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Medicare and Medicaid Help for Families, in Plain Words

By The Hansome Family · Last reviewed

Watercolor of a grandmother, her adult daughter and her teenage grandson reviewing mail together at the kitchen table

Helping a parent with Medicare or Medicaid starts with the papers they already have. Read the Annual Notice of Change before Open Enrollment, which runs October 15 to December 7. Ask the hospital about inpatient or observation status. For nursing home Medicaid, expect questions about five years of finances. Free SHIP counselors can help.

Did you know? The most important Medicare document of the fall may already be in your parent's mail pile. CMS says plans send the Annual Notice of Change so it arrives by September 30, two weeks before Open Enrollment opens. CMS: Guide to consumer mailings

The Medicare fall calendar: the Annual Notice of Change should arrive by September 30, Open Enrollment runs October 15 to December 7, and changes usually start January 1
The Medicare fall calendar.

Myth or fact?

Tap each one to check it against the official source.

Myth: if Mom liked her plan this year, there is nothing to check.

Fact: plans can change premiums, covered drugs, and costs every year. That is what the Annual Notice of Change explains, so it is worth reading even if you plan to stay.

Myth: an overnight hospital stay always counts as being admitted.

Fact: Medicare says someone is an outpatient, even overnight, unless a doctor writes an order to admit them as an inpatient. Ask the hospital which status applies.

Myth: Medicaid only looks at the last year of bank records.

Fact: for long-term care Medicaid, the federal look-back is 60 months, five years, set by the Deficit Reduction Act. States apply the details, so confirm with your state Medicaid agency.

Watercolor of an older couple at their dining table taking notes during a video call with a counselor
Free counseling is available in every state.

Who can help for free?

  • SHIP counselors give free, unbiased Medicare help in every state (shiphelp.org).
  • 1-800-MEDICARE and Medicare.gov can answer coverage questions and compare plans.
  • Your state Medicaid agency and a qualified elder law attorney can explain long-term care Medicaid rules where your parent lives.
The Medicaid look-back is 60 months before the application date and your state applies the details. Free help: SHIP counselors, 1-800-MEDICARE, and a qualified elder law attorney.
The look-back period and where to get free help.

Helping with the fall paperwork? Start with our Medicare Open Enrollment kitchen-table checklist, then keep the plan letters with the rest of the family files.

Thinking about leaving Medicare Advantage for Original Medicare? Read how the Medigap trial right works before anyone cancels a plan: who qualifies in the first 12 months, the 60 and 63 day apply window, and the safe order of steps.

Did a letter say Mom's Medicare Advantage plan is ending, or that her doctor is leaving the network? Read what to do when a Medicare Advantage plan is ending: which letter it is, the December 8 to February Special Enrollment Period, and her right to buy Medigap.

Are drug costs the problem? Read Extra Help for Medicare drug costs: the 2026 income and resource limits, what Social Security counts and what it does not, who gets it automatically, and how to apply for free.

Did the pharmacy say the plan won't cover a drug? Read the pharmacy said no: how to ask for a Part D coverage determination: which exception fits (formulary, tier, step therapy, quantity limit, prior authorization), the 72 and 24 hour deadlines, and a free call sheet.

Does one prescription cost hundreds at the counter? Read the Medicare Prescription Payment Plan: spreading drug costs across the year: how the monthly bill is figured, who it helps and who should skip it, how to sign up for 2027, and a free call sheet.

Did rehab, home health, or hospice hand Mom a Notice of Medicare Non-Coverage? Read got a NOMNC? how a Medicare fast appeal works: the noon deadline the day before the end date, which notice is which, what to say to the QIO, and a free call sheet.

Is the Part B premium the problem? Read Medicare Savings Programs: help paying the Part B premium: the four programs (QMB, SLMB, QI, QDWI), the 2026 income and resource limits, how to apply with your state, and what QMB means at the doctor's office.

If nursing home Medicaid is coming up, read the Medicaid look-back period in plain English for myth vs fact cards, the penalty math, and a free what-to-gather checklist. Our Medicaid Look-Back File keeps the statements and gift log in one place.

For hospital stays, start with our free hospital discharge checklist (inpatient or observation, medicines, and who to call). Our Hospital Discharge Go Sheet helps you write down status, medicine changes, and follow-ups on discharge day.

Guides in this topic

Got a NOMNC? How a Medicare Fast Appeal Works

Rehab, home health, or hospice says Medicare coverage is ending? The noon deadline, a "which notice is this?" decoder, a practice quiz, a call script, and a free call sheet.

· 14 min read

See all our guides

Printables for this topic

Frequently asked questions

When is Medicare Open Enrollment?

Medicare Open Enrollment runs from October 15 to December 7 every year. During that window, people with Medicare can join, switch, or drop a Medicare Advantage or drug plan, and changes usually start on January 1. Medicare.gov and your State Health Insurance Assistance Program can explain the options for your situation.

What is the Annual Notice of Change?

It is a letter Medicare Advantage and drug plans send to members each fall describing what will change next year, such as premiums, covered drugs, and costs. CMS says it should arrive by September 30. Reading it before Open Enrollment starts on October 15 is the easiest way to decide whether to compare plans.

How far back does Medicaid look at finances for nursing home care?

For long-term care Medicaid, the federal look-back period is 60 months, or five years, before the application date. CMS explains that the Deficit Reduction Act set this period, and transfers for less than fair market value can delay coverage. Your state Medicaid agency applies the detailed rules, so confirm them there.

Where can we get free, unbiased Medicare help?

Every state has a State Health Insurance Assistance Program, called SHIP, that offers free one-on-one Medicare counseling and does not sell plans. You can find yours at shiphelp.org. You can also call 1-800-MEDICARE or use the plan comparison tools on Medicare.gov before making any change.

Please note: This printable is an organizational and educational tool only. It is not legal, insurance, financial, or Medicaid planning advice, and it is not affiliated with Medicare, CMS, Social Security, or any state Medicaid agency. Rules, dates, and costs change and vary by state and plan, so confirm them on Medicare.gov, with your State Health Insurance Assistance Program (SHIP), or with your state Medicaid agency.

Sources

  1. Medicare.gov: Joining a plan (Open Enrollment dates)
  2. CMS: Guide to consumer mailings (Annual Notice of Change by September 30)
  3. CMS: Transfer of Assets in the Medicaid Program (Deficit Reduction Act backgrounder)
  4. Medicare: Your Medicare Hospital Benefits (publication 11435)
  5. SHIP: State Health Insurance Assistance Programs