Medicare Basics


Medicare is a federal program that provides health insurance coverage, paying for hospital and medical care for the people over 65, certain people under 65 with disabilities, and people with end stage renal disease of any age. Funded through federal payroll taxes and monthly premiums paid by recipients, Medicare is available to any U.S. citizen or permanent legal resident who is eligible for Social Security benefits and has paid into the system for at least ten years.


Medicare consists of four parts, A,B, C, and D. Part A, or Hospital Insurance, contributes to the cost of inpatient hospital treatment, including meals, testing, supplies and a semi-private room. Part A also covers home health care for up to 100 days, so long as it is provided on a part-time basis and is judged to be medically necessary. Skilled nursing facility care can be covered for up to 100 days and the purchase of certain medical equipment is covered. Part A is available at no cost for those who contributed payroll taxes to the system for ten years or more, while a small monthly premium is collected from those with less than 10 years worth of tax contributions.



Medicaid Information

Medicaid is a health and medical services program that provides low-income families and individuals who meet certain eligibility rules with health insurance. While oversight of the program is done at the federal level, Medicaid programs are administered by the states, with each state setting its own eligibility standards, determining the services it will cover, and setting co-payment rates for those services. However, each state follows federal mandates that demand that certain basic services must be provided in order to collect federal matching funds.



Which One Helps with the Cost of Nursing Homes in NYC?

Medicare will only contribute to the costs of nursing homes in NYC under very limited conditions. Skilled nursing care or rehabilitation services must be deemed medically necessary to receive any coverage, and Medicare will not extend that coverage for more than 100 days. Most often, funding is stopped very short of that allotment. In fact, the average length of a Medicare funded stay in a nursing home in NYC is 23 days. Furthermore, coverage is reduced to 80 percent of cost after the first 20 days of nursing home care.


Medicaid in New York State will foot the bill for a stay in a nursing home in NYC for people whose income and assets are limited enough to meet eligibility guidelines. Most people who are placed in care facilities in NY, such as a nursing home in Queens, start out paying out of pocket, spending from their own assets until they have been reduced to the point of Medicaid eligibility. If the client has a spouse who will continue to live independently, Medicaid will not force those assets to be spent down to the point that he or she is in poverty, nor will they force the sale of the family home.



About SSI Benefits

SSI, or Supplemental Security Income, is a federal program administered by the Social Security Administration. This program provides financial support to low-income individuals over 65 and people of any age who are disabled. SSI eligibility does not depend on taxes paid into the system by the recipient, as do other programs administered by Social Security. People who have never been able to work receive benefits, such as children who are significantly disabled, provided their parent’s income is low enough for them to qualify. SSI beneficiaries must be U.S. citizens with a Social Security number, with the exception of certain categories of aliens that are eligible.


Adults who have permanent disabilities can also receive SSI benefits regardless of work history, so long as they are medically and financially qualified. Benefits are generally around $500 to $600 per month and cost of living adjustments are given annually. SSI beneficiaries are automatically eligible for Medicaid and are not required to re-certify for that medical coverage every six months, as is required of many Medicaid recipients.