Why Procrastination Is a Bad Idea When It Comes to Nursing Home Medicare PlanningThe prospect of placing a loved one in a nursing home is not something that most people are anxious to consider. However, sometimes such a decision is necessary when an elderly family member suffers from mental or physical limitations that require intensive care that is beyond the scope of loved ones to provide to their aging loved one. The number of loved ones that face the challenge of ensuring an elderly family member is taken care of financially and physically will increase as the average age of our population rises. Because many families face critical decisions about paying for nursing home care and meeting qualifying criteria, it is important to have an estate plan in place to avoid problems. We have provided a couple of common traps that can snare families and their elderly loved one without proper estate planning and legal counsel from an experienced New Mexico Estate Planning Lawyer.

Failure to Comply with Medicare/Medicaid Placement Requirements

The Medicare rules require that someone being placed in a nursing home be moved there directly from a hospital after a stay of three days or longer while the patient is receiving some form of rehabilitative therapy. If this criteria is satisfied Medicare will cover all of the costs of the nursing home during the initial twenty days and eighty percent of the next eighty days of the patient’s stay.

When families are in the middle of a crisis in which an elderly loved one is receiving intensive medical care in a hospital because of a serious and potentially debilitating condition, it can be difficult to focus on these types of technical requirements. Sometimes families make the mistake of consenting to having their loved one moved to a hospice care facility prior to a nursing home which would violate the rules and could result in thousands of dollars in uncovered nursing home expenses. Although it is certainly understandable that families may not feel like they have the time or opportunity to deal with seeking legal advice prior to moving a loved one from a hospital to a nursing home, advanced planning based on prior legal advice and a well thought out estate plan can avoid these types of issues.

Lack of Financial Eligibility under the Means Test

Most people lack the financial savings to pay for nursing home care nor do they wish to deplete the legacy intended for their children on such care. There are financial tools like living trusts that can prevent the requirement that the assets in an estate be spent down to meet the financial eligibility requirements for Medicare coverage of nursing home-related expenses. Where this will not fully address the issue, there are also legal means through which the assets in the estate can be spent down to some extent so that a person who needs the care of a skilled residential facility can qualify financially. When legal advice and advance planning is not undertaken prior to a senior reaching this point, Medicare coverage may be denied so that the value of an estate is unnecessarily depleted to cover nursing home costs that can easily involve hundreds of thousands of dollars in expenses.

Understanding a Power of Attorney, Advance Health Care Proxy & Durable Power of Attorney

The above information is designed solely to illustrate general principles of law, and does not constitute a specific legal opinion on individual cases. We suggest that you contact experienced legal counsel for a specific opinion tailored to your individual circumstances.

If you have questions about estate planning or issues involving Medicaid or Medicare coverage of nursing home costs, our New Mexico Estate Planning Lawyers may be able to help. The New Mexico Estate Planning Attorneys at Jay Goodman & Associates, PC offer a free consultation in our centrally located offices in Santa Fe and Albuquerque so that we can discuss your specific situation. Call us today to schedule your free consultation at (505) 989-8117 to learn about your rights and options.


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