Mainecare (Maine’s Medicaid Program)
Most people do not realize that Medicaid/Mainecare is not just for the poor or impoverished. Generally, people who need Medicaid planning are middle-class or upper-middle-class people who have saved their entire lives for retirement, only to be shocked and dismayed at the incredibly high cost of long-term care. This is why long-term care planning is so important.
Proper Medicaid and long-term care planning will put together strategies to assist individuals to pay the incredibly high costs associated with long-term care and protect their assets so they have something to pass onto their heirs.
The United States government provides many benefits and resources for seniors. Chief among these benefits is a government health care program called Medicare. While this may seem like a household name, many seniors are unaware if they are eligible, and what benefits they may receive.
Medicare is the federally funded health insurance program that covers most people aged 65 and over. Original Medicare consists of two parts; part A, which is your hospital insurance, and part B, your medical insurance.
It Covers inpatient hospital care, limited home health services, skilled nursing facility care, and hospice care. Inpatient hospital care will include services that are critical to your care such as your room costs, meals, medications, and nursing services. Home health services are only covered if your doctor deems them medically necessary. This usually includes physical therapy services, part-time nursing care, and even medical equipment. Skilled nursing facility care is covered only after a hospital stay of at least three days and must be provided at a Medicare-certified facility. Hospice care will be covered if your doctor certifies that you are terminally ill with a prognosis of six months or less to live, and you agree to give up treatments to cure your disease; however, Medicare will still cover the costs for comfort treatments.
Generally, seniors are eligible for Part A benefits if they are age 65 or older and a U.S. citizen or permanent legal resident of five consecutive years or more, or you are already receiving retirement benefits such as Social Security, or you are disabled and are receiving disability benefits. You may be eligible to receive these benefits without paying a premium if you have been employed and working for at least 10 years and have paid Medicare taxes during that time. If you are not eligible for premium-free coverage, you may still enroll in Medicare and pay a premium. It is important to enroll as soon as you meet these eligibility requirements because you may be subject to a late penalty if you delay enrollment. If you are already receiving Social Security benefits or benefits from the Railroad Retirement Board, your enrollment is usually automatic when you turn 65.
If this is not your situation, you will need to enroll during the Initial Enrollment Period by either visiting the Social Security website, enrolling in person at your local Social Security office or by calling 1-800-772-1213. The Initial Enrollment Period begins three months before your 65th birthday and continues for seven months.
It covers costs relating to treatment outside of a hospital setting and includes the services and supplies your doctor states is medically necessary to treat your health condition. This may include emergency medical services, outpatient care, and even preventative services. When enrolled in Medicare part B, you may receive a one-time “Welcome to Medicare” checkup which includes preventative disease screenings, vaccinations, and a physical exam.
If you meet the eligibility requirements for the premium-free part A coverage, you are eligible for part B. If you don’t qualify for part A, you may still qualify for part B if you are 65 years or older and a US citizen or a permanent resident for at least five consecutive years. Part B does require payment of a monthly premium which will depend on your income level, but you can expect your premium to be about $134 per month. You will need to enroll for part B coverage during the Initial Enrollment Period described previously.
Mainecare enables seniors to afford quality health care coverage at a price that likely would not be attainable in the private insurance market. It is important that you are aware of these benefits and take advantage of them as soon as you become eligible. If you have any questions about the MaineCare Application process or are ready to get started with your long-term care planning, Aging in Maine can help, please don’t hesitate to call our office at (207)848-5600 or check our CONTACT page.
MaineCare Eligibility Guide:
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