Fong Law Group

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

Some States Testing Out Medicaid Coverage for Healthy Food

Under a federal pilot program, a number of states are using Medicaid funds to cover healthy food costs for Medicaid recipients. Ultimately, the trial program seeks to determine whether nutrition support can help prevent and manage certain chronic illnesses related to diet.

The pilot program’s structure varies across different states, as do the criteria regarding which Medicaid recipients are eligible to take part. In some instances, Medicaid benefits may cover nutrition counseling, grocery store gift cards, “food prescriptions” for fruits and vegetables, and more.

‘Food as Medicine’

Diet-related chronic conditions are not uncommon in the United States. Today, more than 37 million Americans have diabetes. Nearly one in three adults is overweight. Poor nutrition has also been shown to lead to higher risks of heart disease, certain cancers, and other illnesses.

In the fall of 2022, the Biden administration issued a national strategy to address issues in hunger, nutrition, and health. Included in that document is information on the idea of expanding health insurance coverage for nutrition support and education.

Proponents of the pilot program point to the connections that research has made between nutrition and overall health. From their perspective, helping people make better food choices will positively affect the health care system as a whole over time.

One 2022 Tufts University study examined health outcomes for people with certain illnesses who received deliveries of healthy, medically tailored meals. The researchers estimated that establishing similar programs nationwide could prevent more than a million hospitalizations each year. In addition, they projected billions of dollars in savings for Medicaid and Medicare.

Others believe using Medicaid funding to support a “food as medicine” movement is unnecessary and will overload the program’s resources.

Which States Are Using Medicaid Funds to Cover Food?

In most states, Medicaid does not generally pay for groceries or meals. (Some Medicare Advantage plans do offer an allowance for groceries or delivery of meals.)

However, the following three states are currently putting the Medicaid for food program to the test:

• Arkansas
• Massachusetts
• Oregon

California has also been running a program of its own, called CalAIM, since 2021. Through this program, health care providers can prescribe medically supportive meals to qualifying individuals. This includes people without reliable access to affordable, healthy food or who are restricted to a specific diet for medical reasons.

Five additional states are now seeking the go-ahead to participate in the pilot program. The following have requested federal waivers and are awaiting approval:

• Delaware
• Maine
• New Mexico
• New York
• Washington

Awareness of Nutrition and Health Among Seniors

Research suggests that many older adults may not be familiar with the idea of nutrition being one way to improve health.

According to one poll, less than half of U.S. seniors say they feel knowledgeable about how nutrition connects to mental wellness. (In contrast, 80 percent of American adults ages 18 to 34 say they feel “very” or “somewhat” knowledgeable about this link.)

If you are not sure whether you qualify for Medicaid or you are interested in applying, contact your local Medicaid agency. Consult with your elder law attorney for advice on a plan for your future.

Which Should I Choose? Nursing Home Care vs. Hospice Care

End-of-life decisions are never easy. One of the most important decisions you may make regarding health care as you age could be whether you need a nursing home or hospice care.

To make the best choice for you and your family, it helps to know the difference between the nature of the care provided through a nursing home as compared with hospice.

Nursing Home Care

Nursing home facilities offer residential care for the elderly and disabled. The treatment patients receive from a nursing home differs from what is available in hospice care. Residents at nursing homes receive treatment to extend their lives. Care that you can expect from a nursing home may include custodial and some skilled care.

Custodial care includes nonmedical treatment, such as assistance with dressing, bathing, cooking, laundry, and other types of personal care. The provider does not need a medical license to give residents this type of care.

Skilled nursing care is provided by licensed medical practitioners. Nursing home residents may receive some skilled care, including wound care, physical therapy, injections, and other care that they may need to ensure their physical well-being.

Note that Medicare generally does not cover custodial care. And while Medicare Part A (hospital insurance) coverage may be available for enrollees with certain medical conditions, it is often limited to those who need short-term care in a skilled nursing facility, rather than a nursing home. (Learn more about Medicare’s limited nursing home coverage.)

If you are eligible for Medicaid, a program for individuals with limited income and assets, there are nursing homes in many states that accept Medicaid patients.

What Is Hospice Care?

Hospice care is an option for patients who do not wish to receive treatment to help improve their condition or extend their life, but want comfort care as they reach the end of their lives. Your hospice care team may include doctors, nurses, social workers, spiritual advisors, and volunteers.

A hospice care team is trained in treating end-of-life pain. Hospice care can be administered in a patient’s home or in an institutional setting. It also may provide support to family members and caretakers, including respite care.

If a patient has Medicare Part A and meets the following qualifications, they may have hospice care services, including pain-relieving medication and home aide services, covered:

• A primary care physician, or a hospice care doctor, confirms that the patient’s condition is terminal and they will not live for more than six months.
• The patient is willing to receive palliative care only and not care that is intended to try and improve their condition.
• The patient signs a statement confirming that they will receive hospice care instead of any other Medicare-covered treatments related to their physical condition.

For Medicaid recipients with a terminal illness, certain states may provide help in paying for hospice.

A Note on Concurrent Care                                         

Complicating matters is the fact that Medicare will generally not cover nursing home care and hospice care, known as concurrent care, at the same time. Currently, individuals on Medicare must give up Medicare payment for care related to their terminal condition if they want to receive Medicare’s hospice benefit. As a result, many individuals facing a terminal illness may not opt for hospice support services.

Policymakers have been pushing for a benefit within Medicare that would allow patients who wish to benefit from hospice care services (for example, a hospice aide, in-home respite care, or nutritional support) to receive curative treatment (for example, chemotherapy) simultaneously.

The Centers for Medicare and Medicaid Services has spent the past several years testing various models, including one known as the Medicare Care Choices Model (MCCM). MCCM has been shown to improve the quality of patients’ end-of-life while also resulting in Medicare savings. However, this option has not yet been made permanent.

End-of-Life Dilemma: Which Should I Choose?

While considering the next steps to take in your health care plan, speak candidly with your family and health care team about your needs and how you see your future.

If you have questions about coverage options that may be available to you in a nursing home or with hospice care, speak to your elder law attorney.

What Is Hospice Care at Home?

Hospice care is a type of health care that patients with terminally ill conditions rely on at the end of their lives. This type of care focuses on pain management and emotional, spiritual, and familial support for patients nearing the end of their lives.

There are several options for receiving hospice care, including being cared for at home. The type of intimate care a patient receives while in hospice is more conducive to being received at the patient’s home. This becomes a team effort, and it helps to have a peaceful environment when receiving care.

Who Can Benefit From This Type of Care?

Patients with serious illnesses like cancer, heart disease, dementia, kidney failure, or other fatal conditions benefit from hospice care. This type of care can help the patient live a more comfortable life while decreasing the emotional burden of grief for families by preparing them for the loss of their loved one.

When Is Hospice Recommended?

Hospice care should not only be considered by those who have loved ones nearing the end of their lives. While most of these services are generally reserved for people with six months or less to live, early hospice care can be beneficial for patients and their families as well.

You may wish to consider such services in the following cases:

• The patient has a serious decline in their physical well-being
• After a diagnosis of Alzheimer’s disease or dementia
• You have decided to forgo any treatment to improve your physical treatment or care for your illness

Who Makes Up a Hospice Care Team?

Your hospice team can consist of many different types of people. Various professionals and volunteers may be involved in end-of-life care. Some of those you may see on your care team can include:

• Doctors
• Nurses
• Social workers
• Spiritual advisors
• Trained volunteers

Who Pays for Hospice Home Care?

Like any other health care option, these services can quickly become very expensive. Fortunately, there are several ways to cover the cost, including:

Government Programs

If you qualify for government assistance, there may be insurance plans specifically designed to cover the cost of hospice care.

Seniors enrolled in Medicare Part A may qualify for a Medicare hospice care benefit. This benefit program allocates money to pay for such care at home.

For terminally ill patients on Medicaid, hospice care may be covered depending on the state.  

The Department of Veterans Affairs may also provide coverage for these care benefits for seniors who have served our country.

Private Insurance

Check the terms of your insurance policy to determine if your health insurance covers hospice care. Your policy may cover all or part of your hospice care needs.

Options for Uninsured Patients

Even if you do not have health insurance, you may still have coverage options. There are charitable organizations that work with elderly and disabled individuals who need help paying for hospice care services. Hospice care organizations also often have internal departments that work with patients who qualify for this type of care but are indigent or do not have health insurance.

Is In-Home Hospice Right For You?

Making this choice is an important part of your end-of-life care plan. Be sure to gather as much information as you can before deciding whether this type o care is best for you. For example, you may want to consult Medicare’s hospice compare website or CaringInfo.org’s website for other hospice locator tools.

If you have questions about Medicare or Medicaid, contact your elder law attorney to learn more.

What Is a Health Savings Account? Will Medicare Affect Mine?

A health savings account may help you save money on medical expenses, depending on your insurance type. If you are eligible, you can use your health savings account (HSA) to cover certain medical costs, according to HealthCare.gov.

How Does an HSA Work?

If you have a high deductible health plan, you can contribute to an HSA and use the untaxed money to cover medical costs, decreasing your total medical expenses.

High deductible health plans typically have lower monthly premiums than other insurance plans. However, individuals may pay more for medical services before coverage starts, per HealthCare.gov.

What Do Health Savings Accounts Cover?

You can use an HSA to pay for deductibles, copayments, and coinsurance.

Examples of typical expenses for which you can use a health savings account include:

• Acupuncture
• Ambulance costs
• Doctor visits
• Hearing aids
• Medications
• Psychiatric care and psychological therapy
• Certain long-term care services

However, you generally cannot use money from an HSA for monthly insurance premiums, unless you receive Medicare, health care continuation coverage, or unemployment compensation.

For long-term care insurance, you may be able to pay your premiums through a health savings account.

The Benefits of Health Savings Accounts

The advantage of using a health savings account is that funds are not subject to federal taxes when you contribute or withdraw money to pay for qualified medical expenses. You can also earn tax-free interest.

Should you have money left over in your account at the end of the year, it rolls over. The funds stay active, remaining in your account until you need them. Even if you change jobs or retire, you can keep your HSA.

In some cases, you can use your health savings account to cover your spouse’s and dependents’ medical expenses, even if they are not on your plan.

Health Savings Account Rules

2023 Contribution Amounts

The Internal Revenue Service sets contribution limits on HSA’s.

• For 2023, individuals can contribute up to $3,850, and families can put up to $7,300 into a health savings account, Investopedia reports.
• People who are 55 and older by the end of the tax year can make an additional $1,000 catch-up contribution.

Other Insurance Types

Other insurance plans can disqualify you from contributing funds to an HSA.

• Individuals with dollar-first insurance plans – in which the insurer takes care of its share of an included service before the insured individual pays deductibles or copayments – cannot put funds into a health savings account for their outstanding health care fees.
• Those on Medicare cannot add money to health savings accounts, though they can withdraw capital from their accounts to pay medical expenses that Medicare does not cover. While people using health savings accounts typically cannot use the funds to cover monthly premiums, there is an exception for Medicare beneficiaries.

Penalties

Although health savings accounts have several advantages, they also impose restrictions on how you use your money.

Taking money from your account for nonmedical or unqualified expenses before you reach 65 results in a 20 percent tax penalty. The 20 percent tax penalty for ineligible withdrawals does not apply if you are 65 and older. Still, you must pay income tax.

Opening a Health Savings Account

There are several ways to open an HSA.

• Employers can offer them, with the employer and the employee jointly funding the account.
• Some health insurance companies provide health savings accounts with high deductible health plans.
• Banks and financial institutions offer accounts for individuals.

How Does Medicare Affect Your Health Savings Account?

When you enroll in Medicare, you can no longer contribute pre-tax dollars to your health savings account. To put untaxed money in an HSA, you must have high deductible health insurance without additional disqualifying coverage, such as Medicare. Once you have Medicare, you can no longer add tax-free funds to your account.

After you enroll in Medicare, however, you can still access your health savings account. One of the advantages of health savings accounts is that they are vested. As a Medicare beneficiary, you can continue using untaxed funds to cover the medical expenses your insurance does not bear, such as deductibles, coinsurance, and copayments. You cannot, however, use tax-free money to pay for Medicare supplemental insurance.

While the Internal Revenue Service (IRS) prohibits people from using untaxed capital for high deductible health insurance plan premiums, the rule differs for Medicare. When you enroll, you can use your HSA to pay your Medicare premiums without taxes.

Withdrawing Money From Your HSA

People over 65 can withdraw funds from their health savings accounts for nonmedical expenses. Although these withdrawals are no longer tax-free, older adults do not incur the 20 percent tax penalty the IRS imposes on younger people taking funds HSA’s for ineligible expenses.

Since medical costs tend to increase with age, many prefer to keep their money in their health savings accounts to cover eligible medical expenses tax-free.

Delaying Medicare Enrollment

Some people with health savings accounts enroll in Medicare when they initially become eligible, forfeiting the ability to make HSA deposits for Medicare’s coverage. Others delay enrollment in order to continue making health savings account contributions.

• According to the Journal of Accountancy, only individuals with employer-sponsored high deductible health insurance as their primary coverage can continue adding to their health savings accounts past retirement age by delaying Medicare enrollment.
  
  Individuals with private insurance, continuation of health coverage (COBRA), or a health care exchange cannot fund their HSA’s after reaching retirement age.
   
• People who continue to work at small companies after becoming eligible for Medicare must enroll in the program immediately to have any health insurance coverage.
  
  Per MedicareInteractive.org, Medicare must be the primary insurance for those working at companies with fewer than 20 employees. Since the small employer’s health plan does not have to pay until after Medicare contributes, these individuals risk losing health coverage if they delay enrolling in Medicare. Deferment also results in a late penalty.
   
• Those with health insurance from businesses with 20 or more employees can put off Medicare enrollment and continue placing funds into their health savings accounts. Because the company insurance would remain the primary insurer when they join Medicare, they can continue receiving health insurance coverage without Medicare.

Individuals who wish to delay enrolling in Medicare should not accept Social Security payments. This is because Social Security automatically registers beneficiaries for Medicare Part A, rendering them unable to make HSA deposits.

Medicare and the IRS recommend that people who have delayed enrollment after becoming eligible should cease health savings account contributions six months before joining Medicare to avoid a tax penalty. A six-month lookback period applies, as Medicare’s coverage is retroactive.

If you have an HSA, whether you should delay Medicare enrollment depends on your situation. The decision could significantly impact your finances. Speak to your elder law attorney to learn more about your options for your health savings account as you approach retirement age.

Will Medicare Pay for Housekeeping Services?

Medicare is federal health insurance for people over 65, some younger people with disabilities, and those with end-stage renal disease. Coverage of housekeeping services under Medicare can depend on several factors.

Coverage Under Original Medicare?

Medicare is comprised of Part A and Part B coverage. It is often referred to as “original Medicare.”

Part A is free for most people and covers a certain number of days related to hospital inpatient stays, care in a skilled nursing facility, hospice care, and some home health care.

Part B covers doctors’ services, outpatient care, medical supplies, and preventive services. There is a monthly premium for Part B Medicare, plus cost sharing of any care received pursuant to Part A or B.

Original Medicare does not generally cover housekeeping services. Original Medicare labels these services as “homemaker” services, which also include shopping, cleaning, and laundry. If you cannot clean your home for medical reasons, then these costs would be out of pocket.

Coverage Under Medicare Advantage?

However, some Medicare Advantage plans may cover cleaning services. A Medicare Advantage Plan — also commonly referred to as Medicare Part C — is another way to get your Medicare coverage, except through a private insurance company. Many Medicare Advantage plans will cover things original Medicare may not cover and provide additional benefits. However, these companies must follow the rules set by Medicare.

Medicare now allows these private insurers to pay for some limited housecleaning if it is linked to a specific health issue. For example, if you suffer from asthma or breathing conditions, these plans may cover filtration or air cleaners, periodic washing of linens, vacuuming and carpet cleaning, and other similar services. If you suffer from an immune deficiency condition, it may be possible to get coverage for periodic disinfectant cleaning services. However, ongoing or regular services are not likely to be covered.

A senior’s eligibility for Medicare Advantage plan options will depend on what plan options are offered in their area. For more information on Medicare coverage, reach out to your attorney.

Getting Medicare Food Benefits

As people age, accessing healthy meals can become more challenging. According to Feeding America, one in five older adults was food-insecure in 2020. Some older adults struggle with affording healthy foods, whereas others have difficulty going to the grocery store and preparing meals when recovering from an illness or injury.

Although original Medicare does not offer food benefits, some Medicare Advantage plans provide a grocery allowance or cover meal delivery. Some programs also include nutrition education and cooking classes.

Certain Medicare Advantage plans may provide Part C food benefits in addition to Part A hospital, Part B medical, and Part D prescription drug coverage. They may also supply vision, dental, and hearing coverage. The Medicare Advantage plans available to you depend on your state.

Medicare Advantage

Medicare Advantage differs from traditional Medicare, as private companies contract with Medicare to offer Medicare Advantage plans. Plans vary, and finding insurance that fits your unique needs is essential.

Potential enrollees should also be wary of predatory marketing practices and evaluate their options before committing to a plan. Even if you qualify for a Medicare Advantage plan with food benefits, traditional Medicare could be a better option for you, depending on your circumstances.

Special Needs Plans

Special needs plans, which tailor membership to beneficiaries who meet specific criteria, offer grocery and meal benefits options.

Qualifying for grocery benefits through a special needs plan generally requires an individual to have an underlying condition. Examples of conditions that can qualify a person for Medicare Advantage food benefits include diabetes, cancer, heart disease, kidney disease, end-stage renal disease, arthritis, an autoimmune disorder, and obesity.

Grocery Benefits

When Medicare Advantage plans have grocery benefits, they typically give beneficiaries a card that they can use to check out at approved stores like Kroger and Walmart.

The benefits only cover whole foods such as vegetables, legumes, meat, and dairy, as well as pantry staples and water. Only covered food items can go on the card. Enrollees must pay out of pocket for soda, baked goods, and processed foods like chips.

Meal Delivery Services

Instead of grocery benefits, some Medicare Advantage Part C plans cover meal delivery services. Meal delivery services can benefit those who face challenges getting to the grocery store and preparing meals. A service must meet Medicare’s nutritional guidelines for Medicare Advantage to cover it.

Many Medicare Advantage plans only supply meal delivery for a set period. This type of plan can suit those discharged from a hospital or skilled nursing facility who only need help with meals for a set time.

Less common is long-term meal delivery coverage for those homebound with chronic medical conditions.

Other Meal Delivery Options

For older adults who do not qualify for a special needs program with meal benefits or who do not elect to enroll in original Medicare, alternative meal resources are available.

• Meals on Wheels is a federally funded meal delivery program for people aged 60 and above who meet location-specific eligibility requirements.
• You use the Administration for Community Living’s Elder Care Locator to find meal delivery organizations.

Speak with your attorney to access your options before selecting a Medicare Advantage program with grocery or meal benefits.

Majority of Adult Children Cannot Support Boomer Parents, Surveys Find

A recent survey by the American Advisors Group (AAG) finds that 55 percent of adult children say they are not financially prepared to help their Baby Boomer parents cope with rising inflation and living expenses.

“Americans want to see their parents age with grace and dignity and have the resources they need to live comfortably, but for many families the current economy is making that difficult,” AAG Chief of Marketing Martin Lenoir said in a news release.

AAG surveyed more than 1,500 adult children, ages 40 to 55, across the country. Known as the “sandwich generation,” this group faces the responsibilities not only of raising their children, but also of serving as caregivers for their aging parents.

Among the survey’s other key findings:

• More than a third of adult children say they worry that their parents will become a financial burden for them.
• Nearly 60 percent say they cannot afford any kind of professional elder care for their parents.
• Yet almost half admit they have never broached the subject of finances with their senior parents.
• A full 50 percent of them do not know how much debt their parents are carrying.

1 in 3 Adult Children Already Assisting Their Parents Financially

Another survey, conducted in 2020 by GoHealth, Inc., explored GenXers’ and millennials’ involvement in their parents’ financial and health care needs. It found that one in three GenXers and millennials are supporting their parents financially. Nearly the same number are managing, or helping to manage, their parents’ health care.

The survey’s 2,000 GenX and millennial respondents also reported the following:

• On average, they spend 11.5 hours per week managing their parents’ health care by providing transportation, scheduling doctor visits, and explaining insurance claims. They also estimate they’ll spend 14 to 16 years continuing to do so.
• 2 in 5 spent more than $10,000 of their own money supporting their parents in 2020.
• The vast majority (86 percent of GenXers and 82 percent of millennials) worry about having enough money to support themselves and their parents.

Squeezing the Sandwich Generation

Adult children will continue to feel the pressure for the foreseeable future. Every day, on average, 10,000 Boomers (those born between 1946 and 1964) reach age 65, and another 10,000 of them turn 75. According to research by the Blackstone Group, an independent research firm, nearly 80 percent of middle-income Boomers do not have any savings designated to cover their retirement care.

Meanwhile, 30 million Boomers retired from the workforce amid the COVID-19 pandemic. Saddled with college debt, as well as rising inflation and housing costs, those GenXers and millennials who still depend on their parents for financial assistance or housing may no longer be able to count on that support.

Have ‘The Talk’

It’s important for families to have an honest and respectful financial conversation before a medical event occurs or the need for care arises. Talking about money with aging parents can be a delicate matter, but it’s necessary to understand both the degree of care that may be needed and the financial resources available to provide it.

For help planning for the future of your Boomer parents, or for your GenXer and millennial children, consult your attorney.

It Pays to Be a Smart Shopper When Buying a Medigap Insurance Policy

Medigap premiums for plans from insurance companies offering the same benefits vary widely, so it pays to be a smart shopper.

Federal law requires that each insurance company offers the same benefits for each of the Medigap plans lettered A through M, but each company sets its own premium rates.

A Medigap insurance company sets premiums in three ways:

• Community-rated, where the premiums are the same, regardless of age
• Issue or entry age-related, where premiums are cheaper if purchased at a younger age
• Attained-age-related, where premiums are based on your age at the time of purchase

When choosing a Medigap plan, compare the different benefits each plan offers and the price for each company’s plan. Consider your current health status, what your health care needs might be in the years to come, as well as your future health care budget.

Insurers will also consider the state and city where you live. The American Association for Medicare Supplement Insurance Price Index reports found the cost in 2022 of a Plan G policy, the most popular Medigap plan, was $99.24 per month in Dallas, Texas, versus $278.25 per month in New York City.

When shopping for a Medigap policy, get quotes from two or more insurance agents working for different insurance brokers. Every insurance broker may not represent all the insurers offering a plan in the state or city where you live.

It may take time to shop around, but the money you save can be worth it.

What to Do If Your Medicaid Application Is Denied

If you apply for long-term care assistance through Medicaid and your application is denied, the situation may seem hopeless. The good news is that you can appeal the decision. 

Medicaid is a program for low-income individuals, so it has strict income and asset eligibility requirements. Qualifying for Medicaid requires navigating the complicated application process, which has many potential stumbling blocks. However, a Medicaid denial does not mean you will not eventually qualify for benefits. 

The Medicaid agency may deny a Medicaid application for a number of reasons, including the following: 

• Missing documentation. You need to show proof that you are eligible for benefits, which usually means providing Social Security statements, bank records, property deeds, retirement accounts, and insurance records, among other things. 
• Excess assets. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in "countable" assets (in most states). 
• Transferred assets. If you transferred assets for less than market value within five years before applying for benefits, you may be subject to a penalty period before you become eligible for benefits. 

The Medicaid agency is required to issue the denial notice with 45 days of the application (or 90 days if you filed for benefits on the basis of a disability). When you get a denial notice, read it carefully. The notice will explain why the application was denied and specify how to file an appeal. 

Before filing a formal appeal, you can try informally asking the agency to reverse the decision. If you made a mistake on the application, this is the easiest and quickest way to proceed. If the caseworker made a mistake, it may be more complicated and require escalation to a supervisor or a formal appeal. 

Appealing a Decision
The denial notice will tell how long you have to file an appeal—the deadline may be as short as 30 days or as long as 90 days after the denial notice. It is important to file the appeal before the deadline. Whether the denial notice requires it or not, you should submit your request for an appeal in writing, so that there is a record of it.

Once your appeal is submitted, the Medicaid agency will set a hearing date. Applicants must attend the hearing or their cases will be dismissed. You have a right to have witnesses testify at the hearing and to question the Medicaid agency’s witnesses. It is a good idea to have an attorney to help you through the appeal process. An attorney can make sure you have all the correct documentation and information to present at the hearing. 

If you win the appeal, your benefits will be retroactive to the date of your eligibility—usually the date of your application. If you lose the appeal, the notice will explain how to appeal the decision. The next step in the appeal process usually involves submitting written arguments. If the next appeal is unsuccessful, then you will have to appeal to court. It is crucial to have the assistance of an attorney for this. 

Reapplying for Benefits
If your application was denied correctly due to excess assets or income, there are steps you can take to spend down your assets or put your income in a trust. Contact an attorney to find out what actions you can take to qualify for benefits. Once you do this, you can then reapply for benefits. Note that when you reapply for benefits, your eligibility date will change to the date of the new application.