Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 1

“For many, the solution is Medicaid. This program does pay for living assistance if you can qualify, but it is only

available to people with limited assets. Many people obtain eligibility through a process called a spend down.”

DOES MEDICARE PAY FOR

LONG-TERM CARE IN NEW

YORK?

MARK S. EGHRARI NEW YORK ESTATE PLANNING ATTORNEY

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 2

When you pay FICA or self-employment taxes while you are working, it can seem

as though your compensation is being reduced for no particular reason. In fact,

these taxes do provide you with benefits when you attain senior citizen status.

You earn retirement credits when you pay these taxes, you can earn up to four

credits per year. The requirements are very modest, so most people who work for

any length of time during a calendar year do accumulate the maximum four

credits. Once you have accrued a total of at least 40 credits during your lifetime,

you will qualify for Medicare and Social Security.

At the present time, the eligibility age for Medicare health insurance is 65. This

program is divided up into multiple different parts, and there are out-of-pocket

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 3

expenses, so you should budget for these costs when you are devising a

retirement budget.

Medicare Part A is the segment of the program that pays for inpatient

hospitalization, and there are no premiums for this coverage, but there is a

deductible per benefit period, and there can be co-payments for extended

hospital stays.

You do have to pay a monthly

premium for Medicare Part B,

which is the portion of the

program that pays for visits to

doctors and outpatient care. The

exact amount of the monthly

premium depends upon your

income level, but most people

are paying around $105 per

month at the present time.

There are also deductibles, and there are co-payments.

Part C allows you to combine your Medicare coverage with private insurance to

cover some of the gaps, and Medicare Part D is the prescription drug component.

There are co-payments, premiums, and deductibles for this coverage as well.

As you can see, there are reasonably significant costs that you have to pick up on

your own, even if you qualify for Medicare as a senior citizen, so you should keep

this in mind when you are looking ahead toward the future.

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 4

LONG-TERM CARE

Since Medicare is designed to help

seniors address medical costs that they

will invariably face, you would assume

that it is set up to assist with long-term

care expenses. The United States

Department of Health and Human

Services states that seven out of every

10 seniors will someday need living

assistance, so this is a likelihood for

most of us.

Whether it makes sense or not,

Medicare does not pay for long-term

care, because it is considered to be

custodial care. The program will pay

for convalescent care after an injury or

illness, but it does not pay for custodial care, which is the type of care that you

would receive in a nursing home or assisted living community.

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 5

This is a very significant fact of life, because it is not easy to pay for long-term

care out-of-pocket without losing all or most of what you intended to leave to

your loved ones after you are gone. We practice law on Long Island. Long-term

care costs are high everywhere, but assisted living facilities are particularly

expensive in our area.

Genworth Financial has put the subject under the microscope. They have found

that the median annual charge for a private room in a Long Island nursing home

is $162,425, and they expect costs to rise by three percent per year over the next

five years.

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 6

The average length of stay is approximately 2 years and three months according

to a government agency, and 10 percent of nursing home residents reside in the

facilities for a minimum of five years.

CONCLUSION

To sum things up, we can highlight three important facts: most seniors will need

long-term care eventually, it is very

expensive, and Medicare will not pay

for it.

For many, the solution is Medicaid.

This program does pay for living

assistance if you can qualify, but it is

only available to people with limited

assets. Many people obtain eligibility

through a process called a spend

down. They give assets to their loved

ones, but there are strict rules with

regard to the timing, so you have to

act well in advance if you want to

position yourself in the ideal manner.

Contact an elder law attorney if you

would like to discuss nursing home asset protection strategies with a licensed

professional.

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 7

REFERENCES

U.S. Department of Health and Human Services http://longtermcare.gov Genworth Financial https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-of-care.html Medicare https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 8

About the Author

Mark S. Eghrari

Mark S. Eghrari is an attorney in private practice in Smithtown, New

York. He has been in practice since 1988. Mark S. Eghrari provides

extensive estate and tax planning services to individuals and

businesses. Mr. Eghrari’s primary focus is helping clients avoid

probate, minimize or eliminate Federal and State Estate taxes and

protect their assets from the high cost of nursing care, if they become

ill. Mr. Eghrari’s expertise is in providing unique and innovative

estate planning solutions that create a secure future for his clients and their loved ones. Mr.

Eghrari is a member of the American Bar Association and New York State Bar Association as

well as the National Academy of Elder Law Attorneys and the American Academy of Estate

Planning Attorneys.

Mr. Eghrari completed his undergraduate work at Lafayette College in Easton, Pennsylvania

and received his MBA in banking and finance from Hofstra University on Long Island. He

earned his Juris Doctorate from the Hofstra University School of Law, where he was a member

of the Law Review. While in law school, Mr. Eghrari gained practical experience in the

corporate tax department of Citicorp in New York city.

Mark S. Eghrari and Associates PLLC www.myestateplan.com 50 Karl Avenue, Suite 202 Smithtown, NY 11787 Phone: (631) 265-0599 Fax: (631) 265-0754