Q: What’s Medicare?
A: Medicare is basically health insurance from the federal government. You only get it if you have paid into the social security system (paid your taxes), and if you are disabled or you are over 65. It’s insurance, so there are co-pays and deductibles just like other health insurance plans. Medi-Cal can help pay for medical and long term care if you have limited funds.
Q: What is Medi-Cal?
A: Medi-Cal is very different. It’s a California program that helps pay for medical care, and long term care, but you only get Medi-Cal if you have limited assets (like cash and property). Medicare doesn’t pay for long term care (for example, if you are in a skilled nursing facility with Parkinsons’ disease for a long period, Medicare doesn’t cover the long term cost of care). So Medi-Cal is useful if you need extra care in the home, or you need help paying for a skilled nursing facility.
Q: How do I get Medi-Cal?
A: There are loads of rules, but in a nutshell, you have to own less than $2,000 in assets if you are single, and less than about $111,000 if you are married, and the doctor has to agree you need it. The good news is, plenty of assets don’t “count” for Medi-Cal, so you get to keep them and still receive Medi-Cal. Those exempt assets include your house, your car, personal items like jewelry, and more.
Q: But I heard that the State takes my house if I go on Medi-Cal- is that true?
A: No. You are allowed to keep your house (or your spouse keeps the house), and still be eligible for Medi-Cal. When you die, however, the State will try to recover the money it paid for your care. If you are married, the State can’t try and collect on this money until after your spouse is deceased. If you have a child with a disability, the State can’t try to collect while he/she is alive either. But in the end, the State will try to collect for the benefits paid on your behalf (such as the monthly bills for the nursing home). When the state is paying for your nursing home bills, think of it as a zero interest loan. At some point the state will want to be repaid, and they will collect against assets in your estate at death. If your house is the only asset in your estate at death, then yes, the State will try to collect against the house. If there are no assets in your estate at your death to repay the state, then that’s the end of the collection action.
Q: Can I protect my house so my kids get it, even if I go on Medi-Cal?
A: Yes, there are ways to protect your assets so you can get eligibility for Medi-Cal and still avoid recovery when you die. The laws can change, however, so talk to an elder law attorney to make sure you have current information about this.
Q: I don’t need a nursing home, I want to keep my spouse at home- can Medi-Cal help with that?
A: Yes. There are a number of Medi-Cal programs, including Medi-Cal In-Home Support Services and Medi-Cal Long Term Care. The first helps provide a monthly cash benefit to pay a caregiver to support your loved one, and the second helps to cover the cost of monthly care in a nursing home.
Q: If I get Medi-Cal will I lose my Medicare?
A: No, you can have both at the same time.