Share of Cost – Maintaining Good Oral Health with Dental Insurance and Preventive Care

Monday, Mar. 11th 2024 10:00 AM

Hello and welcome! If you’re reading this, chances are you’re either interested in dental insurance or curious about what it entails. Dental insurance is a type of insurance that covers dental care expenses, including preventive care, restorative treatments, and emergency services. It’s an essential investment in oral health and financial well-being, as dental procedures can be costly without insurance coverage. At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs. Our comprehensive and affordable plans ensure you receive the best dental care without breaking the bank. To learn more about our dental insurance plans, please call us at 310-534-3444.

Share of Cost – Preventive Dental Care and Insurance 

Did you know dental insurance can help you save money even if you have healthy teeth and gums? Many dental insurance plans offer preventive dental services, such as bi-annual checkups, cleanings, and X-rays, at little to no cost. Even low-cost plans like HMOs can cost just $8 to $20 a month for individuals, and the savings you can reap on preventive care alone can run upwards of a couple hundred dollars a year. Dental insurance is not just for those with dental problems but also a valuable investment in your oral health and financial well-being. 

The Importance of Having Dental Insurance

Having dental insurance is incredibly important for several reasons. Firstly, dental insurance can help you save money on dental care expenses, such as preventive care, restorative treatments, and emergency services. Dental insurance is especially crucial for those on a tight budget or who want to avoid paying out-of-pocket for costly dental procedures. Dental insurance plans can help cover dental care costs, making it more affordable for everyone.

Secondly, dental insurance can help with a “share of cost” obligation. A share of cost is a type of deductible that some individuals may have to meet before their Medicaid coverage kicks in. Suppose an individual has certain medical expenses in a given month. In that case, the individual may have to pay a certain out-of-pocket amount before Medicaid covers the remaining costs. The monthly cost of dental insurance can count towards this share of cost, meaning having dental insurance can help you meet a spend-down obligation more easily.

Finally, dental insurance can promote good oral health, essential for overall health and well-being. Regular dental checkups and cleanings are crucial for maintaining healthy teeth and gums, and dental insurance plans often cover these preventive services at little to no cost. Individuals with dental insurance are more likely to receive regular dental care, which can ultimately help prevent more serious dental problems.

Having dental insurance is essential for saving money on dental care expenses, meeting a share of cost obligation, and promoting good oral health. At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs and budget. Our plans provide affordable coverage, ensuring you receive the best dental care without breaking the bank.

Do Not Overstate the Significance of Preventive Dental Care.

Preventive dental care is crucial to maintaining good oral health and overall well-being. It involves regular visits to the dentist, routine cleanings, and other preventive measures that can help prevent dental problems before they become more severe. The importance of preventive dental care should not be overstated, as it can save you both time and money in the long run.

One example of the importance of preventive dental care can be seen in a recent study conducted by the American Dental Association. The study found that individuals who received preventive dental care, such as regular cleanings and checkups, were less likely to require more extensive and expensive dental treatments in the future. This is because preventive care can help catch dental problems before they become more severe, allowing for earlier intervention and treatment.

Another example of the importance of preventive dental care can be seen in a personal story. A friend of mine neglected to visit the dentist for several years, thinking she would be fine if she brushed and flossed regularly. However, when she finally did go to the dentist, she found out that she had several cavities and needed a root canal. Regular preventive care could have easily prevented her from painful and expensive dental procedures.

In addition to helping prevent dental problems, preventive dental care can promote better overall health. Poor dental hygiene has been linked to a variety of health problems, including heart disease, diabetes, and even certain types of cancer. Taking care of your teeth and gums can help reduce your risk of these and other health issues.

The importance of preventive dental care cannot be overstated. Regular visits to the dentist, routine cleanings, and other preventive measures can help prevent dental problems before they become more severe, saving you both time and money in the long run. Caring for your teeth and gums can promote better overall health and well-being.

Why Bi-Annual Dental Checkups are Essential for Your Oral Health

Bi-annual dental checkups are an essential part of maintaining good oral health. During these checkups, the dentist thoroughly examines your teeth and gums, looking for any signs of decay, gum disease, or other dental problems. By detecting these issues early on, the dentist can prevent them from becoming more severe and requiring more extensive treatment. Regular bi-annual checkups also allow the dentist to provide preventive treatments such as cleanings and fluoride treatments, which can help keep your teeth and gums healthy and strong. By staying on top of your dental health with bi-annual checkups, you can prevent dental problems from developing and ensure that your smile stays healthy and beautiful for years to come.

The Importance of X-Rays in Dental Care: How They Help Dentists Diagnose and Treat Dental Problems

Dentists take X-rays to help diagnose dental problems that are not visible to the naked eye. X-rays allow dentists to see inside the teeth and gums, identifying issues such as cavities, abscesses, or impacted teeth. X-rays are also essential for monitoring the progress of dental treatments, such as braces or root canals. By taking X-rays, dentists can detect dental problems early on, preventing more severe issues from developing. Overall, X-rays are essential in dental care, helping dentists provide accurate diagnoses and effective treatments.

The Importance of Basic Dental Cleanings

Basic dental cleanings are an essential part of preventive dental care. Regular cleanings can help remove plaque and tartar build-up, which can lead to tooth decay and gum disease if left untreated. These cleanings also allow your dentist to examine your teeth and gums for signs of any potential issues. By scheduling regular dental cleanings, you can maintain good oral health and catch any problems before they become more severe and require more costly and invasive treatments. Basic dental cleanings are integral to keeping your teeth and gums healthy for a lifetime.

Cost of Dental Insurance with Regarding Meeting a Spend Down.

The cost of dental insurance can play an essential role in helping individuals spend down their income to reduce or eliminate their Medi-Cal share of cost. For those eligible for Medi-Cal, the program requires enrollees to pay a share of their medical expenses based on their income. Once an individual has met their share of cost for the month, Medi-Cal will cover the remaining costs. 

By purchasing dental insurance, individuals can use the cost of their dental insurance premiums to help reduce their income and lower their Medi-Cal share of cost. This can be especially helpful for those requiring frequent dental services, as the out-of-pocket costs can quickly increase. Additionally, dental insurance can provide more comprehensive coverage for dental services than Medi-Cal, allowing individuals to receive care without worrying about cost. By carefully considering the cost of dental insurance and comparing different plan options, individuals can find a plan that fits their budget and helps them meet their dental needs while reducing their share of cost.

Cost of Dental Insurance Between Different Plan Types Regarding  

Regarding dental insurance, the cost can vary significantly between different plan types. Understanding the differences between these plans is essential to make an informed decision about which one is right for you.

PPO, HMO, and indemnity plans are the most common dental insurance plans. PPO plans typically offer more flexibility and freedom when choosing a dentist, but they can be more expensive than HMO plans. HMO plans, on the other hand, usually have lower monthly premiums but may restrict you to a network of dentists. Indemnity plans allow you to see any dentist you choose but can be the most expensive option.

In addition to these plan types, there are also varying levels of coverage. Some plans may only cover primary preventive care, while others may cover more extensive treatments like orthodontics or oral surgery. Plans that cover more services will generally come with a higher monthly premium.

When considering the cost of dental insurance, it’s essential to look beyond just the monthly premium. It would help if you also considered each plan’s deductible, co-payments, and annual maximums. The deductible is the amount you must pay out of pocket before the insurance kicks in. Co-payments are the amount you pay for each visit or service; the annual maximum is the most the insurance will pay out in a given year.

Overall, the cost of dental insurance can vary significantly between different plan types and levels of coverage. It’s essential to carefully consider your options and choose a plan that provides the coverage you need at a price you can afford. By doing so, you can ensure that you receive the best dental care without breaking the bank.

Understand an HMO Dental Insurance Plan

An HMO dental insurance plan is a type of dental coverage that offers a network of dentists and dental facilities to its members. With an HMO dental insurance plan, you must choose a primary care dentist from within the network. You must receive all dental services from that provider or obtain a referral from them to receive services from another provider within the network. 

There are several benefits to choosing an HMO dental insurance plan. Firstly, HMO dental plans are typically more affordable than other dental insurance plans, making them an excellent option for individuals on a tight budget. The cost of an HMO dental plan is usually lower. It limits the provider network, and members must choose a primary care dentist from within that network.

Secondly, HMO dental insurance plans often cover preventive care services, such as cleanings, X-rays, and checkups, at little to no cost to the member. Preventive care is essential for maintaining good oral health and can help prevent more severe dental problems in the future. By covering these services, HMO dental plans encourage members to receive regular dental care, which can ultimately save them money in the long run by avoiding more costly dental procedures.

Thirdly, HMO dental plans have a simple process for receiving dental care. Members only need to choose a primary care dentist; that provider will coordinate all dental services, including referrals to specialists if necessary. This means that members don’t have to spend time searching for a provider, as all the necessary resources are provided through the network.

Finally, HMO dental plans often have a low or no deductible, meaning members can receive dental care without meeting a specific out-of-pocket expense first. This can be especially beneficial for those needing frequent dental care or on a tight budget.

In summary, HMO dental insurance plans offer a network of dental providers and are typically more affordable than other dental insurance plans. They often cover preventive services at little to no cost, have a simple process for receiving dental care, and may have a low or no deductible. By choosing an HMO dental insurance plan, you can receive the dental care you need while saving money on dental expenses.

Understand a PPO Dental Insurance Plan

A PPO dental insurance plan is a type of dental insurance that offers a network of dentists who have agreed to provide services to plan members at UCR rates. Unlike other dental insurance plans, PPO plans give you the freedom to choose your dentist, whether in-network or out-of-network. If you are considering dental insurance, here are some benefits of selecting a PPO plan:

1. Wide Network of Dentists: PPO plans have an extensive network of dentists, giving you a greater choice of providers. You can choose a dentist close to your home or workplace, making getting the dental care you need more convenient.

2. Flexibility: With a PPO plan, you can see any dentist you choose, whether in-network or out-of-network. If you choose an out-of-network dentist, you may have to pay a higher percentage of the cost, but you will still receive some coverage.

3. No Referrals Required: PPO plans do not require you to get a referral from your primary care dentist before seeing a specialist. This means you can go directly to a specialist for the necessary care without going through additional steps.

4. Preventive Care Coverage: PPO plans often cover preventive care services like cleanings and checkups at little or no cost to you. This helps you maintain good oral health and catch potential problems early on.

For example, let’s say you need a root canal. With a PPO plan, you can choose your dentist and receive coverage for the procedure. If you choose an in-network dentist, you will likely be within the company UCR rates on the procedure, saving you money. If you choose an out-of-network dentist, you still receive coverage but may have to pay a higher percentage of the cost and may have UCR fees. 

In conclusion, a PPO dental insurance plan offers a vast network of dentists, flexibility, cost savings, no referral requirements, and coverage for preventive care services. These benefits make PPO plans an attractive option for those looking to save money on dental care expenses while still receiving quality care from a dentist of their choice.

The Benefits of Investing in Dental Insurance: Save Money, Promote Oral Health, and Meet Share-of-Cost Obligations with ShareofCost.com

In conclusion, investing in dental insurance is a wise decision to help you save money on dental care expenses, meet a share of cost obligation, and promote good oral health. Regular preventive dental care is essential to maintaining good oral health and overall well-being, and dental insurance can make it more affordable for everyone. 

At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs and budget. Our plans provide affordable coverage, ensuring you receive the best dental care without breaking the bank. We can also help you meet a spend-down requirement by counting the monthly cost of dental insurance towards it. Don’t wait until dental problems become more severe and costly – invest in dental insurance today and take the first step towards a healthier smile!

If you have any questions or would like to learn more about our dental insurance plans, please don’t hesitate to contact us. Our friendly and knowledgeable representatives can assist you from 8 am to 4 pm Monday through Friday. Call our office at 310-534-3444 and let us help you find the best dental insurance plan that caters to your specific needs and budget. 

We understand that dental care can be expensive, and we are committed to providing you with affordable and comprehensive coverage that ensures you receive the best dental care without breaking the bank. Please don’t wait any longer; call us today and take the first step towards better oral health and financial well-being.

Posted on Monday, Mar. 11th 2024 10:00 AM | by Share of Cost | in Dental Insurance, Medi-Cal, Medicaid, Medicare, Share of Cost, Social Security | Comments Off on Share of Cost – Maintaining Good Oral Health with Dental Insurance and Preventive Care

Share of Cost – What can I do if I need help with my share of cost?

Monday, Mar. 4th 2024 10:00 AM

Do you need help finding dental insurance for your spend-down needs? At Shareofcost.com, we can help you find the right dental insurance plan that fits your requirements. Our team of experts can guide you through the process, compare different plans, and help you make an informed decision. With our assistance, you can get the dental care you need without facing financial hardships. Contact us today at 310-534-3444 to learn how we can help you with your dental insurance needs.

A Guide To Learn About Share of Cost 

Hello, this is a guide to learn about the Share of Cost and how to deal with related issues. Patients must pay a certain amount for medical expenses before Medi-Cal can start covering the costs. It is a deductible that needs to be met before insurance coverage becomes effective. The amount of the Share of Cost varies based on the patient’s income and other factors. It can be a significant financial burden for those who struggle to make ends meet. Therefore, it is crucial to comprehend how the Share of Cost works and take necessary steps to address any issues.

Importance of addressing Share of Cost issues

As we mentioned earlier, the Share of Cost is a significant financial burden for those struggling to make ends meet. Addressing any issues related to the Share of Cost is crucial to ensure patients can access the medical care they need without facing financial hardships. 

If you don’t take the necessary steps to address Share of Cost issues, you may pay more than you should, or even worse, you may be denied access to the medical care you need. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

It is also important to note that the Share of Cost is based on a patient’s income and other factors, which can change over time. By staying informed and up-to-date about your Share of Cost, you can ensure that you are prepared for any changes and can take the necessary steps to address any issues.

Addressing Share of Cost issues is essential to ensure patients can access the medical care they need without facing financial hardships. If you have any questions or concerns about your Share of Cost, don’t hesitate to contact your Medi-Cal case worker, request a fair hearing, or contact the Center for Healthcare Rights Hotline for assistance.

Steps to take if you are eligible for free Medi-Cal or your Share of Cost is too high.

If you are eligible for free Medi-Cal or your Share of Cost is too high, there are several steps you can take to address the issue. To take the first step, you should contact your Medi-Cal case worker and write to them inquiring about the reason behind your Share of Cost or why your bill cannot be applied towards meeting your Share of Cost. It would help if you also asked what law Medi-Cal based its decision on.

If you are unsatisfied with the explanation, you can request a fair hearing. A fair hearing allows you to question Medi-Cal’s decision about your bill. You can call 1-800-952-5253 to get a fair hearing. It is important to note that calls to this number are free.

Another option is to speak to your county worker’s supervisor. If your problem is fixed, you can always cancel the fair hearing.

Call the Center of Healthcare Rights Hotline at 1-213-383-4519 if you have questions or concerns. They are available to help you and provide further assistance.

It is essential to take these steps to ensure you can access the medical care you need without facing financial hardships. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

Communicate with your Medi-Cal case worker.

Communicating with your Medi-Cal case worker can be crucial in ensuring you receive the best possible healthcare services. Your caseworker can assist you with various issues related to your Medi-Cal benefits, including eligibility, enrollment, and the application process. Additionally, they can provide helpful information about the multiple types of healthcare services available to you, such as preventative care, mental health services, and emergency care. If you have any questions or concerns about your Medi-Cal benefits, don’t hesitate to contact your caseworker for assistance. They are there to help ensure that you receive the care you need to stay healthy.

Tips on Communicate with your Medi-Cal Case Worker.

1) Request an explanation in writing: When you request someone to explain in writing, they need to put their thoughts into words and provide a clear and concise explanation in a written format. This approach can be beneficial for several reasons. Firstly, it helps maintain a record of the explanation for future reference or sharing with others who were not present when it was given. Secondly, requesting an explanation in writing ensures clarity and understanding, allowing the recipient to read and re-read the written explanation to fully comprehend the information being conveyed. Lastly, if you need a detailed and clear explanation, requesting it in writing is the best way to go.

2) Inquire why one cannot use a bill to cover the expenses: Keeping track of your medical bills and payments is essential, especially when you are enrolled in a Medi-Cal program with a share of cost. Sometimes, despite paying your bills, you may see that they did not go towards your share of the cost. In such situations, you must communicate with your Medi-Cal case worker and ask them about the issue. Your caseworker can help you understand why the bill did not count towards your share of the cost and what steps you can take to resolve the issue. They can also inform you about your current share of cost status and how much more you need to pay to meet your share of cost. So, contact your Medi-Cal case worker with any doubts or concerns about your medical bills and payments.

3) Ask what law Medi-Cal based its decision: If you ever receive a Medi-Cal decision that you are not satisfied with, it is essential to ask your Medi-Cal case worker what law or regulations they based their decision on. Doing so can help you understand the legal basis for the decision and identify any potential errors or misinterpretations. It can also help you prepare a more effective appeal if you decide to challenge the decision. By asking for the specific law or regulation, you can ensure the decision was based on accurate and up-to-date legal information. So, if you have any questions or concerns about a Medi-Cal decision, don’t hesitate to ask your case worker about the legal basis for the decision.

4) Inquire about the status of your application or renewal: If you have applied for Medi-Cal or need to renew your benefits, keeping track of the application status is essential. You can inquire about your application or renewal status by contacting your local county human services agency or calling the Medi-Cal hotline. Ensure your case number or other identifying information is readily available when contacting them. They can update you on your application or renewal status, let you know if any additional information is needed, and guide you through the process if you encounter any issues. It is always better to follow up and ensure that your application or renewal is processed correctly and promptly to avoid any gaps in coverage.

5) If needed, request assistance in finding a healthcare provider: Your Medi-Cal case worker can provide you with a list of healthcare providers in your area that accept Medi-Cal. You can also visit the Medi-Cal website or call their customer service number to obtain a list of healthcare providers. Additionally, you can contact community health clinics or non-profit organizations that assist in finding healthcare providers. Finding a healthcare provider that meets your needs and ensures you receive the best possible care is essential, so don’t hesitate to ask for help if you need it.

6) Report changes in your income or living situation: It is essential to report any changes in your income or living situation to the relevant authorities, especially regarding share of cost. The share of cost is the amount of money a person has to pay before Medicaid starts paying for their medical expenses. If you fail to report any changes, you may be billed for medical expenses you thought were covered. For instance, if you get a raise, your share of the cost may increase, and you will need to pay more out of pocket. Similarly, if you move to a different state, your cost share may change due to differences in cost of living and state Medicaid policies. Therefore, it is crucial to report any changes immediately to ensure you are aware of medical bills you cannot afford to pay.

7) Request an appeal or fair hearing if you disagree with a decision: 

If you disagree with a decision regarding your Share of Cost, you can appeal or request a fair hearing. To request an appeal or fair hearing, contact your Medi-Cal caseworker and request a Notice of Action. The notice will contain:

  • The decision you are appealing.
  • The reason for the decision.
  • Information on how to request an appeal or fair hearing.

You can also call the Medi-Cal Managed Care Ombudsman’s toll-free number for assistance in filing an appeal or fair hearing. It’s essential to act quickly on an appeal as there is a time limit for filing an appeal or fair hearing. Once you file an appeal or fair hearing, you will be notified of the date and time of your hearing, where you can present evidence and argue your case.

8) Inquire about additional benefits or programs you may be eligible for: It is always a good idea to inquire about additional benefits or programs you may qualify for regarding healthcare. Many people may not be aware of the various programs or services they can access that could help them reduce medical expenses or provide additional support. By inquiring about these options, you can potentially find programs that can help you save money, get additional care, or access resources that can make managing your health more accessible. Your Medi-Cal case worker can provide information about available programs and eligibility requirements, so don’t hesitate to ask and explore your options.

9) Ask for assistance with transportation to medical appointments: If you are struggling to cover the costs of transportation to medical appointments due to your Share of Cost, resources are available to help. One option is to contact your Medi-Cal case worker and ask for assistance. Your case worker can provide information about transportation programs that may be available to you. Additionally, many community organizations offer transportation services to medical appointments for individuals with low incomes and disabilities. You can also check with your healthcare provider to see if they provide transportation services or if you can partner with them. Feel free to ask for transportation assistance to ensure you can access the medical care you need without facing financial hardships.

10) Request language or disability accommodations for appointments or services:   If you require language or disability accommodations for appointments or services, it is essential to communicate your needs to your healthcare provider or service provider. Many healthcare providers and service providers offer accommodations such as interpretation services, written materials in other languages, and physical or communication aids for individuals with disabilities. By requesting these accommodations, you can ensure equal access to healthcare and services and receive the care and support you need. Don’t hesitate to ask your provider or service provider about available accommodations, as they help you and ensure that you receive the best possible care.

11) Report any suspected fraud or abuse in the Medi-Cal program: Reporting any suspected fraud or abuse in the Medi-Cal program is essential to ensure the program’s integrity and protect public funds. Fraud or abuse in the Medi-Cal program can take many forms, including billing for services not provided, providing unnecessary services, or falsifying medical records. Such actions can result in significant financial losses for the program and harm patients by providing them with unnecessary or harmful treatments. By reporting any suspected fraud or abuse, you can help ensure that resources are used efficiently and effectively and that patients receive appropriate care. Additionally, reporting such incidents can help prevent future fraud or abuse, protecting both the program and the patients it serves.

12) Inquire about the process for resolving billing or claims issues:  If you have any billing or claims issues related to your Share of Cost, it is crucial to inquire about the process for resolving them. The first step is to contact your Medi-Cal case worker and ask for an explanation. You can request a fair hearing if you are unsatisfied with the answer or the unresolved issue. You can present your case during the hearing and ask questions to Medi-Cal representatives. You can contact the Center for Healthcare Rights Hotline for further assistance if the issue is unresolved. It is essential to take these steps to ensure you receive the medical care you need without facing financial hardships. 

Understanding Your Share of Cost and Advocating for Yourself: Steps to Take for Medi-Cal-Related Issues

When handling your Share of Cost, it’s essential to understand the process and take necessary steps to address any issues. As we previously discussed, patients must pay a certain amount for medical expenses before Medi-Cal can start covering the costs. This deductible can be a significant financial burden for those who struggle to make ends meet.

If you need help with your Share of Cost, there are several steps you can take to address the issue. First, contact your Medi-Cal case worker and inquire about the reason behind your Share of Cost or why your bill cannot be applied towards meeting your Share of Cost. If unsatisfied with the explanation, you can request a fair hearing to question Medi-Cal’s decision about your bill. You can also speak to your county worker’s supervisor. If your problem is fixed, you can always cancel the fair hearing.

It is essential to take these steps to ensure you can access the medical care you need without facing financial hardships. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

Advocating for yourself and seeking assistance when needed is crucial in ensuring you receive the best healthcare services. Your caseworker can assist you with various issues related to your Medi-Cal benefits, including eligibility, enrollment, and the application process. Additionally, they can provide helpful information about the multiple types of healthcare services available to you, such as preventative care, mental health services, and emergency care.

It’s essential to communicate with your Medi-Cal case worker and ask questions when you need help. Request an explanation in writing to ensure clarity and understanding. If you have any concerns or questions about your Medi-Cal benefits, don’t hesitate to contact your caseworker for assistance. They are there to help ensure that you receive the care you need to stay healthy.

Let me share a story to emphasize the importance of advocating for yourself. A few years ago, my friend’s mother was diagnosed with a chronic illness. Her Share of Cost was high, and she was struggling to afford the medical care she needed. They reached out to her Medi-Cal case worker but didn’t receive a satisfactory explanation. They decided to request a fair hearing, and the decision was overturned. She finally received the medical care she needed without facing financial hardships.

In conclusion, taking action and advocating for yourself is essential when dealing with Share of Cost and Medi-Cal-related issues. By following the steps we discussed and seeking assistance when needed, you can ensure that you receive the best possible healthcare services and access the care you need to stay healthy.

Thank you for considering Shareofcost.com for your dental insurance needs. We are always here to assist you, so please don’t hesitate to give us a call at 310-534-3444. Have a great day!

Posted on Monday, Mar. 4th 2024 10:00 AM | by Share of Cost | in Dental Insurance, Medi-Cal, Medicaid, Medicare, Share of Cost, Social Security | Comments Off on Share of Cost – What can I do if I need help with my share of cost?

Is there such a thing as a “Medi-Cal Friendly Annuity”?

Saturday, Jan. 15th 2022 3:03 PM

There is no such thing as a Medi-Cal-friendly annuity. The balance of an annuity is considered unavailable as long as the owner receives equal monthly payments for a number of years, less than or equal to life expectancy (based upon life expectancy tables designated by Health Care Financing Administration for this purpose). The final payment may be smaller to exhaust the annuity. If payments are not equal and monthly, the cash surrender value is counted. If payments extend beyond life
expectancy, a period of ineligibility for nursing facility level of care may result. Some annuities pay very small amounts, with a balloon payment at the end. These annuities, even though set up to exhaust within life expectancy, are not annuitized in accordance with DHS rules. The cash surrender value is counted in determining eligibility. In many cases, these annuities are irrevocable and do not have a cash value and there is nothing to count. Individuals who purchase this type of annuity lose financial control while cashing in their life insurance policies, stocks, bonds, etc. Many times they have to pay heavy capital gains taxes and surrender penalties in the process.

Posted on Saturday, Jan. 15th 2022 3:03 PM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on Is there such a thing as a “Medi-Cal Friendly Annuity”?

The institutionalized spouse has $200,000 of assets protected through a Partnership policy.

Wednesday, Jan. 12th 2022 5:29 AM

The institutionalized spouse has $200,000 of assets protected through a Partnership policy. The spouse at home gives $200,000 to a child on January 1,1999, and applies for Medi-Cal on February 28, 2000. Is there a penalty under the rules for transfer of property?

In this example, assuming the couple has no other countable property (all they have is $200,000 in assets) at the time of the transfer, the transfer of the protected assets is considered a transfer of exempt property. Therefore, there is no period of ineligibility for nursing facility level of care. This above exemption only applies during the lifetime of the institutionalized spouse for eligibility purposes. After the institutionalized spouse dies, this exemption no longer applies. For estate recovery purposes, however, the $200,000 of asset protection continues even after the death of the protected spouse

Posted on Wednesday, Jan. 12th 2022 5:29 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on The institutionalized spouse has $200,000 of assets protected through a Partnership policy.

Are assets from a prior marriage exempt for eligibility purposes? What about estate recovery?

Sunday, Jan. 9th 2022 5:20 AM

The term “exempt” applies to a “type” or “classification” of property given exempt status by statute or regulation. Assets from a prior marriage are not a type of property that is exempt. Property from a prior marriage may be considered separate property if it has not been combined with the property of the current spouse. If the property is separate property, it may or may not be counted, as in the living situations described above. Estate recovery can file a claim against any asset (e.g., the community property interest) that passes from the deceased person to the surviving spouse upon his or her death. Estate recovery only takes place, however, when the surviving spouse dies.

Posted on Sunday, Jan. 9th 2022 5:20 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on Are assets from a prior marriage exempt for eligibility purposes? What about estate recovery?

Anxiety and Heart Disease

Friday, Jan. 7th 2022 2:16 PM

Anxiety Increases Risk Of Complications For Heart Disease Patients

Patients with heart disease who also suffer from an anxiety disorder have a significantly higher risk of having a heart attack, heart failure, stroke and death, compared to other heart disease patients, according to Dutch scientists. You can read about this study in the peer-reviewed medical journal Archives of General Psychiatry

Posted on Friday, Jan. 7th 2022 2:16 PM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on Anxiety and Heart Disease

Are assets my spouse inherits disregarded for eligibility purposes when I apply for Medi-Cal? For the purpose of estate recovery?

Tuesday, Jan. 4th 2022 5:12 AM

In the case of an inheritance, the assets disregarded for determining eligibility are the same as those in a pre-nuptial agreement. The estate recovery program can only file claims against the assets that pass from deceased Medi-Cal beneficiaries to their surviving spouses upon death. Any assets that pass to the surviving spouse before the death of the Medi-Cal beneficiary are not recoverable.

Posted on Tuesday, Jan. 4th 2022 5:12 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on Are assets my spouse inherits disregarded for eligibility purposes when I apply for Medi-Cal? For the purpose of estate recovery?

Inflammation In Heart Disease

Thursday, Dec. 31st 2020 5:04 AM

Degree Of Lifetime Stress Exposure Linked To Inflammation In Heart Disease

Greater lifetime exposure to the stress of traumatic events was linked to higher levels of inflammation in a study of almost 1,000 patients with cardiovascular disease led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

Posted on Thursday, Dec. 31st 2020 5:04 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on Inflammation In Heart Disease

How Does Alzheimer’s Disease Develop?

Tuesday, Dec. 29th 2020 5:03 AM

A second pathway through which Alzheimer’s develops has been discovered after researchers identified a new set of genetic markers for the disease. Most Alzheimer’s genetic research focuses on amyloid-beta, which contributes to the formation of plaques found in the brains of people suffering from Alzheimer’s. In this study, published in the journal Neuron, researchers were able to identify genes linked to the tau protein, a protein which develops in the brain as Alzheimer’s slowly progresses.

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Are the assets identified in a pre-nuptial agreement disregarded for the purpose of eligibility when an individual applies for Medi-Cal? What about estate recovery?

Saturday, Dec. 26th 2020 5:59 AM

With a prenuptial agreement, the county considers the living situation of the individual at the time of application in order to determine Medi-Cal eligibility. Let us take at look at three living situations: Example #1: Both spouses are at home. All non-exempt property over $3,000 (including assets
identified in a pre-nuptial agreement) is counted in determining Medi-Cal eligibility. Example #2: Both spouses are in board & care or only one spouse is in board & care and one remains at home or both spouses are in long-term care. The property of the non-applicant spouse that is established as separate property in the pre-nuptial agreement (as long as it remains
separate) is disregarded for purposes of establishing eligibility. Half of the community property is also disregarded.

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How are retirement annuities treated for Medi-Cal eligibility?

Sunday, Dec. 13th 2020 5:52 AM

Annuities are not considered exempt unless they are IRAs, KEOGHS, or work-related pension funds held in the name of a person who does not want Medi-Cal for him- or herself. If payments are being received, however, those payments are considered income. The cash surrender value of IRAs,
KEOGHS and work-related pension funds held in the name of an individual who does not want MediCal is counted until the individual takes steps to receive either the cash lump sum or periodic payments of principal and interest. The periodic payments are considered income and the balance is considered unavailable.

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What percentage of nursing homes is Medi-Cal approved? Medicare approved?

Wednesday, Dec. 9th 2020 5:50 AM

Nearly 88% of the 1,400 nursing homes in California accept Medi-Cal:
Title 18 only (Medicare): 8.3%
Title 18/19 (Medicare/Medi-Cal): 80.4%
Title 19 only (Medi-Cal): 7.3%
No Participation 4.0%

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Share of Cost – Partnership Policy Covers

Sunday, Dec. 6th 2020 4:48 PM

Question: If a Partnership policy covers a patient’s stay in a private room in a nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a Share of Cost (SOC), do they have to spend the SOC for services specifically pertinent to the nursing home?

Reply: No, the patient can spend their SOC on a variety of medical services. This SOC obligation does not necessarily need to be paid to the nursing home. For example, if the nursing home patient needs four occupational therapy treatments per week, but Medi-Cal only allows two per week, the additional occupational therapy treatments could be paid through the SOC. In this example, even though Medi-Cal covers occupational therapy, any additional services a person wants above and beyond what Medi-Cal would have covered could be paid as the SOC. Therefore, the SOC services paid by the patient must not be Medi-Cal covered services in order for their costs to count toward the Medi-Cal SOC. In addition, services that would usually be covered by Medi-Cal, such as the use of a health aide, can be paid as the SOC if the service provider is not a Medi-Cal provider.

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How much does a person have to pay for services while on Medi-Cal?

Friday, Dec. 4th 2020 1:42 PM

The county looks at the applicant’s income after he or she establishes eligibility for Medi-Cal by spending down assets to no more than $89,280 for a couple with one spouse institutionalized or $2,000 for a single individual. The county looks at the income the individual receives in his or her own name and divides in half the income received in the name of both spouses. Of the income that counts as the income of the applicant, all (less $35) of the applicant’s income is considered his or her “share of cost” for Medi-Cal. This works like a regular health insurance deductible. The applicant pays or obligates him or herself to pay that much each month on medical expenses before Medi-Cal pays the remainder of Medi-Cal covered services.

For example, a single individual in a skilled nursing facility has an income of $1,000 per month. This person is allowed to retain $35 per month for personal needs. The remainder ($965) of the countable income goes toward his or her share of cost each month. Medi-Cal pays the remainder of the expenses for the month up to the Medi-Cal reimbursement rate that is negotiated with the facility. The law precludes the facility from “balance billing” or charging the individual or family for any more than the share of cost.

In the case of an institutionalized spouse with a well spouse in the community, the institutionalized spouse is allowed to allocate some of his/her income to the community spouse as long as the community
spouse’s income is below a certain level. For the year 2002, that amount is $2,232. If the community spouse’s income is over that amount, the community spouse retains all of his/her income. Here is an example of a couple with one spouse in a nursing facility and one spouse in the community:

Institutionalized Spouse $1500 Social Security
$400 Pension
$1900 Total
Spouse $600 Social Security

In this case, the institutionalized spouse is allowed to allocate $1,632 each month to his or her spouse ($2,232 -$600 = $1,632). The remainder, in excess of the $35 the institutionalized spouse is allowed to retain for personal needs, goes toward the share of cost each month. Medi-Cal pays the remainder of his or her medical expenses ($1,900 – $1,632 spousal allocation = $268 – $35 = $233 share of cost).

Posted on Friday, Dec. 4th 2020 1:42 PM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on How much does a person have to pay for services while on Medi-Cal?

What if the above transfer was to a family member, such as an adult child?

Monday, Nov. 30th 2020 5:34 AM

The transfer by the applicant’s spouse must be a real gift transfer. If the adult child, for example, is only holding the assets, it probably really is a trust. In that case, the transfer could either cause a period of ineligibility or simply result in the assets continuing to be counted as available to the applicant.

Posted on Monday, Nov. 30th 2020 5:34 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on What if the above transfer was to a family member, such as an adult child?

If a Medi-Cal applicant’s spouse transfers assets, will that result in any period of ineligibility for nursing home care?

Thursday, Nov. 26th 2020 5:31 AM

Generally, California will not impose any period of ineligibility for nursing home care on the applicant if his or her spouse previously transferred assets. The exception is if the asset/resource transferred originally belonged to the applicant. In that case, a disqualification period will be imposed if the spouse received the assets from the applicant before the applicant went into the nursing home and then transferred them to a third party. This is because the Medi-Cal rules differ for a “community spouse” and an “individual spouse”. If the spouses wait until one of them goes into the nursing home, the spouse will be a “community spouse”. Then a transfer of property from the spouse in the nursing home to the community spouse that is then transferred to a third party, does not trigger any period of ineligibility

Posted on Thursday, Nov. 26th 2020 5:31 AM | by Share of Cost | in Medi-Cal, Share of Cost | Comments Off on If a Medi-Cal applicant’s spouse transfers assets, will that result in any period of ineligibility for nursing home care?