By Sandy Sinclair Lewis, The Baldhead Insurance Strategist
If you live in Nevada and help parents, grandparents or children with healthcare decisions, Medicare and Medicaid may affect your family more than you realize.
Many people assume Medicare is “insurance for seniors” and Medicaid is only for people with very low incomes. The reality is more complicated. One household might have a parent on Medicare, a grandparent with both Medicare and Nevada Medicaid, and children covered by Medicaid, all at the same time.
Two Different Programs
Medicare is a federal program primarily for people 65 and older, plus some younger people with disabilities or certain medical conditions. Part A covers hospital care, Part B covers doctor and outpatient services, and Part D covers prescriptions. People can choose Original Medicare or a Medicare Advantage plan available in their area.
Medicaid is run by each state with federal funding. It is based on income, not age, and covers children, pregnant women, parents, older adults and people with disabilities. In Nevada, eligibility and benefits are set by Nevada’s state programs.
Your Children May Qualify, Even If You Don’t
Children can often qualify for Nevada Medicaid at higher income levels than adults, so a child may be covered even when a parent is not. For families who earn too much for Medicaid, Nevada Check Up, the state’s children’s health program, may help. If your income has recently changed, check whether your children now qualify.
Some People Qualify for Both
People who have both Medicare and Medicaid are called dual eligible. Medicare generally pays first, and Medicaid may help with remaining costs and additional services.
Even people who don’t qualify for full Medicaid may get help through Nevada’s Medicare Savings Programs, which can help pay Medicare premiums and costs, or Extra Help, which lowers prescription drug costs. Don’t assume there’s nothing available. Ask.
The Long-Term Care Surprise
Medicare generally does not pay for long-term custodial care, such as an extended nursing home stay or daily help with bathing and dressing. Medicaid often does, but qualifying usually means meeting strict income and asset limits, and the state can seek repayment from a recipient’s estate after they pass away. Long-term care can affect a parent’s savings, their home and the adult children who become caregivers, so talk about it early.
Medicaid Is Changing in 2027
Under a new federal law, many Medicaid-covered adults ages 19 to 64 will need to renew their coverage every six months instead of yearly, and many will need to show they are working, volunteering, in school or exempt. If anyone in your household has Medicaid, keep your contact information current, open every notice and respond by the deadline. One missed letter can mean lost coverage.
Medicare Is a Family Decision
When Dad retires and moves to Medicare, what happens to the younger spouse who was on his employer plan? When an adult daughter helps her mother choose a Medicare plan, is she also helping care for grandchildren on Medicaid? Healthcare decisions ripple through the whole household.
And because Medicare Advantage and drug plans vary by service area, the plan your neighbor or your sister in another state loves may not fit you. Consider your own doctors, prescriptions, preferred hospitals, travel habits and budget.
Two Dates to Know
Turning 65: For most people, the Initial Enrollment Period starts three months before the month they turn 65 and ends three months after. Work and employer coverage can affect timing, and missing the window can mean coverage gaps or penalties. Start asking questions before the birthday.
October 15 – December 7: During Medicare’s annual Open Enrollment Period, people can change their Medicare Advantage and drug coverage for next year. You don’t have to switch, but you should review your plan. Plans, prescriptions, doctors and your health can all change.
Free Help in Nevada
You don’t have to figure this out alone. Nevada’s Medicare Assistance Program (MAP) offers free, unbiased Medicare counseling and can help families apply for programs that lower Medicare costs. Call 800-307-4444 statewide or 702-616-4926 in Southern Nevada.
For Medicaid and Nevada Check Up, contact Nevada’s Division of Welfare and Supportive Services. For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE.