This Scooter World chair is nearly brand new, used for only a couple of weeks. The chair may have 3 to 4 miles on it. It has brand new batteries and has been fully charged. It belongs to one of our clients and we are trying to assist in selling it. Let us know if you or anyone you know is interested. The price is about half of what her family paid for it, so it’s a pretty great deal!
Medicare benefits start at age 65, but many people continue working past that age, either by choice or need. It is important to understand how Medicare and employer coverage work together.
Depending on your circumstances, Medicare is either the primary or secondary insurer. The primary insurer pays any medical bills first up to the limits of its coverage. The secondary payer covers costs the primary insurer doesn’t cover (although it may not cover all costs). Knowing whether Medicare is primary or secondary to your current coverage is crucial because it determines whether you need to sign up for Medicare Part B when you first become eligible. If Medicare is the primary insurer and you fail to sign up for Part B, your eventual Medicare Part B premium could start going up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it. For details, click here.
Here are the rules governing whether Medicare coverage will be primary or secondary:
- If your employer or your spouse’s employer has 20 or more employees, your employer’s insurance will be the primary insurer and Medicare is the secondary payer. If your employer or your spouse’s employer has fewer than 20 employees, Medicare will be the primary insurer and your employer’s insurance will be the secondary insurer.
- If you are retired and still covered by your employer’s group health insurance plan, Medicare pays first and your former employer’s plan pays second.
- If you receive both Social Security Disability Insurance and Medicare and your employer has 100 or more employees, your employer’s insurance pays first. Some employers are part of a multi-employer plan and if at least one employer in that plan has 20 employees or more, the employer’s insurance pays first. If your employer has fewer than 100 employees, Medicare will pay first.
- If you have end stage renal disease (ESRD) and are in the first 30 months of Medicare coverage of ESRD, your employer’s plan pays first. After the first 30 months, Medicare becomes the primary insurer. It does not matter how many employees your employer has.
- If you are self-employed and have a group health plan that covers yourself and at least one other person, Medicare pays first. Note that if you are self-employed, you may be able to deduct Medicare premiums from your income taxes by including the premiums in the self-employed health insurance deduction.
If your employer’s insurance is the primary insurer, the employer must offer you and your spouse the same coverage that it offers to younger employees. It also cannot deny you coverage, cancel your coverage once you become eligible for Medicare, or charge you more for premiums, deductibles, and copays.
Berger Estate & Elder Law P.A. has been serving Kansas City for over 30 years providing Trusted Council with Proactive Solutions. Call us today at (913) 491-6332, visit our website berger-lawfirm.com or stop by our conveniently located offices at 11233 Nall, Suite 140 Leawood, KS 66211 for more information.
Planning ahead for any unforeseen medical expenses, the Stewards purchased long term care (LTC) insurance. This thoughtful planning proved to be vitally important, because some years later Bernetta suffered a stroke that led to her needing the services of a local senior living community. While this insurance was thoughtful planning on behalf of the Stewards and vitally important in providing financial assistance for her care, after two years of residing in an assisted living community, Bernetta had depleted the funds of her policy. Turning to Medicaid became an essential decision for the Stewards.
Getting Bernetta approved for Medicaid was not something the Stewards could easily handle on their own, and reaching out to us at Berger Estate & Elder Law was the right decision. We would soon know what Bernetta’s options were and how to get her approved for benefits for her much needed care. After conducting a thorough investigation of the Stewards’ assets, it was discovered, like many of the other smart decisions they had made over the years, financial planning was one of them. However, with the increasing costs of health care services, the Stewards assets were insufficient if Bernetta was to continue to live well into her 80s and 90s.
The Stewards were concerned that, like their LTC insurance, their modest joint checking account, IRAs and investments would quickly run out without Medicaid when Bernetta entered her 90s. In order to qualify for Medicaid in Kansas, applicants must need a nursing home level of care, have non-exempt resources of $2,000 or below, have income less than the cost of care and not have made any uncompensated transfers (gifts) during the 5 years prior to applying for benefits. While, their savings didn’t make the Stewards millionaires, they did disqualify Bernetta for Medicaid.
In a married couple situation, Medicaid has special rules that apply in order to prevent the well spouse from becoming impoverished by the high cost of care for the nursing home spouse. Knowing what these rules are and allowing them to work for you is essential in getting approved for Medicaid and not going broke in the meantime. After a thorough investigation, it was decided the Stewards needed to submit a division of assets and purchase a Medicaid qualified annuity, converting some of their assets over to an income source for Burt. This plan allowed Bernetta to spend down less of the Stewards’ total assets in order to be approved for Medicaid. These decisions and a few others protected the Steward’s home and a significant portion of their assets from the high cost of LTC.
The plan proved successful and, after being approved for Home and Community Based Services (Medicaid), Bernetta transitioned from using her LTC insurance policy to having Medicaid pay for the care of the assisted living community she was already in. This provided Bernetta and Burt with peace of mind financially and kept her from having to make any changes with her care.
So case closed, right? Bernetta can ride off into the sunset and Burt can too, staying at home taking care of himself for the rest of his life? We all know that’s not always the case, and it certainly was not for the Stewards. Although the Stewards were able to find a comfortable scenario for Bernetta, there would be more challenging decisions ahead for the them regarding LTC.
It came time for Burt to move into the same assisted living community as Bernetta, so his physical needs could be taken care of, while being with the one he’d loved all his life. But, Burt’s scenario was different than Bernetta’s, because of his own unique circumstances and needed a different type of planning.
While the division of assets protected the Stewards’ home from the costs of LTC when Bernetta needed Medicaid approval, it didn’t protect the home when Burt needed similar care. Burt, knowing that he would soon be in need of care, decided to transfer their home over to one of their sons. This had been a part of Burt’s and Bernetta’s dreams for much of their lives, and Burt wanted to make this decision while he still could. While transferring the house was a lifelong goal, this decision was part of a twofold solution, because it put in motion the strategy necessary to help pay for Burt’s care.
In addition to fulfilling the Stewards’ lifelong desire to pass along their estate, this strategy allowed assets to be passed into the hands of the ones they trusted most. This created another source of funds for the Stewards if they needed it while being cared for together in the same community.
While transferring the home was helpful, it required that Burt undergo a different type of planning than Bernetta. Transferring one’s home in Kansas disqualifies an individual from Medicaid for up to five years. Having a long-term relationship with clients like the Stewards is such a great benefit when BEEL assists with planning for LTC. Knowing that Burt was a veteran, we also knew that he could transfer their house and still qualify for some form of assistance from the VA.
As a result of Burt’s service during the Korean War, he was able to qualify for a not well-known pension plan through the Veterans Administration. These pensions come in three different levels and through planning with us, Burt was able to qualify for the largest benefit. This veteran’s pension not only paid for Burt’s care in the same assisted living community as Bernetta, but preserved their home and many of their assets for their children, who then had funds to cover any shortfall in their care coverage.