Does Your Loved One Qualify for Medicare or Medicaid?


If your loved one is considering a move to a private care facility, it’s important to find out exactly what combination of public and individual insurance is available to help with the expense of these services. Here are some considerations to keep in mind as you begin to search for this information.

State and Federal Laws

Although Federal laws broadly govern Medicare and Medicaid, latitude is granted to states for a variety of aspects of eligibility. It is essential that you consult the Medicare and Medicaid guidelines in your loved one’s state to determine their exact eligibility status.


Medicare coverage is available to all Americans older than 65 who have paid Medicare taxes for at least ten years of their working lives. (It is available as well to people under 65 under specific circumstances) Parts A and B cover medical care and insurance respectively and are available to anyone who meets the age and tax conditions. Part C, known as Medicare Advantage, is offered by private insurance companies with an additional premium and expanded services. Part D covers prescription drugs.


Medicaid is a health care program for lower income citizens, and is paid for by a combination of federal and state taxes. Eligibility and benefits are determined largely at the state level, with a variety of benefits being available for different income levels. It is possible to be “dual eligible” for Medicare and Medicaid. In this case, your loved one may be eligible for benefits from Medicare Savings Programs that help cover Medicare costs. This status is known as Full Benefit Dual Eligible, and like much of Medicaid, its eligibility conditions are determined on a state-by-state basis.

Private Insurance

Once you know which public services your loved one is eligible for, you can consider private insurance to cover any gaps in coverage or needs that are unique to your family member.


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