Elder Law Answers

Medicare Basics

• Medicare Part A (hospital insurance): Covers short-term, medically necessary skilled nursing facility (SNF) care if you meet specific requirements. Many people assume Medicare will cover a stay in a SNF indefinitely, but coverage is limited and tied strictly to skilled medical needs.

• Medicare does not cover long-term or custodial care.

• Maximum 100 days per benefit period:

o New benefit period: starts when out of any hospital or SNF for 60 consecutive days & then have a new 3+ days hospital stay (resetting the 100-day SNF allotment and the deductible).

• Coinsurance pay: Patient pays increasing coinsurance after day 20.

• Understanding rules is key to avoiding unexpected bills: for older adults, people with disabilities, and family caregivers

What Is Skilled Nursing Facility (SNF) Care?

• Short-term, medically necessary care provided in a licensed facility following a hospital stay.

• Offers a higher level of care than custodial nursing homes or assisted living communities.

• Care must be provided by, or under supervision of, licensed medical professionals such as registered nurses (RNs) or physical therapists.

Common reasons someone might need SNF care include:

• Recovery after surgery

• Rehabilitation following a stroke or serious illness

• Wound care or IV therapy

• Physical, occupational, or speech therapy

• Monitoring and treatment of complex medical conditions

• SNF care is designed to help individuals recover and regain function so they can safely return home or to a lower level of care.

Medicare Part A may help pay for SNF on short-term basis if:

• Qualifying inpatient hospital stay: Inpatient for at least 3 consecutive days, not counting the day of discharge. Time spent in the hospital under “observation status” does not count toward this requirement.

• Admission to the SNF shortly after hospital discharge (usually must begin within 30 days of leaving the hospital).

• Medical need for skilled care. The care must be medically necessary and require skilled services, such as daily nursing care or rehabilitation therapy that can only be provided by trained professionals.

• Medicare-certified skilled nursing facility.

Services Medicare A cover in a SNF (generally) includes:

• A semi-private room

• Meals

• Skilled nursing services

• Physical, occupational, and speech therapy

• Medical supplies and equipment used during care

• Qualifying medications related to the SNF stay

• Ambulance transportation to the nearest provider of necessary services if other modes of transportation would pose a health risk

Medicare A does Not Cover SNF Care when:

• Long-term or custodial care, such as help with bathing, dressing, or eating when no skilled medical care is required

• Stays not following a qualifying 3-day inpatient hospital admission

• Facilities that are not Medicare-certified

• Continued SNF care once no longer needs skilled services

Cost of SNF Care Cost Under Medicare:

• Medicare-covered SNF care is limited to up to 100 days per benefit period, and costs depend on how long a person stays.

• Days 1 to 20: Medicare Part A pays the full approved cost.

• Days 21 to 100: Part A covers part of the cost.

o Patient pays a coinsurance: $217/day in 2026.

• Days 100+: Patient pays all the costs of their SNF care.

• Medigap (Medicare Supplement) some plans may cover some or all the daily coinsurance for days 21 to 100.

Why Understanding SNF Coverage Matters:

• Confusion can lead to financial strain and difficult decisions during an already stressful time.

• Many people assume Medicare will cover a stay in a skilled nursing facility indefinitely, when in reality, coverage is limited and tied strictly to skilled medical needs.

The Great Wealth Transfer:

• As baby boomers are the primary source of wealth, their death begin transferred to younger generations.

• This is one of the most substantial intergenerational transfers of wealth in history & it is expected to continue for another couple of decades.

• Some estimates put the amount of assets that will be transferred at $68+ trillion.

• Potential to reshape individual financial futures and the broader economy.

• Will provide opportunities that weren’t previously available (early retirement, investment opportunities, or funding for personal passions).

• Complexities require careful planning and decision-making.

Estate Planning and Elder Law

We have dedicated our entire practice to providing estate planning to families in West Virginia and Pennsylvania. Our purpose is to ensure people of all ages and their loved ones have financial security now and in the future.

Visit us online at: https://www.seamonlawoffices.com

Preparing for the possibility of long term care.

Estate Planning and Elder Law

We have dedicated our entire practice to providing estate planning to families in West Virginia and Pennsylvania. Our purpose is to ensure people of all ages and their loved ones have financial security now and in the future.

Visit us online at: https://www.seamonlawoffices.com

Learn more about this special program created for West Virginian's with special needs.

https://wvpacetrustfund.com

Estate Planning and Elder Law

We have dedicated our entire practice to providing estate planning to families in West Virginia and Pennsylvania. Our purpose is to ensure people of all ages and their loved ones have financial security now and in the future.

Visit us online at: https://www.seamonlawoffices.com

This multi-episode series will follow a hypothetical couple through their lives to see what role estate planning had on their family. This hypothetical story is based on having worked with over 1500 families over the past thirteen years, but it is not based on a specific client.

Estate Planning and Elder Law

We have dedicated our entire practice to providing estate planning to families in West Virginia and Pennsylvania. Our purpose is to ensure people of all ages and their loved ones have financial security now and in the future.

Visit us online at: https://www.seamonlawoffices.com

Most parents of younger children feel that nearly every day is focused on their children, but as we get older the tables begin to turn.

I’ve worked with amazing children who sacrifice quite a bit to help their parents as they age. I am often touched at how much love and care so many adult children provide to their parents sometimes at the sacrifice of their own children or grandchildren. People often express that we do not take care of our elderly anymore and while there are many examples of that, I’ve been blessed to meet some pretty amazing ‘kids’ over the years.

Make it easier for kids, have good estate planning documents that give the appropriate power/controls for them to protect your care decisions.

Estate Planning and Elder Law

We have dedicated our entire practice to providing estate planning to families in West Virginia and Pennsylvania. Our purpose is to ensure people of all ages and their loved ones have financial security now and in the future.

Visit us online at: https://www.seamonlawoffices.com

The internet is a wonderful tool to learn about a myriad of topics, we can even watch YouTube videos that demonstrate exactly how to a variety of things. We ask Google, Alexa and Siri for television schedules, the weather report, and trivia questions. It used to be the younger generation who reached for their smartphone to look up the answers to questions that came up during conversation, but nowadays, it is folks of all ages.

A common question on Facebook groups is for an estate planning attorney in the area and while some attorneys are named, there is usually at least one suggestion to use an online option. The internet is a great place to get information regarding estate and elder law issues, but I do not recommend relying on that technology for our estate planning needs.

Beware of the potential pitfalls to getting online estate planning documents.

Money, Money, Money

A lot of people just really don’t understand what types of accounts/investments they have which makes it difficult to advise them on how to set up their estate plan to achieve their goals.

April is National Financial Literacy Month. Take the time to talk to your trusted advisors (banker, insurance agent & financial advisor) to try to understand your assets. Don’t be afraid to ask for help from ‘trusted’ people. People spend a lot of time worrying about their finances, but don’t always do something about it. Get the knowledge, then take action to make sure it is how you want it.

• Recent survey by Bay Alarm Medical indicates that eight in ten Americans are very concerned that they may run out of money as they age.

• More Americans are worried that they will face financial instability than they are of their spouse’s death or even their own death.

• Fear of financial instability is a fear we can mitigate with knowledge and action.

• April is National Financial Literacy Month (per 2004 Senate resolution).

• Senate’s goal was to help raise public awareness regarding financial education and the consequences of not understanding personal finances.

• Financial literacy:

• Many Americans do not yet have the ability to understand and effectively use various financial skills such as personal financial management, budgeting, paying bills, setting financial goals and investing.

• Test financial literacy on the National Financial Educators Council (NFEC) website.

 30-question test called the National Financial Capability Test.

 NFEC reports that of the 40,000 people who have taken this test, the average score was less than 68%, with 42% actually failing the test.

• Tie into estate planning: What financial literacy has to do with estate planning, my answer would be ‘everything’.

• My clients typically want to know how to achieve two goals.

 First, how to protect their assets from the high cost of long-term care.

 Second, how to pass their estate to their heirs without incurring unnecessary expenses or hassles.

 My advice depends on what assets they have.