When Mom and Dad Say No to Going to a Care Facility

Medicare and Medicaid. They sound almost the same. But they are very different programs — and knowing the difference could save your family thousands of dollars and a lot of confusion.

You are not the only caregiver who gets these mixed up. Most people do, until they suddenly need to figure it out in a hurry. Let’s fix that right now.

Please note: This page provides general information for family caregivers — not legal or financial advice. Rules change often. Always verify current details with Medicare.gov, your state Medicaid office, or a benefits counselor.

What Is Medicare?

Medicare is federal health insurance. It is run by the U.S. government and available to almost everyone who is 65 or older — regardless of income.

Your parent likely already has Medicare if they are 65 or older. It covers:

Hospital stays (Part A). This includes inpatient hospital care, skilled nursing facility care (short-term), hospice, and some home health care. Most people do not pay a premium for Part A if they worked and paid Medicare taxes.

Doctor visits and outpatient care (Part B). This includes doctor visits, preventive care, lab tests, medical equipment, and outpatient procedures. There is a monthly premium for Part B.

Prescription drugs (Part D). A separate plan you choose and pay for to help cover the cost of medications.

Medicare Advantage (Part C). A private insurance alternative to original Medicare that bundles Parts A, B, and usually D together.

What Medicare does NOT cover is critical to understand: it does not pay for long-term custodial care. This means it will not pay for an assisted living facility, a nursing home (beyond a short skilled nursing stay), or someone to help your parent bathe and dress at home long-term. This surprises many families.

What Is Medicaid?

Medicaid is a joint federal and state program. Unlike Medicare, Medicaid is based on financial need. Your parent must have low income and limited assets to qualify.

Each state runs its own Medicaid program with its own rules, so what Medicaid covers — and who qualifies — varies significantly by state.

What Medicaid CAN cover that Medicare does not:

Long-term care in a nursing home is the big one. Medicaid is the primary payer for nursing home care in the United States. If your parent has spent down their assets and meets income requirements, Medicaid can cover the full cost of a nursing facility.

Many states also offer Medicaid waiver programs that pay for in-home care, adult day programs, and assisted living — keeping people out of nursing homes. These programs often have waiting lists.

Can a Parent Have Both?

Yes — and many do. When someone has both Medicare and Medicaid, they are called “dual eligible.” In this case, Medicare pays first, and Medicaid pays some or all of the remaining costs. This combination can dramatically reduce out-of-pocket costs for your parent.

The Key Differences

Medicare: Federal program. Available at 65 regardless of income. Covers hospital, doctors, short-term skilled nursing, prescriptions. Does NOT cover long-term custodial care.

Medicaid: Federal/state program. Based on financial need. Covers long-term nursing home care and, in many states, in-home care. Rules vary by state.

What Should You Do Now?

Find out exactly what Medicare plan your parent has. Look at their Medicare card and any supplemental insurance they carry.

If your parent has limited income and assets, look into Medicaid eligibility in your state. Search for “[your state] Medicaid long-term care” to find the right office.

Consider a free benefits counseling appointment. Every state has a SHIP (State Health Insurance Assistance Program) that offers free help understanding Medicare. Search “SHIP near me” to find your local office.

If your parent has significant assets, talk to an elder law attorney before a crisis hits. Medicaid planning can legally protect some assets, but it must be done well in advance.

Questions to Ask the Doctor or Benefits Counselor

“Does my parent’s current Medicare plan cover the care they need?” “Does my parent qualify for Medicaid based on their income and assets?” “Does our state have a Medicaid waiver program for in-home care?” “Should we meet with an elder law attorney about Medicaid planning?” “Is there a SHIP counselor in our area who can help us understand our options?”

Helpful Resources

• Medicare.gov — official Medicare information and plan comparison
• Benefits.gov — check eligibility for federal and state benefit programs
• SHIP Locator at shiphelp.org — free Medicare counseling in your state
• Legal Documents Checklist