More Than 20 Years Of Serving Colorado Families And Businesses In Times Of Need

Medicaid, Medicare, Social Security And Veterans’ Benefits

You may qualify for public and private benefits through a combination of many sources. For example, you may have paid for benefits through your employer, served in the military, or have a disability under the regulations of the Social Security Administration. At Chayet & Danzo, LLC, we help the elderly and disabled qualify for and receive the benefits for which they are eligible and entitled. We represent clients in administrative hearings and appeals that may be necessary to obtain those benefits after a denial of the initial application or claim.

The public benefit system is a complicated bureaucracy that is, more often than not, frustrating for people and their families who are trying to navigate the system. As an elder law firm, we are able to focus on the process required and provide clients with the targeted advice they need to successfully complete the process. We understand the importance of a successful application and we help our clients get it right the first time. To schedule a free consultation to learn how we can help you, contact Medicaid and Social Security Disability benefits lawyers at Chayet & Danzo, LLC, today.

Public Benefits – Understanding The Options Available To You

Benefits that are administered by the government include:

  • Medicare
  • Medicaid
  • Social Security Disability Insurance
  • Supplemental Security Income
  • Veterans Benefits
  • Federal/State Employee Benefits
  • Section 8 Housing for the Elderly and Disabled
  • Railroad Benefits

With the average annual cost of nursing home and long-term care far exceeding most individual’s income, it is increasingly important to formulate a plan to maximize your personal assets and your benefit options so that your care is not compromised by lack of resources. We also help clients protect their personal assets while qualifying for Medicaid in the future. This can be done legally through a variety of ways including transferring assets, but proper advanced planning is critical as the regulations are strict and the penalties for a misstep are severe. In the case of Medicaid, the Deficit Reduction Act of 2005 (DRA) now requires assets to be transferred from one individual to another or to a trust at least 5 years prior to applying for Medicaid.

Look Back Penalties And Medicaid

Essentially, under the terms of the DRA, for every month’s worth of assets that are transferred that are equal in value to what is considered the average monthly cost of nursing home care in the state of Colorado, a month’s worth of ineligibility is assigned. For example, assume the average monthly cost for nursing home care in Colorado is $5,000. Suppose Mrs. Jones transferred $50,000 to her son last year. Under the 5-year look back penalty under the DRA, Mrs. Jones would have to wait 10 months before she would be eligible to receive Medicaid ($50,000 divided by $5,000 = 10). The same look back penalty would apply had she transferred her assets to a trust. At Chayet & Danzo, LLC, our lawyers can help you avoid these kinds of penalties by planning early and taking advantage of allowances within the law that exempt certain kinds of assets from consideration by Medicaid.

Frequently Asked Questions About Medicaid/Medicare Benefits

Here are some common questions we hear about Medicaid and Medicare in Colorado.

What is the difference between Medicaid and Medicare?

  • Medicare falls under the Entitlement Programs category, while Medicaid falls under the Need Based Programs category
  • You will be entitled to Medicare when you reach the age 65. Medicaid requires an income and asset limit, as well as a need for custodial type care.
  • Medicare will pay for most care if it is considered skilled care, but once the patient has plateaued and is diagnosed as not needing any more skilled care, the Medicare coverage ceases. Medicaid will cover custodial type care.

What is an exempt asset according to Medicaid regulations?

  • Exempt assets are not considered when attempting to qualify for Medicaid
    • The home of any value, including the land on which it sits and adjoining property;
    • Household goods and personal effects with a value up to $2,000;
    • One wedding and engagement ring, and any items required by physical condition, i.e., prosthesis or wheelchair, or any value;
    • One vehicle of any value if equipped for a handicapped person, or used to obtain medical treatment or used for employment (must be verified by a letter from a physician or employer); exemption limited to $4,500 in all other circumstances;
    • Value of any burial space;
    • Value of any burial plan if it is irrevocable; if it is not irrevocable, a burial plan of $1,500;
    • Life insurance with a cash surrender value of $1,500
  • Shifting (converting) countable assets to exempt assets is permissible. Examples include: making improvements to the home, purchasing an exempt vehicle, purchasing an irrevocable burial plan, etc.

What steps can you take to plan for unexpected medical costs?

Being retired and having assets to pass along is fortunate. But large, unexpected medical expenses can really start to drain even the most well-managed wealth. What steps should you consider in order to prevent this from happening or address it when it does occur? Here are some considerations:

  • Is it possible to get hit with large medical bills even when you’re insured? Yes. The problem is two-fold. First, healthcare costs keep going up. And second, the copayments and deductibles insurance companies try to put on policy holders keep going up as well.
  • What can you do if a medical bill seems excessive? Financial planners and wealth managers are increasingly encouraging clients to push back against excessive medical bills. For example, it may be possible to negotiate a discount on a pricey procedure from a provider that is outside of your insurance company’s network. Another possibility is to offer to pay cash in exchange for a reduction in the overall bill.
  • What if the charges on certain medical bills don’t seem accurate? It is definitely legitimate to raise concerns about questionable charges. For example, if you were supposed to be charged in-network rates, it is improper for a healthcare provider to switch that up on you and charge out-of-network rates.

Are there ways to protect your personal assets from major medical costs while becoming eligible for Medicaid or other government resources?

Absolutely. By using a trust or other advance planning methods, it is possible to preserve certain assets and pass them along to heirs. A knowledgeable elder law attorney can guide you in this process.

If someone dies with unpaid debts, can those end up reducing the amount that heirs receive from the estate?

Yes, that can happen, especially when an estate goes through probate. With effective estate planning, however, there are ways to preserve assets to the greatest degree possible. This includes being proactive about addressing large unanticipated medical bills.

Frequently Asked Questions About Social Security Disability Benefits

Read on for additional information about SSD/SSDI.

What is the definition of “disabled” under the Social Security Administration’s regulations?

You are considered “disabled” and entitled to disabled worker’s benefits if you meet the following conditions:

  • You cannot engage in any substantial gainful activity because of a physical or mental impairment. You must not only be unable to do your previous work, but also any other type of work considering your age, education, and work experience. (Note: It does not matter whether such work exists in your immediate area, whether a specific job vacancy exists, or whether you would be hired if you applied for work.) Your impairment is determined medically by a doctor;
  • It is expected that your impairment(s) can either result in death or last for at least 21 months in a row; and
  • Your impairment(s) must be in the primary reason for your inability to engage in substantial gainful activity.

In addition to the definition of disability, you must have worked long enough – and recently enough – under Social Security to qualify for disability benefits.

What are work credits for determining SSDI eligibility?

Work credits are based on your total yearly wages or self-employment income. You can earn up to 4 credits each year. The amount needed for a credit changes from year to year.

The number of work credits you need to qualify for disability benefits depends on your age when you became disabled. Generally, you need 40 credits, 20 of which were earned in the last ten years ending with the year you become disabled. Younger workers may qualify with few credits

Contact Our Colorado Medicaid Lawyers

If you have been denied public benefits, or if you will need assistance qualifying for benefits in the future, contact a lawyer from our firm. We offer free consultations and will travel statewide to meet with clients. We can work with you on your application and any appeals of a denial, if necessary.