Can anyone tell me how does Medicaid spend down and Medicare Part B works?

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My father is 66 and was diagnosed with Alzheimer's while traveling in China. He came back to NYC and I am trying to get him Medicaid and Medicare Part B. From what I heard, since he missed the deadline last year for Medicare Part B, he has to apply for it in January and it doesn't take effect until June or July. While applying for Medicaid, his income is too high and is eligible for Spend Down or Pay In Program. Does anyone have experience with this and can help me with the following questions? Do I have to apply every month for spend down or pay in? Is the start date for every month, the 1st of the month? Do I have to go in person or can I do it through mail, phone or the web? How long can I participate in each program and can I switch whenever I want? if the bills do not go over the excess income amount, what happens? do I have to go in person to deliver the bills or mail them? For the pay in program, how is the money taken? As of now, my father can take care of himself but does not go out. How do I get him out to see a doctor to get diagnosed in the States? In the future, I might consider Managed Long Term Care, home attendant, nursing home, personal care service, etc. Can anyone tell me also how that works? Thanks for all your help.

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Medicare is age based and you need to be 65 to get it or disabled and on Social Security disability for 2 years in most cases. In NYS Medicaid eligibility income level in a single person household is $825 per month or less. In cases where there is a need due to high medical bills and an inability to pay them a spend down is possible. Meaning must spend down on medical expenses to the $825 level and then Medicaid will kick in for that month. In hospital care or nursing home care is treated differently and usually takes all the income except $50 for personal items. There is a different income level and rules if there is a spouse. Again consult local Office on Aging or SHIP for help handling these issues. A consult with Elder care attorney is also a good idea.
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Yes, I got Plan F through United Health Care-AARP and it's great.
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Plan F is also the most expensive I think.
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AARP has supplemental plans also that are very well rated to cover parts of what mediCARE does not.
Medicare is AGE based eligibility and you qualify at age 62 I believe.
Everyone gets it in the USA- period MediCAID is a poverty/safety net based program. It is Federal & State funded and based on a family/individual's income level. An elderly person must be basically in poverty. Each state has a different income they consider poverty but say in Ohio it's like I think $1900 a month for an individual. If you fall below that you can get Medicaid services.

'Spend down' means- spend all your money and deplete your assets then we'll(Medicaid) will help you -once you're basically destitute. If he has assets like a house and savings and 401k etc. that has to be spent down before taking Medicaid services. If it's hidden/etc -the state will come back for it when they find out you had it. State Medicaid's have entire divisions that that's all they do- collections. They also do a 5 year look-back for people trying to hide assets and will collect on that too if they identify it.
Each state Medicaid Plan is different and has different services available
It seems you are in NY so you'd have to speak to/research online with those Medicaid folks. Usually your resident COUNTY acts as the intake for Medicaid. eligibility so they can give you the numbers plain and simple(maybe). Good luck-it is a situation where it's best to either be dirt poor or very wealthy and able to pay $7k/month at a nice alzheimers facility. The goal of the govt. programs is to keep people in their home as long as possible. And Alzheimers/Dementia care is not as fully developed in the state/federal plans so coverage and care isn't built around that health problem- it's more of a physical disability - and Medicaid /Medicare are 95% focused on physical issues. The mental health arena has up til recently been really subjugated. Persisstent problems in our society like homelessness, addictions and people killing innocent people for no reason-have caused policy makers to take a 2nd look at preventative help for mentally disturbed individuals and policies are shifting back to give mental health the respect it deserves- so hopefully dementia care/services will be better covered. it's a bit of a gap right now- I know my mother is in early stages..and there's zero 'coverage' to assist her. it's on the family for now.
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Medicare Supplemental Plan F is a good one.
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New York State has continuous open enrollment for Medicare supplement plan. There is no 6 month period or questions asked as long as the person has been continuously with health insurance without a lapse of 63 days or more. That being said he needs to enroll in Medicare part A and B during the General enrollment period from Jan to March to be effective on July 1 since he did not enroll when he first became eligible at 65. Social security can help with this enrollment and answer any questions. Make an appointment with ssa.gov. They can do this over the telephone. Then when he is enrolled check in with his area SHIP office. Social Security can give you this number. They should be able to explain the different insurance available. He should also look into EPIC to help cover medications and allow him a special enrollment period for a Part D plan and or a Medicare Advantage plan with part D. I know it is complicated and this is just Medicare. That is why I encourage you to investigate help from SHIP. I volunteer for the program and it is great. Also they can help you with the Medicaid questions and getting enrolled with them. When on Medicaid and Medicare, Medicare pays first and then Medicaid.
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See an elder attorney in the state that he resides in. Federal may be the same but each state has their rules
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I am on medicare part a and b and have a high deductible supplement with a 2800 deductible before it kicks in , you can sign up for a supplemental policy up until six months after you go on medicare with no questions asked , if you wait longer you will have to go through the underwriting process with a lot of health questions and it might cost more to get covered
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There are around 7 different Medicare supplement policies. Difference being deductibles and co pays. We have the plan F , most expensive, that has no deductibles or co pays. A lot of web sites can explain the differences in the 7 policy forms.
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One of the things, I have learned is that an Elder Care attorney consult is a must in these situation, once you do consider a spin down, etc. Consult should be free and then you have the choice to hire or not. States differ in their laws about assets , Medicaid etc. We made much better decisions with this information.
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