Medicare & Medicaid Lawyers

What Is Medicare & Medicaid?

Medicare is federal health insurance for people 65 and older (and some younger people with disabilities), covering hospital care, medical services, and prescription drugs through its different parts. Medicaid is a joint federal-state program for people with limited income, and it is the largest payer of long-term nursing home care in the United States. A common source of confusion: Medicare generally does not pay for long-term custodial nursing home care. Because Medicaid eligibility involves strict income and asset limits that vary by state, families often seek guidance on planning, applications, and appeals.

The Most Common Misunderstanding

Many families assume Medicare will cover a parent’s nursing home stay — then discover it does not cover long-term custodial care. Learning this distinction early, before a crisis, gives families time to understand Medicaid eligibility, veterans benefits, long-term care insurance, or other options.

Get Free Counseling First

Every state has a State Health Insurance Assistance Program (SHIP) offering free, unbiased counseling about Medicare choices. For Medicaid questions, your state’s Medicaid agency and local Area Agency on Aging (findable through the Eldercare Locator) are good starting points before you ever pay for advice.

Common Issues This May Cover

When Someone May Consider Legal Help

Every situation is different. In general, people tend to explore legal help around this topic when facing circumstances like these:

• You are approaching 65 and need to understand Medicare enrollment
• A loved one needs nursing home care and you are unsure how to pay for it
• A Medicaid application was denied or is stalled
• You received a notice about Medicaid estate recovery
• You need help understanding what Medicare does and does not cover
• You are weighing how to structure assets given Medicaid's eligibility rules

If any of these sound familiar, you may want to consider speaking with a qualified legal professional licensed in your state.

Questions to Ask a Legal Professional

If you decide to speak with a legal professional, these questions can help you make the most of the conversation:

1. What area of law do you practice, and how much involves Medicare or Medicaid?
2. Are you licensed in my state, since Medicaid rules are state-specific?
3. How do you charge for your services?
4. What is the look-back period, and how might past transfers affect eligibility?
5. What documents should we gather for an application or appeal?
6. What are our options if benefits are denied?