General information about aging, care, and legal authority. Benefits rules and individual documents require current professional review.
Medicare is a federal health-insurance program and does not function as a general payer for indefinite custodial long-term care.
Side-by-side comparison
Use the table to locate the controlling difference; then verify the governing document and state law for your facts.
| Question | Medicare | Medicaid |
|---|---|---|
| Program type | Federal health insurance | Federal-state health coverage with financial and category rules |
| Long-term care | Limited coverage for qualifying medical or skilled services | May cover qualifying long-term services and supports |
| Financial eligibility | Generally not means-tested for ordinary enrollment | Income, resources, transfers, and state rules may apply |
| Application focus | Service, provider, benefit, and medical criteria | Program category, care level, finances, and state process |
| Estate recovery | Not a Medicare feature | May apply to specified benefits subject to protections |
| Where to verify | Medicare.gov and coverage notices | State Medicaid agency and Medicaid.gov |
Define the immediate decision
- Coverage depends on the service, setting, medical criteria, provider, benefit period, and current program rules.
- Long-term-care Medicaid eligibility, transfer review, spousal protections, estate recovery, and available planning tools are governed by federal and state rules.
- Asset labels, ownership, income, transfers, trusts, care level, and application timing all need documentation.
Authority, care, and payment records
- Medicare notices, coverage decisions, care plan, and provider records
- supplement, Advantage, prescription, and long-term-care policy information
- multi-year financial statements, transfers, deeds, trusts, and insurance
- marriage, care, income, benefit, and application records
Escalation and safeguards
- Is the requested service medical, skilled, rehabilitative, or custodial?
- What notice and appeal rights apply to the coverage decision?
- Which program and eligibility category applies?
- How do transfers, a spouse, the home, and existing trusts affect the application?
Risks to pause on
- Assuming Medicare will pay for all nursing-home or home-care needs can leave a family without a realistic financing plan.
- Giving away assets or retitling a home before state-specific advice can create ineligibility, tax, control, and recovery problems.