Five Critical Steps to Take When Mom’s (or Dad’s) Medicare Runs Out

Many senior citizens are hesitant to think about the possibility of requiring long-term health care. While this reluctance is natural, it is vital to know the facts: hundreds of thousands of elderly Californians currently reside in long-term nursing facilities. Many of these people are paying for their custodial healthcare out of pocket. Unfortunately, by the time Medi-Cal steps in, they will be impoverished.

To avoid such a scenario, you must be aware that Medicare doesn’t cover long-term care and make proper arrangements in time. Our estate planning attorneys at California Probate and Trust, PC recommend that seniors and their families take five simple steps when Medicare runs out.

1. File a Medicare Appeal

Once Medicare decides to end healthcare coverage for your parent, you will receive an official discharge notice—a NOMNC or Notice of Medicare Non-Coverage. The health care facility administration must deliver this notice no less than two calendar days before Medicare ends your parent’s coverage.

Once you receive the NOMNC, you have the right to a quick appeal. Make sure to include any reasons you believe Medicare should extend your parent’s coverage, such as your conviction (with the support of relevant medical documentation) that their health will deteriorate without continued care.

However, keep in mind that even if you manage to extend Medicare, the program limits days of care per beneficiary. If your parent needs long-term care, you will need to plan accordingly.

2. Take Care of Relevant Legal Documents

At this point, make sure you have:

  1. Your parent’s Advance Medical Directive, and;
  2. A Durable Power of Attorney document that allows you to make crucial medical, financial, and legal decisions for your parent in case they cannot do so themselves.
  3. A Revocable Living Trust. If your parent is in a skilled nursing facility, it’s time to talk about a changing of the guard, and appointing a new trustee to oversee and preserve your parent’s money.

If your parent hasn’t signed a POA yet, now is the time. If your parent loses their mental capacity due to dementia, stroke, or another medical condition, and you don’t have a legally valid POA in place, you will have no choice but to file for guardianship with all the ensuing legal costs and hassle.

Likewise, ensure your parent’s trust, will, estate planning documentation, prenuptial and postnuptial agreements, and any other essential documents are valid and up to date.

3. Prepare to Apply for Medi-Cal

For most people, paying for long-term health care out of pocket is not an option. Unless your parent has private insurance, Medi-Cal is probably the most realistic possibility of covering nursing home costs.

To help a parent apply for Medi-Cal, you will need to gather records of all their income and assets, including:

  • Gross income documentation
  • Insurance policies
  • Checking and savings accounts
  • IRAs, CDs, and annuities
  • Mortgage documentation or rent contract

Medi-Cal has ways of confirming income and asset statements, and an inaccurate application may result in denied benefits, so provide complete, up-to-date information. Remember to include all other necessary documentation such as your parent’s social security card, driver’s license, and marriage license.

4. Learn About Medi-Cal Requirements and Asset Protection Strategies

To be eligible for Medi-Cal, California’s Medi-Cal program for long term care (skilled nursing facility or the PACE program). Medi-Cal has complex rules regarding income and assets. However, do not fear. In most cases, with proactive planning, it is legal and possible to preserve most or all of the money, investments, and real estate. In some cases, a married couple can also preserve all of the monthly income.

If you call the Medi-Cal office, the Medi-Cal worker is only trained to tell you to spend all of your money and to deny your claim. We know better, and can save nearly everything. We can even avoid the look-back period. Don’t go broke when Medicare runs out. Let us help you save everything.

We recommend preparing for a Medi-Cal application well in advance so your family can preserve their assets; all of their assets. It’s your choice. You can keep your money in the family or you can give it to the government.

5. Consult an Elder Law and Estate Planning Attorney

Even if your parent hasn’t planned for Medi-Cal and needs immediate help with health care coverage, a knowledgeable asset protection lawyer can suggest several effective legal strategies, such as:

  • Asset protection trusts
  • Caregiver agreements
  • Spousal Support Order

An estate planning attorney can help you comply with current Medi-Cal requirements, especially as California prepares to implement changes to the Medi-Cal asset test.

California Probate and Trust, PC: Estate Planning and Elder Law Firm in Fair Oaks, CA

At California Probate and Trust, PC, we help families & professionals in California plan for long-term care while protecting their assets.

Many of our clients worry that they will have to go broke paying for nursing home care and lose all their hard-earned money. Please know that an estate planning attorney can suggest effective legal methods to protect your assets from Medi-Cal claims.

Our free guide, The 7 Reasons Why You Need an Estate Plan, answers many of the common questions about end-of-life planning. Call 916-603-2782, leave your name, mailing address, and phone number, and the guide will be on its way to you shortly.

Click to listen as R. Dustin MacFarlane explains the Durable Power of Attorney and What to Look for in an Estate Planning Attorney on his podcast, Legally Speaking.

Have any questions or concerns? A trust lawyer with California Probate and Trust, PC would be happy to assist. Call (916)-674-2066 or fill out our contact form today for a free consultation.

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