🏥 Medicare & Medicaid
What these two programs cover, what they do not, how to qualify, and how to fight back when they say no.
✓ What Medicare covers
✓ How Medicaid pays for home care
✓ How to appeal denials
✓ Hospice & end of life
Medicare and Medicaid are not the same thing. Millions of caregivers confuse them — and that confusion costs families tens of thousands of dollars. Medicare does NOT pay for long-term home care. Medicaid does — if you qualify. This page explains both clearly.
Medicare — the basics
- Federal program — same rules in every state
- For people 65+ or with certain disabilities
- Covers hospital stays, doctor visits, some home health
- Does NOT cover long-term home care or nursing home stays
- Covers skilled nursing facility only after 3-day inpatient stay
- Covers hospice 100% — most families wait too long to use it
Medicare will not pay for daily bathing, cooking, or dressing help. That is Medicaid’s job.
Medicaid — the basics
- State-run — rules are different in every state
- For people with low income and limited assets
- Covers long-term home care, nursing homes, personal care
- In most states — can pay a family member to be the caregiver
- Asset limit: $2,000 for a single person (some things are exempt)
- 60-month look-back period on financial transfers
Medicaid is the most important benefit most caregivers have never fully explored.
Parts A, B, C, and D explained in plain English. What Medicare will never cover. What pays for long-term care instead. Simple covered vs not covered table.
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Income limit, asset limit, what is exempt, Community Spouse Resource Allowance, legal ways to spend down, and what triggers a penalty.
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60-month look-back, how the penalty is calculated, what is NOT penalized, common mistakes, and the Caretaker Child Exception.
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100% covered by Medicare. Includes medications, nurses, equipment, and emotional support at home. Most families enroll in the last 2 weeks — too late.
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Why waivers exist, what they cover including family caregiver pay, waitlists — get on one today even if you do not need it yet, and how self-direction works.
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5 levels of appeal and win rates at each. The Jimmo v. Sebelius ruling. The doctor letter that wins most appeals. SHIP counselors — free help in every state.
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The $2,000 out-of-pocket cap. Extra Help eliminates most costs for lower-income seniors. Formularies. Open enrollment Oct 15–Dec 7. Late enrollment penalty.
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Observation status looks like a hospital stay but is not — and it kills your skilled nursing facility coverage. How to find out, how to appeal, the NOTICE Act.
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Trade-offs: dental and vision vs network restrictions and prior authorization. When Original Medicare is better for serious illness. What to check before enrolling a parent.
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🔧 Free tools for Medicare & Medicaid situations
Exact words to appeal Medicare denials
Find Medicaid paid caregiver programs in your state
Ask the right questions from day one
Does your state have a paid family caregiver program?
Most states do — through Medicaid. Answer 6 questions and find the exact program name, pay rate, and how to apply.