Medicare vs. Medicaid at a Glance
Medicaid and Medicare are both government health coverage programs, but they serve different purposes and have different eligibility requirements and benefits.
For New Yorkers who need ongoing assistance at home, understanding the difference is especially important. Medicare can cover certain medical and home health services, while New York Medicaid may cover a broader range of home care and long-term care services for people who meet the applicable requirements.
| Medicare | Medicaid | |
|---|---|---|
| Program | Federal health insurance program | Federal and state health coverage program |
| Primary eligibility | Primarily people age 65 and older, plus certain younger people with disabilities or specific medical conditions | Eligibility depends on income and other requirements, which vary by Medicaid category |
| Income-based? | Generally not based on income | Income and other financial requirements apply to many eligibility categories |
| Home care | Covers certain home health services when Medicare requirements are met | May cover personal care and other home care services for eligible individuals |
| Long-term care | Generally does not cover long-term care | May cover qualifying long-term care services |
| Can you have both? | Yes | Yes |
What Is Medicare?
Medicare is a federal health insurance program primarily for people age 65 and older. Certain younger people may also qualify because of a disability or specific medical conditions.
Medicare can cover certain home health services, including skilled nursing and physical, occupational, or speech therapy when the applicable requirements are met. However, Medicare generally does not pay for long-term custodial or personal care when that is the only care a person needs.
What Is New York Medicaid?
Medicaid is a joint federal and state program that provides health coverage to eligible New York residents. Eligibility requirements vary depending on the individual’s circumstances and the Medicaid category involved.
New York Medicaid may cover services such as medical care, prescription drugs, transportation, personal care, Home Care Services and certain Long-Term Care Information services. New York State notes that financial and medical eligibility requirements may apply depending on the service or program.
The Key Difference: Home Care and Long-Term Care
The distinction between Medicare and Medicaid becomes particularly important when someone needs ongoing assistance with everyday activities.
Medicare may cover certain medically necessary home health services when specific requirements are satisfied. It does not generally cover long-term care, including most ongoing assistance with activities such as bathing, dressing, or using the bathroom.
New York Medicaid may cover a broader range of home and community-based services for eligible individuals. Depending on the program and the person’s needs, these can include personal care, home health aide services, nursing services, adult day care and other long-term services.
What Is CDPAP?
The [Consumer Directed Personal Assistance Program CDPAP Information is a New York Medicaid program for eligible individuals who need home care.
CDPAP allows eligible participants, or their designated representatives, to take an active role in choosing and managing their personal assistant. New York State determines eligibility and has established specific requirements for the program.
CDPAP is different from traditional agency-provided home care. With agency-directed care, the home care agency generally manages caregiver staffing and supervision. With CDPAP, the eligible participant or designated representative has greater responsibility for selecting, training and supervising the personal assistant.
Can You Have Medicare and Medicaid?
Yes. Some people qualify for both Medicare and Medicaid and are commonly referred to as dually eligible.
When someone has both programs, Medicare generally pays first for Medicare-covered services. Medicaid may then help with certain Medicare-related costs and may cover additional services, depending on the person’s Medicaid coverage and eligibility.
Having Medicare does not automatically qualify someone for Medicaid. Medicaid eligibility must be determined under the applicable New York requirements.
How Do You Know Which Program Applies?
The answer depends on your age, income, disability status, medical needs, existing coverage and the type of care you need.
If you are researching Medicaid eligibility, use official government resources for current requirements. New York State Medicaid eligibility and benefit decisions are made by the appropriate government agency or Medicaid plan, not by Sincere Care Agency.
If you already have New York Medicaid and are looking for Sincere Care Home Care Services, Sincere Care Agency can explain its agency-provided services and intake process.
Official Resources
For the most current eligibility and program information, consult:
The Bottom Line
Medicare and Medicaid are different programs with different eligibility rules and coverage. Medicare primarily provides health insurance for older adults and certain younger people who meet specific requirements, while Medicaid provides coverage to eligible individuals based on applicable state and federal requirements.
For New Yorkers who need ongoing assistance at home, Medicaid can be particularly important because it may cover home care and long-term services that Medicare generally does not cover.
If you already have New York Medicaid and need care at home, Sincere Care Agency can explain its agency-provided home care services and intake process.
