Medicaid and Medicare Numbers
SPOUSAL LIMITS
Minimum assets: $21,912
Maximum assets: $109,560
Minimum income: $1750
Maximum income: $2022.00
GIFTING PENALTY DIVISOR: 4348.00
RESOURCE LIMITS:
Individual $2,000
Couple $3,000
MONTH PERSONAL NEEDS ALLOWANCE:$40
INCOME CAP AMOUNT: $2,022
Don’t let the above number scare you from applying! If your income is above that, you must create an Irrevocable Income Only Trust (a.k.a Miller Trust). This must be created and in place to accept the income the first month you want to receive services.
MEDICARE COVERAGE PART A Hospital Insurance
- a. 60 Regular Days: coverage is 100% for a semi-private room after payment of the deductible. Days 61-90 is $267/day and days 91-150 is $534/day (which are your lifetime reserve days). The Hospital deductible is $1068/benefit period.
- b. Long Care Facility payments: The first 20 days are paid in full by Medicare part A and then the co-insurance amount is $133.50 per day for the 21st - 100 day.
- c. 60 Lifetime Days: Patient is responsible for $534.00 per day in a semi-private room. Once used, the 60 lifetime days are exhausted.
- d. Medicare deductible: Due each new benefit period in the amount of $952.00.
- e. Benefit Period: A patient can rebuild his/her 60 Regular Days by staying out of the hospital or other facility primarily providing skilled nursing or rehabilitation services for a 60 day period. Once used, the 60 Lifetime Days are exhausted.
- f. Four conditions for inpatient hospital coverage:
1) A doctor prescribes inpatient hospital care
2) The care the patient requires can only be provided in a hospital
3) The hospital participates in the Medicare program
4) The Utilization Review Committee of the hospital or a professional Standards Review Organization approves the patient’s stay.
Medicare Part B Medical Insurance Premium is $96.40 taken out of the Social Security check. This can be higher if you did not sign up when first eligible.
- a. Can help pay for: Doctor bills, ambulance fees, lab, x-ray, durable medical equipment and part-time home health care.
- b. Medicare Deductible: $135.00 due each year. This may be covered by some other insurance.
- c. Payment: Will pay approximately 80% of “allowed” charges after the annual deductible is met.
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