $1,736
   

• Coinsurance for hospital stay

  • Days 1 to 60 = $0

  • Days 61 to 90 = $434 per day

  • Days 91 onward = $868 per day

• Coinsurance for skilled nursing facility

  • Days 1 to 20 = $0, after an inpatient hospital stay of at least three days

  • Days 21 to 100 = $217 per day

Medicare Part B

Medicare Part B focuses on outpatient medical care and preventative care. It covers a range of outpatient surgeries, cognitive assessments, medically necessary treatments, medical equipment such as walkers, and vaccinations; an initial Welcome to Medicare health visit; and an annual wellness visit. (As mentioned above, Part A and Part B together make up Traditional, or Original, Medicare.)

You become eligible for Part B when you are 65. As with Part A, if you are receiving Social Security retirement or disability benefits, your enrollment in Part B is automatic. (If you are still working and have an employer or union group health insurance plan, you may not need to enroll immediately. However, beware of the late enrollment penalty.)

Costs for Medicare Part B in 2026 include:

• Monthly Part B premium = $202.90

• Annual Part B deductible = $283

Medicare Part C

Medicare Part C, also known as Medicare Advantage or managed care, is an alternative to Traditional Medicare (Parts A and B). Part C plans are offered by private insurers that contract with Medicare, so the coverage benefits – as well as the costs – will vary according to the specific Medicare Advantage plan you choose.

If you have Medicare Parts A and B (Traditional Medicare), you do have the option to join a Medicare Advantage (Part C) plan instead. However, once enrolled in a Medicare Advantage plan, you can change your plan only at certain times of the year. (For more information, refer to the section below titled When You Can Sign Up for Medicare.)

Again, Part C costs may vary widely depending on the plan you select. Nationwide, the average monthly premium for a Medicare Advantage plan is currently $14 but can be as high as $200 or more a month. Out-of-pocket costs can also differ from one Medicare Advantage plan to the next.

Medicare Part D

Medicare Part D encompasses coverage for most prescription drugs. Although you may not yet rely on any prescriptions, you might in the future. So, consider enrolling in Part D prescription drug coverage when you are first eligible, as it’s possible you could face a permanent late enrollment penalty if you wait too long.

Part D is available only through private insurers. The monthly cost can vary, as there are various plan options available.

You can obtain Medicare drug coverage through Medicare Part D or you may find that it is included as part of your Medicare Advantage plan.

When You Can Sign Up for Medicare

Generally, once you turn 65 years old, you are eligible for Medicare coverage. Several months before your 65th birthday, you’ll receive a “Welcome to Medicare” packet that will outline the enrollment process.

Initial Enrollment Period

• Medicare’s Initial Enrollment Period will be your first chance to sign up for Medicare.

• This period is seven months long; it begins three months before your 65th birthday and remains open for you through the three months after you turn 65.

• If you do not sign up during your Initial Enrollment Period, you will have to wait until the General Enrollment Period or a Special Enrollment Period to sign up. (Continue reading for more information on these enrollment periods.)

Medicare Open Enrollment Period

• The Medicare Open Enrollment Period runs every year from October 15 to December 7. Changes made during this time take effect the following January 1.

• If you have already enrolled in Medicare, you can use this time to shop around and compare your current Medicare plan benefits with that of other plans. Changing plans is not required but could save you a major headache – and money. For example, you want to ensure that your preferred physicians and any prescription medications you take are still part of your current plan. If not, this may prompt you to change plans.

Medicare General Enrollment Period

• The Medicare General Enrollment Period runs from January 1 to March 31. If you missed the Initial Enrollment Period, you can sign up during this time for Medicare Part A coverage, Part B coverage, or both through the Social Security Administration (SSA).

• If you enroll in Medicare during this period, your coverage will begin the first day of the month after you enroll.

Medicare Special Enrollment Periods

• If you encounter specific life events, you may be able to enroll in certain parts of Medicare during a Special Enrollment Period, allowing you to forgo late enrollment penalties.

• Events that may make you eligible for a Special Enrollment Period include missing enrollment because you were facing a natural disaster, were incarcerated, or lost your coverage.

Medicare Advantage Open Enrollment Period

• This is different from the Medicare Open Enrollment Period outlined above. The Medicare Advantage Open Enrollment Period, which occurs annually from January 1 through March 31, applies if you have a Medicare Advantage plan and wish to change to a different Medicare Advantage plan or switch to Traditional Medicare.

• You are not required to make any changes during this period.

• Read more about entering and leaving Medicare Advantage plans in a related article.

Where to Find Help With Medicare

Numerous resources are available to address your questions regarding Medicare:

• Medicare.gov website, including its Plan Finder tool

• Call 1-800-MEDICARE (1-800-633-4227); for TTY users, 1-877-486-2048 (available 24/7, except some federal holidays)

• Medicare’s live online chat (available 24/7, except some federal holidays)

• SSA website or call 1-800-772-1213 (weekdays 8 a.m. to 7 p.m.)

• Your local State Health Insurance Assistance Program (SHIP) location, where you can connect with trained counselors providing objective, one-on-one guidance on your Medicare questions and issues; or call 1-877-839-2675

• An elder law attorney in your area

• From Elder Law Answers 2026

What If I Miss the Medicare Sign-Up Deadline?

When Should I Sign Up for Medicare?

 You should sign up for Medicare during your Initial Enrollment Period, which begins 3 months before you turn 65, includes your birthday month, and ends 3 months after—making a 7‑month window. This timing avoids gaps in coverage and late‑enrollment penalties.

What If I Miss the Deadline for Enrollment?

  It’s important to sign up for Medicare coverage during your Initial Enrollment Period, unless you have other coverage that’s similar in value to Medicare (like from an employer). If you don’t, you may have to pay an extra amount, called a late enrollment penalty.

Late enrollment penalties:

• Are added to your monthly premium.

• Are not a one-time late fee.

• Are usually charged for as long as you have that type of coverage (for most people, that’s a lifetime penalty). The Part A penalty is different.

• Go up the longer you wait to sign up – they’re based on how long you go without coverage similar to Medicare. Find out when you should sign up to avoid penalties.

Open Enrollment

Open Enrollment happens from October 15 – December 7 and is the time each year when you can make changes to your coverage. The changes you make during Open Enrollment are effective January 1 of next year (the plan must get your enrollment request by December 7).

 During this time, you can join, drop, or switch to another Medicare Advantage Plan with or without drug coverage (or join, switch or drop drug coverage).

 If you do not do anything, your current plan will automatically renew.

How to Avoid Family Conflict Over Aging Parents

Family conflict over an aging parent rarely starts with a lawsuit. It usually develops through subtle changes, such as a phone call that goes unreturned, a sibling who suddenly handles all of Mom’s paperwork, or a will that gets changed without anyone else knowing why. By the time these changes result in a courtroom battle or a permanent rift at the holiday table, the real damage often happened months or years earlier.

Understanding the early warning signs and addressing them while relationships and options are still flexible can spare families enormous pain, expense, and regret.

Why These Conflicts Build Slowly

Aging often brings challenges, such as cognitive changes, physical decline, isolation, and dependence on others for daily tasks. These changes can create opportunities for both confusion and undue influence or exploitation. Because the shifts happen gradually, family members may not notice a pattern until it has reshaped who has access, information, and control.

Warning Signs to Watch For

Changing Communication Patterns

• An older relative starts speaking only to one adult child or caregiver, while other family members are told less and less.

• The adult child or caregiver starts to act as a gatekeeper by screening or blocking calls and visits from other family members.

• The aging relative starts answering questions with vague or rehearsed-sounding responses, as though someone has coached them.

Erosion of Transparency

• Without discussion or group consent, one family member becomes the sole point of contact for attorneys, banks, or doctors.

• Legal documents, financial statements, and medical updates that used to be shared openly become harder to access.

• Questions related to estate planning, money, or health are met with defensiveness or deflection rather than straightforward answers.

Movements of Assets Without Discussion

• Family members’ names are added to or removed from bank accounts, property titles, or investment accounts.

• Large gifts, transfers, or loans are learned of after the fact and often by accident.

• Money or property is moved in ways that don’t match the aging adult’s known history or wishes.

New Relationships Later in Life

A new relationship late in life is not, by itself, a warning sign. Many older adults find new companionship in their later years. Concern is warranted, however, when a new partner appears to isolate the older adult from family, moves quickly toward shared finances or legal changes, or discourages independent contact with children and grandchildren.

Sudden Estate Planning Changes

• A change to a will, trust, or beneficiary designation shortly after a health decline, a new relationship, or a period of increased dependence on a caregiver may be a sign that something is amiss.

• The replacement of a long-trusted attorney with a new attorney chosen and brought in by only one family member might be a red flag.

• Documents signed with unexplained secrecy, urgency, or without the older adult’s longtime advisors present could signal coercion.

Ways to Prevent Problems Before They Start

• Start conversations early. Don’t wait for a crisis to talk about finances, caregiving, and end-of-life wishes. Do it while everyone is healthy and thinking clearly.

• Preserve the older adult’s control. Encourage the older adult to name trusted people to help with financial, legal, or health care matters and decide what information should be shared, how decisions should be reviewed, and what safeguards should apply.

• Avoid giving one person unchecked control. One family member managing legal affairs, money, and medical decisions alone can lead to mistakes and a lack of transparency, even when that person has good intentions.

• Keep communication routine, not just reactive. Periodic family check-ins, even informal ones, can keep everyone informed and make sudden changes easier to spot.

• Use nonfamily professionals. An independent elder law attorney, financial advisor, or geriatric care manager can provide an outside perspective and help put safeguards in place for major decisions.

Ways to Address Conflict That Has Already Started

• Raise concerns calmly and early. Talk to the older adult directly and, without accusing anyone, ask open questions about recent decisions and how they’re feeling about them.

• Request documentation. Bank records, legal filings, and medical records can clarify what has actually changed, separate from assumptions or rumor.

• Involve a neutral third party. Adult Protective Services, an elder law lawyer, or a long-term care ombudsman can assess whether a formal intervention is warranted.

• Consider mediation before litigation. Family mediation, led by a professional experienced in elder or family disputes, can resolve conflict without the cost and permanence of litigation.

• Know the legal options. If you suspect someone is being manipulated, money is being misused, or your loved ones cannot make decisions independently, an attorney can explain what steps you can take.

Protecting Your Loved One and Your Family Relationships

Family conflict over aging parents usually doesn’t erupt overnight; it accumulates through small, often overlooked changes in communication, transparency, and control. Families who stay engaged, keep communication open, and establish shared oversight are far better positioned to catch problems early, protect their loved one, and preserve their relationships with one another.

Elder Law Answers

Will Paying Off House Affect Medicaid or Medicare?

I am on disability. I have Medicaid and Medicare. My brother won a lawsuit. He wants to pay my house off ($123,000 dollars). Will this affect my Medicaid and Medicare?

His gift likely won’t affect your Medicare, but it could definitely put your Medicaid at risk depending on how the transaction is handled.

Medicare is an “entitlement” program based on your work history or disability status, not your financial need.

• Having your mortgage paid off generally has no impact on your Medicare eligibility.

• Medicare does not have asset limits. Whether you live in a $100,000 home or a $1,000,000 home, your Medicare stays the same.

Medicaid, however, is a “means-tested” program, meaning it is strictly for people with limited income and resources.

• In most states, to keep Medicaid, you cannot have more than $2,000 in countable assets (the limit varies slightly by state).

• Your primary residence is usually an “exempt” asset, meaning its value doesn’t count toward that $2,000 limit.

• However, if your brother gives you the $123,000 directly to your bank account, Medicaid will see that as a massive spike in your income and assets. Even if you spend it 10 minutes later to pay off the house, that brief moment of possession could disqualify you for months or years.

How to Protect Your Benefits

To keep your Medicaid while accepting this gift, you may consider the following common strategies:

• Direct payment to the lender. If your brother pays the bank directly, the money never touches your hands. While this is safer than a cash gift, some state Medicaid offices may still view the “debt relief” as a form of unearned income. You must check your specific state’s rules on “in-kind support and maintenance.”

• Special needs trust (SNT). Your brother places the money into a third-party SNT, and the trust pays off the mortgage. Because the money is held by the trust and not you, Medicaid typically ignores it.

• ABLE account. If your disability began before age 46, you can use an ABLE Account. However, these have annual contribution limits (usually around $19,000), so it wouldn’t be enough to cover a $123,000 mortgage payoff in one go.

An Important Note Regarding SSI

If your disability payment comes from Supplemental Security Income (SSI) rather than Social Security Disability Insurance (SSDI), the rules are even stricter. A mortgage payoff can be considered in-kind support and maintenance and could reduce your monthly check.

Call our office to schedule an appointment to learn more about how to protect or to apply for Medicaid.

~ Elder Law Answers

Will Mom Face a Medicaid Penalty If She Sells Her Home?

My mom and dad owned a home. He went into a nursing home under Medicaid and later passed away. My mom retained the home (not recovered under Medicaid Recovery) because she still lived there. The home is still in her name and my deceased father's name. Now my husband and I would like her to sell the home; we would use the proceeds to buy a house for her to live with us. Would she be penalized under the 60-month lookback period?

The 60-month lookback probably isn’t your biggest concern here. A separate issue — your dad’s deferred Medicaid estate recovery claim — is.

What the 60-Month Lookback Actually Covers

The look-back period only applies to gifts or transfers for less than fair market value made by someone who is (or may soon be) applying for Medicaid themselves. If your mom simply sells the home for what it’s worth, that’s not a gift — it’s just converting one asset (a house) into another asset (cash) of equal value. Selling at fair market value doesn’t trigger a penalty, no matter when it happens.

In other words:

• Selling the home for fair market value: Not a lookback problem.

• Buying a new house in your mom’s own name with the proceeds: Also not a problem — she’s just converting cash into a home she’ll live in.

• The risk area: If the new house ends up titled in your name (or jointly with you) rather than hers, and she’s contributing the money without retaining ownership, that portion could be treated as a gift to you. If your mom applies for Medicaid within five years of that transfer, it could create a penalty period. Keeping the new home titled in her name (even if she lives with you) avoids this.

The Bigger Issue: Your Dad’s Deferred Medicaid Claim on the House

Here’s the part that’s easy to miss. Medicaid estate recovery rules provide protection for surviving spouses — states aren’t allowed to seek reimbursement for a deceased beneficiary’s long-term care costs while the surviving spouse is alive, and they can’t put a lien on the home or collect through its sale while the surviving spouse lives there. That protection is why nothing happened when your dad passed away.

But “protected” isn’t the same as “forgiven.” Once the surviving spouse passes away, the state may then seek to recover from the estate any money it spent on the deceased recipient’s care. In other words, the claim is deferred, not erased — and some states’ rules tie that deferral specifically to your mom continuing to live in that home, not just to her being alive.

That matters a great deal here, because your mom is about to sell the home and move, which could be the exact trigger that ends the deferral in some states, depending on how that state administers recovery. Some states tie estate recovery deferral to the protected person continuously living in the home. Federal guidance implies that states can recover when:

• the surviving spouse dies,

• when a protected child’s status changes, or

• when a protected relative moves out of the home — and moving out to live with you could fall into that category depending on state policy.

What to Do Before Listing the House

1. Contact the state Medicaid agency (or your dad’s old caseworker) and ask directly: “Is there a deferred estate recovery claim tied to my father’s Medicaid benefits, and does selling the home or my mother moving out trigger it?” Get the answer in writing if you can.
    

2. Clear up the title first. Since the home is still listed in both your mom’s and your late father’s names, you’ll likely need a death certificate, an affidavit of survivorship, or a short probate step (depending on how they held title — joint tenancy vs. tenants in common) before the sale can close cleanly. A title company or attorney can confirm which applies.
    

3. Keep the new home titled in your mom’s name, not yours, to avoid creating a transfer-penalty issue if she ever needs Medicaid herself.
    

4. Talk to an elder law attorney in your state before the sale closes. In this type of situation — involving deferred spousal recovery plus an upcoming sale — state-specific rules make a real difference, and getting it wrong could mean a chunk of the sale proceeds unexpectedly goes to repaying your dad’s Medicaid costs instead of funding your mom’s new home.

What This Means for Your Family

The 60-month lookback likely isn’t the risk — selling at fair value and buying a new home in your mom’s name should be fine on that front. The real question to run down is whether your father’s deferred Medicaid estate recovery claim gets triggered by this sale, since that depends on your state’s specific rules and is worth confirming before you sign anything.

Elder Law Answers

Probate v. Non-Probate: What Is the Difference?

When planning your estate it is important to understand the difference between probate and non-probate assets.

What Is Probate?

Probate is the process through which a court determines how to distribute your property after you die. Some assets are distributed to heirs by the court (probate assets), and some assets bypass the court process and go directly to your beneficiaries (non-probate assets). 

The Probate Process

The probate process includes filing a will and appointing an executor or administrator, collecting assets, paying bills, filing taxes, distributing property to heirs, and filing a final account. This can be a costly and time-consuming process, which is why some people try to avoid probate by having only non-probate assets.

Probate Assets vs. Non-Probate Assets

Probate assets are any assets that are owned solely by the decedent. This can include the following:

• Real property that is titled solely in the decedent's name or held as a tenant in common

• Personal property, such as jewelry, furniture, and automobiles

• Bank accounts that are solely in the decedent's name

• An interest in a partnership, corporation, or limited liability company

• Any life insurance policy or brokerage account that lists either the decedent or the estate as the beneficiary

Non-probate assets can include the following:

• Property that is held in joint tenancy or as tenants by the entirety

• Bank or brokerage accounts held in joint tenancy or with payable on death (POD) or transfer on death (TOD) beneficiaries

• Property held in a trust

• Life insurance or brokerage accounts that list someone other than the decedent as the beneficiary

• Retirement accounts

When planning your estate, you need to take into account whether property is probate property or non-probate property. Your will does not control the distribution of non-probate property. Check the ownership of your property and your accounts to make sure jointly owned property will be distributed the way you want it to. It is also important to review your beneficiary designations.

Additional Reading

• Probate Law: A Look Across States

• Navigating Disputes in Probate Court

• 3 Common Probate Questions

• The Benefits and Risks of DIY Estate Administration

  ~ Elder Law Answers

How to Get Medicaid Coverage for Care at Home

Traditionally, Medicaid has paid for long-term care in a nursing home, but because most individuals would rather be cared for at home and home care is cheaper, all 50 states now have Medicaid programs that offer at least some home care. In some states, even family members can get paid for providing care at home. 

Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers care in a nursing home for those who qualify.

Medicaid Home Care Services

Medicaid home care services are typically provided through home- and community-based services "waiver" programs to individuals who need a high level of care, but who would like to remain at home. Medicaid's home care programs are state-run, and each state has different rules about how to qualify. Because Medicaid is available only to low-income individuals, each state sets its own asset and income limits.

For example, in 2021, an applicant in New York must have income that is lower than $884 a month and fewer than $15,900 in assets to qualify. But Minnesota's income limit is $2,382 and its asset limit is $3,000, while Connecticut's income limit is also $2,250 but its asset limit is just $1,600. 

States also vary widely in what services they provide. Some services that Medicaid may pay for include the following: 

• In-home health care

• Personal care services, such as help bathing, eating, and moving

• Home care services, including help with household chores like shopping or laundry

• Caregiver support

• Minor modifications to the home to make it accessible

• Medical equipment

In most states it is possible for family members to get paid for providing care to a Medicaid recipient. The Medicaid applicant must apply for Medicaid and select a program that allows the recipient to choose his or her own caregiver, often called "consumer directed care."

Most states that allow paid family caregivers do not allow legal guardians and spouses to be paid by Medicaid, but a few states do. Some states will pay caregivers only if they do not live in the same house as the Medicaid recipient. 

Contact our office at 803-980-1199 and schedule an appointment today!

~ Elder Law Answers

Medicaid's Coverage of Nursing Home Care

For better or worse, Medicaid is the primary method of paying for nursing home care in the United States. However, navigating the Medicaid system is complicated and confusing.

 Medicaid Basics 

Medicaid (sometimes called by other names, such as Medi-Cal in California, MassHealth in Massachusetts, and TennCare in Tennessee) is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers long-term care for those who qualify. This coverage has traditionally meant care in a nursing home, although coverage of care in an assisted living facility or at home is possible (see below). 

In the absence of any other public program covering long-term care (Medicare provides only limited nursing home coverage), Medicaid has become the default nursing home insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care services until they become eligible for Medicaid. 

Medicaid Rules Vary By State

Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the state's Medicaid costs. This complicates matters since the Medicaid eligibility rules are somewhat different from state to state, and they keep changing. To be certain of your rights, consult an elder law attorney to guide you through the complicated rules of the different programs and help you plan ahead. While the majority of nursing homes accept Medicaid patients, there are some that do not. Even nursing homes that accept Medicaid recipients may only have a limited number of Medicaid beds available. Nursing homes must be certified by the state in order to accept Medicaid payments. Check with the facility before applying for admittance. 

Medicaid Qualifications and Medical Requirements

To qualify for coverage, applicants must have limited assets and income. You typically can't have more than $2,000 in assets; the figure may be slightly higher in some states. To lower your assets, you need to spend them down by paying for things that benefit the Medicaid applicant. You can't simply give away your resources in order to qualify for Medicaid. Income limits vary by state. In some states, you can keep excess income in trust; in other states, you must pay your excess income to the nursing home. 

In addition to the strict income and asset limits, you must meet level of care requirements in order to qualify for nursing home coverage. Each state sets its own level of care criteria, and the criteria are not always clear. The state looks at an applicant’s functional, medical, and cognitive abilities to determine if they need care in a nursing home. You are usually determined to need long-term care if you need help with two or more activities of daily living (such as bathing, dressing, eating, moving, and going to the bathroom). But to need a nursing home level of care, you may also need frequent medical care, such as assistance with medication, injections, IVs, or other medical treatment. The state may also consider your cognitive abilities—i.e., whether you have the ability to make decisions on your own. 

Once you qualify for Medicaid, the program pays for all your basic expenses, but nursing home residents may be charged extra for certain amenities, like a private room, comfort items, or specially prepared food. 

In-Home Care and Assisted Living 

In addition to nursing home care, Medicaid may cover some home care services or, in limited circumstances, care in assisted living. Home care is typically provided through home- and community-based services "waiver" programs to individuals who need a high level of care but who would like to remain at home. States vary widely on how to qualify and what is covered. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents. - Elder Law Answers

Call our office at 803-980-1199. Schedule an appointment to learn more about Medicaid. Be prepared BEFORE you need Medicaid services!