Most New Yorkers know the basic rule: Medicare pays 80% of covered medical costs. Many families also carry a supplemental insurance plan — sometimes called Medigap — to cover that remaining 20% and avoid surprise bills. Smart planning. But when your parent needs ongoing help at home, both Medicare and the supplemental plan stop covering — and that's where Medicaid becomes essential.
How the Three Layers Work Together
Think of it this way:
- Medicare covers 80% of medical services — doctor visits, hospital stays, short-term skilled nursing
- Supplemental insurance covers much of the remaining 20%
- Medicaid either layers on top of both as a third level of coverage — or replaces the supplemental plan entirely, eliminating that monthly premium at no loss of coverage
That last point surprises most families. If your parent qualifies for Medicaid, they may no longer need to pay for their supplemental plan at all. Medicaid steps in to cover what the supplemental was covering — and then goes further, covering services neither Medicare nor any private plan will touch.
What Medicaid Covers That Nothing Else Does
The biggest one: long-term home care. Medicare covers a short window of skilled nursing after a hospitalization, then stops. The home health aide your parent needs every day — for bathing, dressing, meals, and daily safety — that is Medicaid's coverage, not Medicare's.
Medicaid also covers durable medical equipment (DME) — wheelchairs, hospital beds, walkers, oxygen equipment — and other community-based services that make staying home possible.
Without Medicaid, families across Nassau County, Queens, and Brooklyn pay out of pocket. Home aides in the New York metro area start around $25 per hour, which can run $4,000 to $8,000 or more per month depending on hours. That is not sustainable for most families.
The Good News for New York Families
For Community Medicaid — the program that pays for home care — there is currently no five-year look-back period in New York. That rule applies to nursing home Medicaid, not home care. Even if your parent has already started receiving help at home, there may still be meaningful steps to protect their home, their savings, and their legacy.
Talk to an Elder Law Attorney
At Kirshblum Taber PC, we help families throughout Nassau County, Queens, Brooklyn, and Long Island understand their options and plan before a crisis forces their hand. The sooner you act, the more we can protect.
Call (516) 545-0059 or visit ktlawgroup.com to schedule a consultation.
This post is for informational purposes only and does not constitute legal advice.