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Mark Cornwall: Medicare and Medi-Cal Make Medi/Medi
I wasn’t the only one to learn the very valuable lesson regarding health-care management — short term and long term — over the holiday season. There is nothing that brings the lesson to life more than a firsthand experience of observing an elderly friend or family member dealing with convalescent medical bills of $500 per day with no end in sight.
Since the holidays are the season you finally make time to visit your great aunt in “the home,” you can see how her situation — if not planned for — eats up an entire estate.
It starts with the fact that many don’t understand California’s system of comprehensive medical coverage, which is different than any other State in the Union. Unfortunately, there aren’t counselors standing in line to help the elderly understand what they should do. It takes initiative — and sometimes it’s too late. This is complicated further by the new laws in 2010 that change significantly the preparation for being able to become eligible for Medi-Cal coverage.
First, you need to forget about the term “Medicaid” when dealing with the agencies governing California’s health coverage. Medicaid is not in California’s lexicon. In the vernacular, Medicaid has been replaced with Medicare and Medi-Cal, otherwise known as Medi/Medi.
Medicare is an offspring of the Social Security Administration and intertwines with that agency such that if you’re already receiving Social Security benefits, you automatically become entitled to the health insurance program at age 65. Medicare provides some — but not all — the benefits you may need to pay for a $500-a-night stay in the hospital, particularly longer than 100 days. That’s why there’s Medi-Cal.
Specific benefits aside, there is no way to say this except that if you postpone signing up for Medicare when you’re 65, and continue to work and stay with your employer’s health-care plan, you have made your eligibility options for Medicare when you do retire much more complicated and limited. You can’t just sign up when you feel like it. There are deadlines that must be met. If you want the least hassle, apply during the seven-month enrollment period beginning three months before your birthday month and three months after — giving you seven months.
But you must be aware of what you’re getting from Medicare. It’s broken down into four parts. Part A covers hospitalization for free if age 65 or older; Part B covers doctor visits and other forms of outpatient care but charges a monthly premium of $96.40 to $353.60, depending on income; Part C are individual “Advantage” plans from Medicare that A and B don’t cover and for which the individual pays a premium; and Part D is the prescription drug plan.
This is a simplistic overview to give people an idea of the choices they face. It takes research to make sure your employment plan is going to be better in the long run. If you don’t have coverage from an employment plan, and you delay signing up in time, you will still be charged an ongoing 10 percent late-enrollment penalty on the Part B premium for every 12 months you delayed signing up.
If you have an employment plan, you can sign up at any time, but be aware of the traps. There are many: a sudden layoff, the choice of COBRA, and once a person age 65 or older stops working, he or she has only eight months to sign up for Medicare or must wait until the general sign-up period of Jan. 1 to March 31. Even then, it doesn’t take effect until the following July, and the late enrollment on the Part B premium applies.
Generally speaking, medical expenses for nearly all seniors in California are covered by Medicare, supplemental insurance, HMOs, veterans benefits, Medi-Cal and any combination of those. You can file for Medicare and be eligible for the benefits, even if you’re still working and even if you’re not collecting Social Security. For all practical purposes, if you choose Medicare Advantage, Part C, it replaces Parts A and B, and covers the same services and benefits.
Medi-Cal is California’s version of Medicaid. It’s a combined federal and state program that pays for health care and long-term care for eligible low-income citizens and legal residents of the United States. Some people receive both Medicare and Medi-Cal — thus the term Medi/Medi.
Whatever the case for you or those you love, winding through the maze of limitations and benefits needs more than a treasure map. You need an attorney trained by the National Academy of Elder Law Attorneys, the National Elder Law Foundation or a California State Bar specialist in estate planning and probate in the Elder Law Section.
— No opinion herein is a “marketed opinion” and no information provided herein can be used to avoid tax penalties for which the taxpayer would otherwise be responsible. Mark S. Cornwall has lived in Santa Barbara for more than 30 years and practiced law here for 25 years. He is accepting new clients. His book, Estate Planning: The Heroes Way for Baby Boomers, can be purchased via his Web site, www.MarkCornwall.com; Amazon.com; or locally at Chaucer’s and Borders bookstores. To schedule an appointment, contact him at .(JavaScript must be enabled to view this email address) or 805.845.7558.
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» on 01.05.10 @ 08:27 PM
Mark, I always look forward to your colums… however, in this instance, you are backpeddling. Already a common MISCONCEPTION among beneficiaries, unless you are 100% absolutely clear AND ABLE TO EXPLAIN Tclearly tHE DIFFERENCES TO CONSUMERS about Medicare and Medi-Cal , especially regarding the long term care issue ... you need to hit the books before you are able to give good advice..
» on 01.06.10 @ 06:58 AM
There won’t be any money to bail us 30 & 40 year old’s out when we are old enough to qualify for Medicare. The system is a cluster (bleep). Hitting the books won’t help anyone thanks to our gov’t! Maybe my iphone will soon have a medicare app - wishful thinking. Forever, Pessimistic
» on 01.06.10 @ 10:02 AM
The idea of “hitting the books” in order to give the general public an overview of California’s health care plan for the elderly does not begin to help anyone start thinking about planning for their future. The intricate rules governing the system is far too complicated to explain in one article. However, every stated fact in this article regarding the nature of Medicare and Medi-Cal is easily substantiated in “California Guide to Tax, Estate & Financial Planning for the Elderly” by Zimring and Bashaw, and the “Medicare Enrollment Deadlines” published by the California Health Advocates. The point is not to advise, but to make aware the need for expert advice on how to make the most of what lies in the future.
» on 01.07.10 @ 10:33 AM
This article was the clearest overview of Medicare and Medi-cal I’ve yet read. Although I’m only 53, it made me start to think about how I might deal with this issue when I reach retirement age. What I particularly liked was that it provided information without the typically concomitant editorial value judgments. Thanks for the information!
» on 01.11.10 @ 03:58 PM
Wow. Pretty impressive.
But all this will soon change. You better hope those Democrats keep the Medicare/Social Security structure in place or you are out of business as it relates to going to that feed basket on Estate Planning.
Forget Medi-Cal. My guess is none of your clients qualify for it and if they did you are not going to represent them anyway. No dinero hombre!
In the future the healthcare system is going to come out of our pockets,PERIOD. starting with the Baby Boomers!It is already occuring in the healthcare delivery system I have been involved with for 25+ years.The 3rd party reimbursement industries that dominate healhcare and drugs write the laws and dictate policy.
The children past the Bay Boomers, God help them all as they enter the reality of a third world country.
Huge compliment to you: Well written and thought out.
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