how much does medicare take from spouse if spouse goes in nursing home

In order to be eligible for Medicaid

benefits a nursing home resident may have no more than $2,000 in assets (an amount may be somewhat higher in some states). In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $137,400 (in 2022).

Full Answer

How much money can a nursing home take from a spouse?

In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in assets (an amount may be somewhat higher in some states). In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $126,420 (in 2019).

What happens when a spouse enters a nursing home paid by Medicaid?

When a spouse enters a nursing home paid for by Medicaid and the other spouse is healthy and can live independently, couples have many questions. Some questions are financial in nature, such as what happens to each of the spouse’s income.

Can I receive my spouse’s income if they move into a nursing home?

One doesn’t necessarily lose the income of their institutionalized husband or wife simply because that spouse moves into a nursing home paid for by Medicaid. Whether you, as the healthy spouse, can receive your spouse’s income depends on your own income, and if you need the extra income to support yourself.

Does Medicare pay for nursing home care?

Medicare vs. Medicaid Roles in Nursing Home Care Medicare does cover nursing home care—up to a point. If you are sent to a skilled nursing facility for care after a three-day in-patient hospital stay, Medicare will pay the full cost for the first 20 days.

What happens when one spouse goes to a nursing home?

When your spouse goes to a nursing home, you can retain some income and assets and still qualify for Medicaid. Medicaid does not require a healthy spouse to give up all of her income and property so the spouse needing care can qualify for long-term care through Medicaid.

Does Medicare pays most of the costs associated with nursing home care?

Medicare doesn't pay anything toward the considerable cost of staying in a nursing home or other facility for long-term care.

Can my spouse put me in a nursing home?

In brief, the federal government has written a law to ensure the healthy spouse does not go broke and is not left without a place to live when their spouse enters a nursing home. In Medicaid-speak, this law is referred to as Spousal Impoverishment Protection, Spousal Impoverishment Law, or Division of Assets.

What is spousal protection?

What are the “Spousal Impoverishment Protections”? The spousal impoverishment protections are Medi-Cal rules designed to prevent the impoverishment of. one spouse, when the other spouse enrolls in Medi-Cal payment for nursing home care, or “Home and. Community Based Services.”

What does Medicare Part B cover in a nursing home?

Original Medicare Part A covers inpatient hospital care, skilled nursing facility care, and hospice stays. Part B provides coverage for outpatient services, such as visits to a doctor's office, durable medical equipment, therapeutic services, and some limited prescription medication.

How Long Will Medicare pay for home health care?

To be covered, the services must be ordered by a doctor, and one of the more than 11,000 home health agencies nationwide that Medicare has certified must provide the care. Under these circumstances, Medicare can pay the full cost of home health care for up to 60 days at a time.

Does a wife have to pay for husbands care?

Does your spouse or partner have to pay for your care? If you're wondering whether one partner in a couple is liable for the other's care costs, generally speaking the answer is no.

Will I lose my house if my husband goes into care?

If you or your spouse / partner (or certain other people) want to continue living in your home, then you'll avoid having to sell up to pay for care. You and/or any qualifying dependants who live in your home have the right to stay there indefinitely, and can't be forced to sell up to pay for your care.

How do I protect my assets when my husband has dementia?

So, in order for you to be able to direct your assets into a protective Trust, you must hold title to the assets in your name alone or in your own individual Revocable Trust. The Revocable Trust is best because it avoids probate when you survive your spouse and the assets are paid out to your children or other family.

How much money can a spouse keep?

In general, the community spouse may keep one-half of the couple's total "countable" assets up to a maximum of $137,400 (in 2022). Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order.

How does Congress protect community spouses from destitution when the other spouse enters a nursing home?

Spousal impoverishment rules include a Minimum Monthly Maintenance Needs Allowance (MMMNA) and a Community Spouse Resource Allowance (CSRA) that “protect” a portion of a couple's income and assets (including the home) for the non-applicant spouse. Thereby, preventing the impoverishment of the non-applicant spouse.

What is a countable asset?

Countable Assets They are sometimes called liquid assets, which are assets that are easily converted to cash. Countable assets include cash, bank accounts (checking, money market, savings), vacation houses and property other than one's primary residence, mutual funds, stocks, bonds, and certificates of deposit.

What happens when a spouse goes into a nursing home?

When a spouse goes into a Nursing Home, you may experience a whirlwind of clinical and financial circumstances that can leave you feeling disoriented and helpless. When a spouse goes into a Nursing Home, he or she will either return home having successfully improved or, alternatively, will need long-term care.

What is a spouse in the community?

The Spouse in the Community. There is a team dynamic to a Post-Acute stay at a Nursing Home in the context of a married couple. The spouse in the community (i.e. the one who has not suffered a health decline) may have to do more of the long-term planning, coordination, and decision-making with the Nursing Home Staff due to the spouse's inability.

What should be the first step in nursing home care?

Clinically, when you enter a Nursing Home for post-acute care there should be an initial focus on care planning and therapy goal setting. These care paths are driven by the professional therapists at the Nursing Home along with the Attending Physician orders for care. In order for your spouse to return home successfully, the overall clinical and functional condition of your spouse must have improved and the Attending Physician along with the Interdepartmental Team must deem your spouse safe to discharge.

Why are assets maintained in nursing homes?

Another reason why assets can be maintained is because, in some cases, Medicaid can be terminated if your functional status and clinical condition improve or stabilize enough where you can be moved to a separate silo of Medicaid coverage - group homes or HCBS. I’ve seen this happen to residents who have lived at my Nursing Home for over 3 years. In fact, one Medicaid Case Worker in my state admitted to me that, on an annual basis, there is an effort to review & transition up to 10% of their Nursing Home caseload to a lower level of care for cost purposes.

What is the importance of capturing all living expenses and liabilities to turn into the Medicaid office for determination?

Because of this, it is critical that there is total cooperation and prudence given to capturing all living expenses and liabilities to turn into the Medicaid office for determination. Bottom line - the more qualifying expenses the spouse in the community can find, the less the Patient Liability will be.

Can a spouse be in a nursing home for short term care?

Assuming the spouse has possessed social security income and/or a retirement pension before entering a Nursing Home for short-term care, there is really no substantial effect besides the copay incurred, if at all.

Can a spouse go into a nursing home?

When a spousal unit reach es a certain age, there must be planning around what happens when one spouse goes into a Nursing Home. Though you’d like to think that you’ll never need Nursing Home Care, national data trends imply that there is a moderate chance, based on your health, that you may rely on some type of Nursing Home care in the future. That percentage goes up if you are of a certain socioeconomic group, or have certain health conditions. By understanding insurance systems and the planning of care, you and your spouse can be most prepared for an unexpected or permanent health setback requiring Nursing Home care.

What Happens When My Spouse Enters into a Nursing Home?

When your spouse enters into a nursing home, his needs would be catered for. Medicaid takes up all the healthcare costs. He will lose his/her income. The only money he will be having is his personal allowance which is determined by the state and your joint allowance is also considered.

What Assets Are Protected from Nursing Home?

You can protect both countable and uncountable assets from a nursing home. With the help of a Medicaid expert, you will be guided through the process. You can protect your money by investing in Trust or turning it into your irrevocable funeral trust.

Can Nursing Home Take Spouse Assets?

For anyone applying for Medicaid, there are two kinds of assets: countable and uncountable assets.

How much does Medicare pay for 2020?

For the next 100 days, Medicare covers most of the charges, but patients must pay $176.00 per day (in 2020) unless they have a supplemental insurance policy. 3 . These rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits 4  5 .

How long does it take to transfer assets to Medicaid?

The transfer of assets must have occurred at least five years before applying to Medicaid in order to avoid the program's lookback period.

What is Medicaid for seniors?

Medicaid is for individuals and families living on a limited income; many seniors use it to pay for long-term care in nursing homes.

What age can you transfer Medicaid?

Arrangements that are allowed include transfers to: 13 . Spouse of the applicant. A child under the age of 21. A child who is permanently disabled or blind. An adult child who has been living in the home and provided care to the patient for at least two years prior to the application for Medicaid.

Is medicaid a welfare program?

While Medicare is an entitlement program, Medicaid is a form of welfare—or at least that’s how it began. So to be eligible, you must become ‘impoverished’ under the program’s guidelines,” says Laura M. Krohn, a Rhode Island-based elder law attorney. 2 . Let's look at how the economics work, and how Medicaid can be used to pay for a nursing home.

Can nursing homes accept Medicaid?

Some nursing homes won’t accept Medicaid patients outright, but the law forbids them from throwing you out if you become dependent on Medicaid when you are in their care.

Does a house count as a principal residence?

A house must be a principal residence and does not count as long as the nursing home resident or their spouse lives there or intends to return there. 9 . Upon becoming eligible for Medicaid, all of the applicant's income must be used to pay for the nursing home, where the applicant resides.

Do they look at one spouse's assets when determining eligibility?

Myth – They only look at one spouse’s assets when determining eligibility.

Does Medicaid take your home?

Medicaid does not take anyone’s home , let alone the primary residence of a community spouse. Instead, the Medicaid considers the primary residence of a community a non-countable, or exempt, resource when determining eligibility. This myth, I believe, arises from the fact that if a single individual does not reside in real property ...

Can an institutionalized spouse be eligible for Medicaid?

Once the institutionalized spouse is eligible for Medicaid, the resources and income of the community spouse will not be considered for continuing eligibility of the institutionalized spouse.

What is the number to contact if your spouse goes into a nursing home?

Contact our asset protection lawyers now at 239-222-2222.

What is the law that protects spouses from going broke?

The law, enacted by Congress in 1988, is called Spousal Impoverishment Protection , and ensures a spouse still living in the community will not go broke. In fact, the law ensures that a specific amount of assets and funds are protected, so the spouse living independently has enough to live on.

What happens to other assets such as a home or retirement savings?

In terms of other assets, you will be able to keep your home if you continue to live in it, no matter what the value is. The home is considered exempt from counting toward Medicaid, as is your furnishings, personal effects, vehicles, and funeral plots and prepaid burials.

Is my spouse's income considered for Medicaid?

In fact, your income is not considered when your spouse’s Medicaid application is filed, and eligibility is determined. Only your spouse’s income will be considered for eligibility in the program. In some states, some contribution is required to nursing home costs for a spouse if your income exceeds a certain amount.

Can non-exempt assets be used for Medicaid?

Unlike income, non-exempt assets are considered jointly owned, and can be used toward Medicaid eligibility. However, there are ways to protect these assets by placing the money into exempt assets. Because of the laws surrounding Medicaid eligibility, it’s important to seek counsel from an experienced asset protection lawyer at The Mattar Firm, ...

Do you have to contribute to nursing home for spouse?

In some states, some contribution is required to nursing home costs for a spouse if your income exceeds a certain amount. However, it would not be enough of a contribution so that the independent spouse would not have enough to live on. Although your spouse may be entering a nursing home, that does not mean that you automatically lose their income.

Can you use 401(k) for Medicaid?

However, working with an experienced asset protection lawyer at The Mattar Firm will help you maintain these items and protect the assets. Unlike income, non-exempt assets are considered jointly owned and can be used toward Medicaid eligibility.

How much can a nursing home spouse have in 2021?

While a nursing home spouse may not have more than $2,000 in countable assets in order to receive Medicaid long-term care benefits, federal law permits their community spouse to retain up to $130,380 in countable assets in 2021 (e.g., cash, stocks, bonds, and real estate in addition to their primary ...

How much of Medicaid is held by spouse?

In most states, the community spouse may only retain 50 percent of the total countable assets of both spouses, up to their state’s maximum CSRA. Medicaid considers all property owned by a married couple to be joint assets. Therefore, all countable assets—regardless of whether they are titled in the husband’s name, the wife’s name or jointly—are totaled up and then divided by two.

What Happens When Only One Spouse Needs Medicaid Long-Term Care?

This makes sense for a single applicant, but does a married couple have to spend down all their assets and income when only one spouse requires Medicaid? Fortunately, the answer is no.

How much does a semi private nursing home cost?

The current national median cost of a semi-private nursing home room is $7,756 per month. Even couples who have made legal and financial preparations for retirement can quickly exhaust their savings when just one spouse develops a need for long-term care. This scenario was dubbed “spousal impoverishment” and Congress created rules to prevent it in 1988. Prior to the passage of spousal impoverishment protections, community spouses faced serious financial hardship after spending down their income and assets on nursing home care to get Medicaid coverage to kick in for their institutionalized partners.

How much of a nursing home spouse's assets can be disposed of?

The community spouse is then permitted to keep one-half of the total assets, up to the maximum CSRA. The other half (minus the $2,000 exemption allowed for the nursing home spouse) must be “spent down” or otherwise disposed of before the applicant can qualify for Medicaid.

What is the maximum community spouse resource allowance?

This is known as the maximum community spouse resource allowance or CSRA. States can set their own CSRA standard, but it cannot exceed the $130,380 maximum CSRA or be lower than the $26,076 minimum CSRA set by federal law. Read: Assets You Can Have and Still Qualify for Medicaid.

What is the maximum CSRA for community spouse?

These states (called 100 percent states) simply allow the community spouse to retain 100 percent of the couple’s assets up to their state’s maximum CSRA, which is $130,380 for most.

How much does Medicaid cover for nursing home expenses?

Without friends and family helping to cover the cost of home expenses, this isn’t feasible given the small Medicaid asset limit (generally $2,000 ) and personal care allowance (approximately $30 – $100 / month) for a person on nursing home Medicaid.

What happens to Medicaid if a spouse dies?

For instance, in some states, such as Florida, if the Medicaid recipient passes away, leaving a surviving spouse, the state will try to recover long-term care costs after the surviving spouse dies.

How to protect your home from Medicaid?

Another option to protect one’s home is to establish an irrevocable (it cannot be changed or cancelled) trust that holds the title of the home. (In an oversimplified explanation, there is a “trustee” who manages the trust, and the person who created the trust no longer is considered to be the owner of the assets. However, one’s children can be named as beneficiaries, which protects the home as inheritance.) The problem with Medicaid Asset Protection Trusts is timing, as this type of transfer will violate Medicaid’s look back rule and create a period of Medicaid ineligibility. Therefore, this strategy needs to be implemented well before it’s thought one might require Medicaid assistance. Five years to be exact, in order to avoid the look back period. However, one exception is the state of California, which only has a 30-month look back period. (New York is also in the process of implementing a 30-month look back period for long-term home and community based services). Another exception is a married couple with just one spouse requiring nursing home Medicaid assistance. In this situation, if the home is solely in the name of the community spouse, he/she can transfer the home into an irrevocable trust without impacting the Medicaid eligibility of the institutionalized spouse.

How long does a sibling have to live in a nursing home?

The Sibling Exemption allows the home to be transferred to a sibling who is part owner of the house and who lived in the home for at least one year prior to his/her sibling moving into a Medicaid-funded nursing home. This must be done correctly in order to avoid violating Medicaid’s look back period and creating a period of Medicaid ineligibility.

What is the value of a nursing home in 2021?

(In 2021, the equity interest limit is either $603,000 or $906,000. To see what the equity interest limit is in the state in which one resides, click here .). Essentially, an “intent to return home” statement protects your home from Medicaid while you reside in a nursing home facility. Without an “intent to return home” statement, your home would make you ineligible for Medicaid. Therefore, you would have to sell it and use the proceeds for your nursing home care until you are financially eligible for Medicaid.

How much can a person retain for Medicaid?

This means he can retain up to $352,000 in assets (Medicaid’s asset limit is generally $2,000, so $350,000 + $2,000 = $352,000) and still qualify for Medicaid. Furthermore, up to $350,000 in assets can be declared “protected” from estate recovery.

How much is home equity in 2021?

In other words, it is not counted towards Medicaid’s asset limit, which in most states is $2,000. As of 2021, one’s home equity interest must be under $603,000 or $906,000, depending on the state in which one resides. For state specific equity interest limits, click here. If your home is exempt (not counted towards the asset limit) ...

The Spouse in The Community

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Care Planning and Clinical Considerations

The Spouse in The Nursing Home