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Plain-language guides to Medicare, CDPAP, home care, and patient rights in New York. Written by advocates.
Key Facts for New York Families in 2026
- 6.4 million New Yorkers are enrolled in Medicare — and most do not fully understand what Part A and Part B cover separately.
- CDPAP lets family members get paid as caregivers — New York's Consumer Directed Personal Assistance Programcovers over 200,000 participants through Medicaid.
- Over 200 million Medicare claims are denied each year nationwide — but patients who appeal win roughly 80% ofthe time.
- CDPAP caregiver pay ranges from $18.55 to $22.50 per hour depending on region, with overtime at 1.5x after 40hours per week.
- Free help is available — Medicare patient advocates, SHIP counselors, and organizations like UnderstoodCare help families navigate the system at no cost.
Key Terms Explained
What Is Medicare?
Medicare is a federal health insurance program for Americans aged 65 and older, as well as certain younger people with disabilities. It is administered bythe Centers for Medicare and Medicaid Services (CMS). Medicare has four parts: Part A covers hospital stays and inpatient care. Part B covers doctor visits,outpatient services, and medical equipment. Part C (Medicare Advantage) is a private insurance alternative that bundles Part A and B. Part D coversprescription drugs.
What Is CDPAP?
CDPAP stands for Consumer Directed Personal Assistance Program. It is a New York State Medicaid program that allows people who need home care to hiretheir own caregivers — including family members, friends, or neighbors. Unlike traditional home care agencies, CDPAP gives the consumer full control over whoprovides their care, when, and how. The caregiver does not need any medical certification or license.
What Is a Medicare Denial?
A Medicare denial is a decision by Medicare or a Medicare Advantage plan to not pay for a specific medical service, treatment, or item. Common reasonsinclude coding errors, lack of prior authorization, and determinations that a service was not medically necessary. Patients have the right to appeal every denial through a five-level process, starting with a Redetermination within 120 days.
What Is a Medicare Patient Advocate?
A Medicare patient advocate is a professional who helps patients understand their Medicare benefits, resolve billing disputes, file appeals, and navigatethe healthcare system. Many advocates work for free through nonprofit organizations, hospitals, or state programs like SHIP (State Health Insurance Assistance Program). Their role is to ensure patients receive the coverage and care they are entitled to under federal law.
What Is SHIP?
SHIP stands for State Health Insurance Assistance Program. It is a free, federally funded counseling service available in every state. SHIP counselorshelp Medicare beneficiaries understand their coverage options, compare plans, resolve billing issues, and file appeals. In New York, SHIP is operated throughthe Health Insurance Information, Counseling, and Assistance Program (HIICAP). You can reach SHIP at 1-800-MEDICARE or through shiphelp.org.
Which Guide Is Right for You?
Use this table to find the guide that answers your specific question. Each guide is written in plain language by Debbie Hall, Director of Operations atUnderstood Care, with 20+ years of experience in CDPAP and home care coordination.
Frequently Asked Questions
Get the clear answers you need to your questions
Is Medicare the same as Medicaid?
No. Medicare is a federal program based on age (65+) or disability. Medicaid is a state and federal program based on income. In New York, many seniorsqualify for both — this is called "dual eligibility." If you qualify for both, Medicaid can cover costs that Medicare does not, including CDPAP home care services.
Can a family member really get paid to be my caregiver in New York?
Yes. Through the CDPAP program, a family member (except a spouse) can be hired as your paid caregiver. They do not need any medical certification. CDPAPis funded through Medicaid, and pay rates in 2026 range from $18.55 to $22.50 per hour depending on which county you live in.
What should I do if Medicare denies my claim?
File an appeal. You have 120 days from the date on your Medicare Summary Notice to file a Redetermination (Level 1 appeal). According to CMS data, roughlyhalf of first-level appeals result in the denial being overturned, and the success rate improves at each subsequent level. The process is free, and you can get help through SHIP at 1-800-MEDICARE.
How much does Medicare cost per month in 2026?
Most people pay $0 for Medicare Part A (hospital insurance) because they paid Medicare taxes for at least 10 years while working. Medicare Part B (medicalinsurance) costs $185 per month for most beneficiaries in 2026, with higher premiums for those with incomes above $106,000. Part D prescription drug plans vary by carrier.
Do I need to pay for a Medicare patient advocate?
No. Most Medicare patient advocates are free. You can access free help through your State Health Insurance Assistance Program (SHIP), hospital patientadvocacy departments, nonprofit organizations, and community legal services. In New York, call the HIICAP helpline or visit shiphelp.org to find a counselor near you.
Key Takeaways
- Medicare covers hospital and medical care for 65+ Americans; Medicaid covers low-income residents — many New Yorkers qualify for both.
- CDPAP pays family caregivers $18.55–$22.50/hour through Medicaid with no certification required.
- 80% of Medicare appeals succeed — the process is free and you have 120 days to file.
- Free help is available through SHIP, patient advocates, and organizations like Understood Care.
Reputable Sources
These sources come from government agencies, nonprofit organizations, and trusted institutions.
- Medicare.gov — Official U.S. Medicare Information
- CMS.gov — Centers for Medicare and Medicaid Services
- NY Departmentof Health — CDPAP Program
- SHIP — State Health Insurance Assistance Program
- HHS.gov — Medicare and Medicaid Answers
- Medicaid.gov — Official Medicaid Information
- KFF — Kaiser Family Foundation Medicare Research
- AARP — Medicare Resources and Guides