Medicaid can pay for long-term care if you meet its means-testing restrictions. The federal-state program is designed to help only people of limited financial means. However, people with more substantial assets can use three different strategies to shield those assets from Medicaid and ensure their eligibility for long-term care benefits. To get assistance with your planning for long-term care, consider talking to a financial advisor.
What Is Long-Term Care?
First off, what is long-term care? The term encompasses a range of services necessary for people who can’t perform everyday tasks due to debilitating health conditions or disabilities. Long-term care is distinct from traditional healthcare like doctor’s visits and medicine, so it isn’t covered by health insurance.
Rather, this type of care often covers custodial services like helping people with bathing, using the bathroom, eating and more. Long-term care may refer to any of the following facilities and services:
- Skilled nursing facilities
- Nursing homes
- Assisted living
- Adult daycare
- Homemaker services
- Home health aides
How to Pay for Long-Term Care
Paying for long-term care can potentially be a significant financial challenge. For example, the median annual bill for a semi-private room in a skilled nursing home was $94,900, according to the Genworth 2021 Cost of Care Survey.
There are four ways to pay for long-term care:
- Paying for it with your own assets
- Purchasing long-term care insurance
- Medicare (in some instances)
Paying for skilled nursing home care with your own personal assets can deplete even a sizable estate quickly, so many planners look for other ways. If purchased in advance and the premiums are regularly paid, long-term care insurance can cover some or all long-term care costs. Medicare, the federal old-age health insurance program, can pay for up to 100 days of nursing home or rehabilitative care, but basic Medicare is not set up to cover long-term care.
That leaves Medicaid, a federal-state program designed to help older or disabled people of limited financial means pay for healthcare and other services, including long-term care. In many states, Medicaid may cover the cost of living in a skilled nursing facility indefinitely.
To get benefits, however, you have to meet Medicaid’s means-testing requirements. These vary from state to state but generally require recipients to have no more than $2,000 in assets and income amounting to no more than twice the federal poverty level. Anyone with more substantial assets may not qualify for benefits or may be subject to fines and other penalties if they violate any of the rules governing qualification.
But one way people with more resources can qualify for Medicaid assistance is to “spend down” their assets – pay for care with their own money until their assets and income have declined enough to satisfy the program’s requirements.
Another tactic is to gift assets to someone else, such as a family member, so the long-term care patient can pass the means test. However, Medicaid has a five-year look-back provision that says any asset transfers must be completed at least five years before applying for Medicaid assistance.
For more recent transfers, Medicaid applies a penalty. This is calculated by dividing the size of the asset transfer by the local monthly cost of nursing home care. Transferring $200,000 in an area with $10,000 monthly costs would require the patient to pay out of pocket for their care for 20 months.
How to Protect Assets from Medicaid
There are other ways to protect assets from Medicaid while still receiving long-term care benefits. These can involve costs of their own and all have some limitations to consider, but they may be preferable to a spending down strategy:
- Medicaid asset protection trust. By setting up an irrevocable trust and transferring into it any assets in excess of the Medicaid financial limits, you can effectively shield those assets from the program’s fines and other penalties. One issue here is that assets cannot be transferred back out of the trust, so you have lost control of them forever. Also, the look-back period applies. And trusts can be expensive to set up, so they are less useful for smaller estates.
- Life estate. A life estate allows you to own real estate jointly with someone else, like your spouse, and have it pass it on to them upon your death. This can exclude the value of the family home from Medicaid’s means test. Life estates are, like Medicaid trusts, irrevocable, so you can’t change your mind and regain control of the real estate. Medicaid’s five-year look-back rules also apply, so it’s necessary to plan ahead.
- Medicaid annuity. An annuity designed to comply with local Medicaid rules can be excluded from your assets for means testing. Someone who needs long-term care unexpectedly can transfer part of their assets to a relative, which will likely trigger the look-back period. They can then use the remainder of their assets to purchase a Medicaid annuity that generates enough monthly income to cover their long-term care costs until the penalty period expires. Annuities are expensive, however, and some states limit their use for this purpose.
The Bottom Line
It’s possible to get long-term care through Medicaid, but you’ll need to use some special strategies to shield your assets in order to pass the program’s means testing. Medicaid asset protection trusts, life estates and Medicaid-compliant annuities are three ways people who otherwise may not qualify for Medicaid can receive benefits for long-term care.
Long-Term Care Planning Tips
- A financial advisor can help you design a strategy to pay for long-term care that will suit your own financial objectives. SmartAsset’s free tool matches you with up to three financial advisors in your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
- A qualified income trust is specifically designed to help people whose income is too large to qualify for local Medicaid means tests. A qualified income trust creates an account to which a high-earner can divert enough of their monthly income to meet Medicaid income restrictions.
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