Where can I get help understanding Medicare and Medicaid?

By Amy Goyer

Handling health insurance is a common task for family caregivers, and if you’re caregiving for older adults, chances are you will find yourself dealing with Medicare. It can be difficult to make provider and plan choices, understand coverage and handle claims. If your loved ones are enrolled in Medicaid, you may face some of the same challenges, in addition to unraveling eligibility requirements. The following information, tips, and resources can help you navigate these two important health insurance programs.

What is the difference between Medicare and Medicaid? According to the U.S. Department of Health and Human Services, “Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.”


Medicare consists of four parts:

  • Part A provides inpatient/hospital coverage.
  • Part B provides outpatient/medical coverage.
  • Part C offers an alternate way to receive your Medicare benefits, such as a Medicare Advantage plan or a Medicare private health plan.
  • Part D provides prescription drug coverage.

Most people receive Medicare through Part A and Part B, often called “Original Medicare”, but Medicare Advantage plans are growing in popularity and although they may limit which providers you can go to, they may also offer coverage of health benefits and services that original Medicare doesn’t cover, like vision and dental coverage, transportation to healthcare appointments, and exercise programs.

There are increasingly more options as you choose your Medicare plan.  The State Health Insurance Assistance Program (SHIP) offers free one-to-one unbiased counseling and assistance, and their counselors can help you save money, make coverage choices, clarify how your Medicare interacts with a supplemental policy or Medicaid, and understand your loved ones’ rights under Medicare. Visit www.SHIPHELP.org and click on “SHIP LOCATOR” to find SHIP counselors in your state.


Medicaid is administered by the states, with federal requirements, and is funded jointly by the states and the federal government. Eligibility for Medicaid is based on family size, income, and assets, but the specifics of each, as well as the benefits, can vary from state to state. Therefore, it’s important to check with your loved ones’ state Medicaid office for accurate information. Keep in mind that people enrolled in Medicaid will have to go through a “redetermination” process every year to verify that they are still eligible.

For assistance applying for Medicaid, the Health Insurance Marketplace at healthcare.gov provides a search tool to find a local agent/broker or assister.

Another resource is a Certified Medicaid Planner (CMP). The CMP board provides a CMP locator tool to find a local CMP who can help you understand Medicaid eligibility and plan for it if appropriate.

An elder law attorney can help you understand and plan for Medicaid eligibility, and if needed, help with preparing applications. The National Academy of Elder Law Attorneys (NAELA) has a search tool to find a local elder law attorney.


Amy Goyer is a nationally known caregiving expert and author of Juggling Life, Work, and Caregiving. A passionate champion for caregivers, she has also been one her entire adult life, caring for her grandparents, parents, sister, and others. Connect with Amy on Facebook, Twitter, and LinkedIn.

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