When you or a loved one needs medical assistance, the costs mount quickly, and you may need help paying affording the bills. With our Ocean County attorneys’ assistance, you may be able to avoid the frustration of being denied coverage and save your spouse or children the costs associated with paying for your medical care out of pocket.
For the elderly, two of the more common programs that offer assistance are Medicare and Medicaid.
Medicare is administered by the federal government, and Medicaid is administered by the State. There are many requirements to be eligible for these programs, and the elder law attorneys at Costanzo & Russom Law Group can assist you in determining whether you are eligible and, if not, what you could do to become eligible.
Medicare is a federal program of health insurance which helps pay for acute illness situations and not for long-term or custodial care. To determine if you are eligible for Medicare, you should contact your local Social Security Office.
For those that need long-term care, Medicaid is available in New Jersey. There are a number of Medicaid programs, each with its own eligibility guidelines and covered services. These programs are designed to provide health care coverage to the poor, disabled, and elderly.
For those over the age of 65, Medicaid can be an important source of financing for long-term care. If you have to enter a nursing home to receive custodial care, your assets (other than your residence and various personal items which may be exempt under certain circumstances) are worth less than $2,000.00, and your income (including social security) is less than $2,250.00 for 2018, you may be eligible for Medicaid to pay substantially all of your nursing home costs. Please note that these figures vary based on your circumstances. It is also possible for a married spouse who remains at home to preserve a significant portion of the assets of the couple if the other spouse is institutionalized.
The rules for Medicaid applications are quite complex and transfers of assets to third parties (such as gifts to children) in order to become eligible for the program can result in a penalty period being imposed. Asset transfers made within five years of the application for Medicaid are penalized. During a penalty period, the State will not pay for nursing home care. Our attorneys can help you plan to eliminate, reduce, or offset transfer penalties.
If your application for Medicaid benefits is denied, your Medicaid eligibility is terminated, or Medicaid refused to pay a claim for you, you have a right to a fair hearing before a New Jersey Administrative Law Judge. At that hearing, you have a right to be represented by counsel and to present evidence including testimony to support your case. The judge makes a recommendation to Medicaid regarding your case. Then, if Medicaid still denies your claim, you have a right to appeal to the Appellate Division of the Superior Court of New Jersey. If Medicaid has advised you that it intends to discontinue the payment of benefits, you may have a right to have benefits continued until you appeal has been decided.