Part I: Medicare and Medicaid Understanding What Is Covered

One of the first things to do when you (or a loved one) are living with a serious illness is to get informed about the benefits for which you may qualify. These include national and state programs as well as community agencies.

This issue of Quick Facts will briefly explain the services provided by Medicare and Medicaid, who qualifies and what is offered.


Medicare is quite good insurance for people age 65 and over, those under age 65 with certain chronic disabilities and people of all ages with permanent kidney failure. You are generally eligible if you or your spouse have worked for at least 10 years in Medicare-covered employment, you are a citizen or permanent resident of the United States and you are 65 years or older. Medicare is a federal program (so coverage is the same in each state) and divided into parts A, B and D – each of which cover different facets of care.

Medicare A pays for hospitalizations, rehabilitation, home care and hospice.

Medicare B is elective. If you choose this coverage a monthly fee will be deducted from your social security check. The fee will then pay for 80% of doctor visits and for medical equipment such as canes, walkers, wheelchairs and oxygen, when appropriate.

Medicare D is for prescription coverage. There are many different plans in each state and you can only change plans at a certain time during the year.


Medicaid is a state and federally funded program providing medical care for those with limited income and resources. Because it uses state funds, the benefits of this program will vary in each state.

For people who already get health coverage through Medicare, the huge advantage of Medicaid is coverage for long-term care. This care may be provided either at home or in a nursing home, depending on the state.

If Medicaid is your only health care plan, it will cover many of the services provided by Medicare (outlined above).

Income limits vary, but for an individual, monthly income limits are in the range of $500-$600. In addition people may only have assets (not including a house or car) of about $2000.

If you are not sure if your loved one qualifies, contact your local government benefits office. You might also speak with an eldercare attorney or financial advisor. Many people who do not qualify initially may find they do qualify when they have become impoverished from months or years of paying for long-term care.

For more information about Medicare and Medicaid, visit: