• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • Home
  • Who We Are
    • About Our Firm
    • Career Opportunities
    • Meet Our Team
    • News and Events
    • Seniors Rock Radio
  • Estate Planning
    • Elder Law & Medicaid Planning
    • Estate Planning Services
    • Estate and Gift Tax Figures
    • Family Farm Succession Planning
    • Family-Owned Businesses & Farms
    • IRA Planning
      • Planning With An IRA
      • IRA & Retirement Planning
    • Legacy Planning Services
    • LGBTQ Estate Planning
    • Pet Planning
    • SECURE Act
    • Special Needs Planning
    • Trust Administration & Probate
    • Young Families
  • Elder Law
    • Coping With Alzheimer’s
    • Elder Law Resources
      • Elder Law Reports
    • Guardianship & Conservatorship
    • Hospice Care
    • Veteran’s Benefits
  • Resources
    • Definitions
    • FREE Estate Planning Worksheet
    • FREE Webinars
    • Estate Administration Legal Guide
    • Estate Planning Articles
      • Questions for Your Estate Planning Attorney Before Creating Your First Estate Plan
      • How to Create Your First Estate Plan in 2022
      • How to Choose a Guardian for Your Child
      • Address These Three Questions in Your First Estate Plan
    • Estate and Gift Tax Figures
    • Frequently Asked Questions
      • Adult Guardianship
      • Alzheimer’s Care
      • Custodial Accounts for Minors
      • Estate Planning
      • FAQs for Families Without an Estate Plan
      • Elder Law
      • IRA & Retirement Planning
      • Is Your Estate Plan Outdated?
      • Legacy Planning
      • LGBTQ Estate Planning
      • Medicare and Social Security
      • Probate
      • Probate Avoidance
      • Irrevocable Trusts
      • Trust Administration
      • Trusts
      • Veterans’ Benefits
      • Wills
    • Newsletters
    • Reports
      • Advanced Estate Planning
      • Basic Estate Planning
      • Estate Planning for Niches
      • Trust Administration
    • Top Estate Planning Techniques
  • Reviews
    • Our Reviews
    • Review Us
  • Medicaid Planning
    • Medicaid Planning
    • Emergency Medicaid & Nursing Home Planning
    • Medicaid Frequently Asked Questions
    • Medicaid Resources
  • Blog
  • Contact Us

Law Office of Michael Robinson, P.C.

Estate Planning Services in Rochester, New York and the Finger Lakes Area

Connect With Us Today

(585) 374-5210
Law Pay Button
Attend a Free Webinar
Home » Medicaid » The Medicaid “Look-Back” Period Explained

The Medicaid “Look-Back” Period Explained

May 28, 2019Medicaid

Medicaid look-back Like many people, you may make it to your retirement years without ever giving the need to qualify for Medicaid a second thought because you were fortunate enough to be covered by employer-sponsored or privately purchased health insurance. As a senior, however, the likelihood that you will need to qualify for Medicaid increases substantially as a result of the high cost of long-term care. Consequently, it is wise to plan for the possibility by learning more about the Medicaid eligibility requirements. Among the most important of those requirements to understand is the Medicaid look-back period which is what causes many seniors trouble if they failed to plan ahead by including Medicaid planning in their estate plan.

Why Might I Need to Qualify for Medicaid as a Senior?

If you have never before needed to rely on Medicaid, why would you as a senior? The answer can be found in the very real possibility that you will need long-term care (LTC) at some point during your retirement years. When you reach retirement age, around age 65, you will already stand more than a 50 percent chance of needing some type of LTC services before the end of your life. Every year, those odds increase, and your spouse shares the same odds if you are married. If either of you ends up in LTC, the cost of that care will be steep. The nationwide average for a year in LTC for 2018 was about $100,000. If you are a New York resident, however, you can expect to pay considerably more. For 2018, the typical yearly cost of LTC in the Rochester, New York area was closer to $177,000 – and the cost will continue to rise in the years to come. Given that the average time spent using LTC services is three years, it becomes easy to see how you could deplete entire retirement nest egg if required to pay out of pocket for LTC.

Won’t My Insurance Cover LTC?

The short answer is “probably not.”  As a senior, you will likely rely on Medicare for most of your health care expenses. Medicare, however, will not cover LTC expenses nor will most private health insurance plans. In fact, unless you purchased a separate long-term care insurance policy at an additional cost, you will probably be faced with covering your LTC expenses out of pocket. This is why over half of all seniors in LTC turn to Medicaid, because Medicaid does cover LTC expenses. First, however, you will need to qualify for Medicaid.

How Does the Medicaid Look-Back Rule Work?

Because Medicaid is a “needs based” program, Medicaid uses both an income and a “countable resources” limit when determining eligibility. Although some assets, such as a primary residence and a vehicle, are sometimes exempt from consideration, it is still easy for a retiree to have non-exempt assets that exceed the countable resources limit.  If that is the case, your application will be denied. To prevent applicants from transferring assets out of their name in anticipation of applying for benefits, Medicaid imposed the “look-back” period. The look-back period in almost all states, including New York, is 60 months. The look-back rule allows Medicaid to review your finances for the 60 month period preceding your application for asset transfers made for less than fair market value.  If any are uncovered it may trigger a penalty period during which you will be responsible for covering your LTC expenses.

The length of the penalty period is calculated using the value of the assets you transferred and the average monthly cost of LTC in your area. By way of illustration, imagine that you gifted assets valued at $300,000 to an adult child during the look-back period. Using the average monthly cost of LTC in Rochester, New York for 2019 of $12,342, the length of the penalty period imposed by Medicaid is determined by dividing your excess assets by the average monthly cost of LTC. Using the above figures, you would incur a penalty period of 24.3 months ($300,000/$12,342 = 23.43). You would be responsible for paying your LTC expenses for the duration of the waiting period, after which Medicaid would begin paying for your care.

To avoid putting your assets at risk, include Medicaid planning in your overall estate plan well ahead of the time you are likely to need long-term care.

Contact Rochester Medicaid Attorneys

For more information, please download our FREE estate planning worksheet. If you have additional questions or concerns about the Medicaid look-back period, contact the Rochester Medicaid attorneys at the Law Office of Michael Robinson, P.C. by calling 585-374-5210 to schedule an appointment.

  • Author
  • Recent Posts
Michael Robinson, Estate Planning Attorney
Michael Robinson, Estate Planning Attorney
Clients notice Michael Robinson’s unique approach to his estate planning practice the minute they walk through his office doors.
Michael Robinson, Estate Planning Attorney
Latest posts by Michael Robinson, Estate Planning Attorney (see all)
  • How Estate Planning for a Family May Trap the Unwary Practitioner - August 31, 2022
  • State Income Taxation of Social Security Benefits - August 24, 2022
  • Understanding Tax Apportionment Clauses - August 17, 2022

Other Articles You May Find Useful

Pittsford Medicaid Attorney
Common Mistakes in Medicaid Planning
Law Office of Michael Robinson, P.C.
Medicaid Laws Are Changing October 1 – And It’s Not Good!
bath medicaid planning
How Bath Medicaid Planning Helps Parents of Disabled Children
medicaid planning
Medicaid Planning Mistakes You Must Avoid
qualifying for medicaid
Can Medicaid Take Your Home After Death?
medicaid attorneys
Can You Give Away Your Wealth to Get Medicaid?

Primary Sidebar

Law Office of Michael Robinson, P.C.

Blog Subscription

  • This field is for validation purposes and should be left unchanged.

Follow Us

  • Facebook
  • Twitter
  • Linkdin
  • Youtube

TESTIMONIALS

News & Events

Seniors Rock Radio Show Recording 5-1-21

https://drive.google.com/file/d/1U7UkQbEGy-xY7XFAXvX9Qz7pKSVDVV3D/view?usp=drive_web   Author Recent Posts Michael Robinson, Estate Planning AttorneyClients notice Michael Robinson’s unique approach to his estate planning practice the minute they walk through his office doors. Latest posts by Michael Robinson, Estate Planning Attorney (see all) How Estate Planning for a Family May Trap the Unwary Practitioner -... Read more →

Pittsford Office

1163 Pittsford-Victor Road, Suite 120 (Powder Mill Office Park)
Pittsford, NY 14534-3817
Phone: (585) 374-5210
Fax: (585) 485-0394

See Larger Map Get Directions

Map

mrobinson_sidbr_map

Footer

  • Advantages of Working With Our Firm
  • About The American Academy
  • Disclaimer
  • Privacy Policy
  • Sitemap
  • Contact Us

Connect with Us

  • Facebook
  • Twitter
  • Linkdin
  • Youtube
robinson law logo

The Law Office of Michael Robinson, P.C.

Attorney Advertisement


© 2023 American Academy of Estate Planning Attorneys, Inc.