Medicare is a federal health insurance program for:

• people 65 years of age and older

• some people under 65 who have disabilities

• people with end-stage renal disease.

Medicare helps pay for hospital care, skilled nursing facilities, hospice care, some home health care, doctors´ services, outpatient hospital care, and some other medical services.

Medicaid is a health insurance plan for New Yorkers who cannot afford medical care.

You may be eligible for Medicaid if you receive Supplemental Security Income (SSI) or meet certain income, resource, age, or disability requirements.

Medicaid can pay for a variety of medical services that can help you continue to live in your home, or for special services available to participants in waivers.

Some of the covered services are: doctor and clinic services, prescription and non-prescription drugs, home care, personal care aides, adult day care, lab tests, transportation to medical care, physical, occupational and speech therapy, mental health services, x-rays, durable medical equipment such as wheelchairs, orthotic and prosthetic appliances.

Contact me to see if you are eligible for Medicaid.

 Long term care services may include the medical, social, housekeeping, or rehabilitation services a person needs over months or years in order to improve or maintain function or health.

Such services are provided not only in nursing homes, but also in patients´ homes or in community-based settings such as assisted-living facilities.

New York State has many services and programs as alternatives to nursing home care.

Both medical and non-medical care may be received at home or in residential settings, and can range from simple (light housekeeping) to complex (nursing care or physical therapy) services.

You may be able to receive a service or participate in a program through your private health insurance, a managed care agency, Medicaid or Medicare - depending on whether you are financially and medically eligible and meet the criteria of the service or program you are interested in - or by paying for it yourself.

Some services are available to persons who are eligible for Medicaid, have Medicare coverage, use their own funds ("private pay"), or have private health or long term care insurance.

Contact me to see if you are eligible for Medicaid.

Some services are available only to persons who are eligible for Medicaid.

Contact me to see if you are eligible for Medicaid.

A pooled trust is an irrevocable supplemental needs trust (SNT) that, under Federal and New York statute, allows people with disabilities and older adults seeking long-term care services to spend down excess funds in order to qualify financially or maintain eligibility for government benefits, such as Medicaid and/or Supplemental Security Income (SSI).

Pooled trusts give people with disabilities a way to access vital health benefits while utilizing the excess funds they deposit into the trust to pay for items and services not covered by those benefits.

New York residents of any age who are disabled as defined by Social Security Law can establish a pooled trust to deposit excess monthly income and/or resources so that those funds are no longer considered when determining a person’s eligibility to receive services through means-tested government benefits. 

* Qualify and maintain eligibility for Medicaid and/or SSI benefits

* Protect funds for supplemental needs that enhance quality of life

* Get care in the community and be able to afford to pay bills

* Avoid having to spend-down funds quickly

Medicare Part B premiums vary based on beneficiary’s income and can change each year. For current rates visit the Medicare Cost site.

Each year, Social Security sends a letter to people collecting Social Security benefits (and those who pay higher premiums because of their income) stating each person’s exact Part B premium.

What Medicare Part B Covers

Part B will cover 80% of certain services at the Medicare-approved amount as long as you visit a physician that accepts assignment. Most of these services are done on an outpatient basis, but not all of them. (Services you get while you’re staying as an inpatient in a hospital will be covered by Part A). A Medicare-approved supplier has to administer your care for approval, like an NP, DO, MD, or other medical professionals. 

Services that Medicare Part B cover may include: 

• Certain prescription drugs a physician administers or those that you get intravenously in an outpatient or inpatient setting

• Chiropractic care for a spinal subluxation

• Colonoscopies 

• Diagnostic mammograms for men and women

• Durable medical equipment

• Emergency transportation like an ambulance

• Hepatitis B vaccine if you’re someone who is at high risk for contracting it

• Laboratory testing like blood work

• Medically necessary outpatient hospital care, like emergency room visits or same-day surgical procedures 

• Mental health services

• Most doctor visits if they’re preventative or medically necessary as long as they’re from a Medicare-approved supplier

• Pap smears

• Preventative mammograms for women

• Smoking cessation counseling

• Some home health services

• Some nonemergency transportation services

• Some vaccines like an annual flu shot or pneumonia shot

• X-rays

To be eligible for coverage under Part B, you have to be at least 65 years old, unless you qualify under the age of 65 due to certain disabilities. Additionally, you have to be a permanent resident of the United States who has lived here for at least five consecutive years or be a citizen of the United States to sign up for Medicare.