When you or a loved one needs medical assistance, the costs mount quickly, and you may need to look to new entities for coverage assistance. With our Ocean County attorneys’ affordable assistance, you may be able to avoid the frustration and health costs of being denied coverage and save your spouse or children the costs associated with paying for your medical care out of their own pockets.
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 Toms River lawyers 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, the disabled, and the elderly. If, for example, you are unable to afford health care, you may be eligible for New Jersey Care which is a special Medicaid program. If you are approved for Supplemental Security Income, you are automatically entitled to receive Medicaid. There are also a number of other programs similar to Medicaid that help people afford medical care of services. You should contact your local board of social services to determine whether or not you are eligible for any Medicaid programs.
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 nursing home costs. Please note that these figures vary based on the size of your household. 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.
When considering an application for Medicaid, one should bear in mind that the rules are fairly complicated 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 during which payments by the State will not be made for nursing home care. As of January 2012, such asset transfers made within five years of the application for Medicaid are penalized. With the assistance of one of our attorneys, many of these complications can be eased with proper estate planning.
The penalty is a period of ineligibility for Medicaid, determined by dividing the value of the assets transferred by the average cost of a nursing home in New Jersey. States must apportion the period of ineligibility between spouses to that only one penalty applies. In the case of a joint asset, a withdrawal by one party is considered a transfer. Transfer penalties can be avoided by returning all the assets which were transferred. However, certain types of trusts are permitted.
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.