Eligibility & Cost

Your parent qualifies for Hera if they meet three criteria:

1. They have Original Medicare (not Medicare Advantage)

2. They live in New York State

3. They have a chronic condition (like diabetes, heart disease, COPD, dementia, or others)

Not sure if your parent fits? Schedule a complimentary consultation and we'll verify their eligibility at no cost and no commitment. Even if your parent doesn't qualify, we are happy to point you toward other resources that might help.

Call us at 332-203-2533 or fill out our contact form to get started.

90% of Hera clients pay $0 out of pocket.

Our care management services are covered by Original Medicare as part of a program called Chronic Care Management (CCM).

If your parent also has Medicaid or a supplemental plan like AARP/UnitedHealthcare Medigap, that typically covers the standard Part B coinsurance.

During your complimentary consultation, we verify your parent's Medicare coverage and let you know exactly what to expect. There are no hidden fees, no contracts, and no surprise costs.

If your parent has Medicare Advantage (instead of Original Medicare), we unfortunately cannot provide services at this time, but we're working to accept MA plans soon.

This is a common question and the distinction can be confusing.

Original Medicare, sometimes called "Traditional Medicare", is administered directly by the U.S. government and
consists of:

• Part A: Hospital insurance

• Part B: Medical insurance

If your parent has a red, white, and blue Medicare card from the government, they have Original Medicare, and likely qualify for Hera.

Medicare Advantage (Part C) is offered by private insurance companies like UnitedHealthcare, Humana, Aetna, or Blue Cross. These plans bundle Parts A, B, and usually prescription drug coverage.

It's worth noting that many people with Original Medicare also have supplemental "Medigap" plans from private insurers like UnitedHealthcare or Aetna. This is different from Medicare Advantage.

Currently, Hera's services are covered by Original Medicare only. Not sure which type of Medicare your parent has? We can help verify during a complimentary consultation.

Yes! Hera serves all of New York state, including all five NYC boroughs:

• Manhattan

• Brooklyn

• Queens

• The Bronx

• Staten Island

Our NYC-based Heroes are familiar with local hospital systems (like Weill Cornell, NYU Langone, Mount Sinai), community resources, and NYC-specific programs like SCRIE, SNAP, and HEAP.

Beyond NYC, we serve families throughout New York State, from Westchester to Long Island to the Hudson Valley. If your parent lives anywhere in New York, we can help.

Medicare classifies many different conditions as chronic. Common qualifying conditions include:

• Diabetes

• Heart disease or heart failure

• COPD or chronic lung disease

• Alzheimer's or dementia

• Arthritis

• Chronic kidney disease

• Depression

• High blood pressure (hypertension)

• Osteoporosis

• Cancer (current or in remission)

• Stroke

• High cholesterol

If your parent has one or more of these conditions, or others not listed, they likely qualify. Not sure? We can confirm eligibility during a free consultation.

Your parent qualifies if they have two or more chronic conditions expected to last 12 months or more.

Common qualifying conditions include diabetes, heart disease, COPD, hypertension, dementia or Alzheimer's, arthritis, depression, and chronic kidney disease. Your parent must also have Original Medicare (not Medicare Advantage). Hera verifies eligibility during a free consultation — no paperwork required from you.

Medicare Part B covers chronic care management services. 90% of Hera clients pay $0 out of pocket.

If your parent has Medicaid or a Medigap supplement plan, the standard 20% coinsurance is typically covered — meaning no cost to you. Hera verifies your parent's coverage during the complimentary consultation. There are no hidden fees or contracts.

Medicaid doesn't directly pay for CCM, but it covers the coinsurance.

Medicare Part B is the primary payer for chronic care management. For patients who are dual-eligible (both Medicare and Medicaid), Medicaid covers the 20% coinsurance — which is why most Hera clients pay $0. Your Hero can also help with Medicaid applications if your parent isn't enrolled yet.

Private geriatric care managers typically charge $150–$300 per hour, with initial assessments running $500–$1,500+.

Monthly retainers of $500–$2,000+ are common. Most of this is out of pocket — private geriatric care management is rarely covered by insurance. Through Hera, you get the same coordination from licensed geriatric social workers and nurses, covered by Medicare. 90% of our clients pay $0.

Not directly — but Medicare does cover care management through the Chronic Care Management (CCM) program, which provides the same services.

Traditional private geriatric care managers charge $150–$300/hour out of pocket. Through CCM, Medicare covers a dedicated care manager for patients with 2+ chronic conditions. Hera provides this service — 90% of clients pay $0.

Medicare Secondary Payer (MSP) means Medicare pays second when your parent has another form of insurance that should pay first.

This happens when a senior has employer-sponsored coverage, workers' compensation, or certain other insurance. Medicare coordinates with the primary payer to cover remaining costs. It can be confusing — your Hera Hero handles all insurance coordination so you don't have to figure out which plan pays for what.

Original Medicare generally does not cover routine transportation, but Medicaid does in most states.

Medicaid covers non-emergency medical transportation (NEMT) to doctor appointments, dialysis, and other healthcare visits. In New York, Access-a-Ride and Medicaid transportation services are available. Your Hera Hero can arrange transportation through these programs and help your parent access rides they're entitled to.

Medicare is federal health insurance based on age (65+) or disability. Medicaid is state-run insurance based on income and assets.

Many seniors qualify for both — this is called dual eligibility, and it's the most powerful combination. Medicare covers doctors and hospitals. Medicaid fills the gaps: long-term home care, personal care aides, transportation, and some medications. Your Hera Hero can determine what your parent qualifies for and handle enrollment.

Yes — and if they do, they may pay $0 for almost all of their healthcare.

This is called dual eligibility. Medicare covers medical care and Medicaid covers the cost-sharing (premiums, copays, deductibles) plus additional services like home care and transportation. Hera's Heroes help families determine dual eligibility and handle the Medicaid application process from start to finish.

A standard Medicaid application in New York takes 30–45 days, but can take longer if documentation is incomplete.

The process involves gathering financial documents, proof of residency, and medical records. Denials and requests for additional information are common and add time. Your Hera Hero handles the entire application — gathering documents, submitting forms, following up with the county office, and appealing if denied.

No. Medicare does not cover assisted living facilities.

Assisted living is almost entirely out of pocket — averaging $6,500–$12,000+ per month in New York City. Medicaid may cover some assisted living costs, but only after a family spends down assets to qualify. What Medicare does cover: care management for seniors aging at home. Through programs like CCM, your parent can get a dedicated care manager at $0 — helping them stay safely at home longer.

Assisted living in New York City averages $6,500–$12,000+ per month depending on the level of care.

Memory care adds another $1,000–$3,000 per month on top of that. These costs are almost entirely out of pocket — Medicare doesn't cover assisted living, and Medicaid coverage requires spending down assets. For families exploring alternatives, Medicare-covered care management through Hera helps seniors age safely at home at $0 for 90% of clients.

Medicare-covered care management is often the most affordable starting point — 90% of Hera clients pay $0 out of pocket.

Beyond care management, Medicaid-covered home care aides, community programs (SNAP, HEAP, SCRIE), and Medicare home health services can significantly reduce costs. The challenge is knowing what your parent qualifies for. Your Hera Hero reviews your parent's full financial and insurance picture and connects them to every benefit available.

Yes — for eligible patients, Medicare covers care coordination through its Chronic Care Management (CCM) program. To qualify, your parent needs Original Medicare and two or more chronic conditions expected to last at least 12 months. At Hera, 90% of clients pay $0 out of pocket because Medicaid or Medigap plans cover the remaining coinsurance. Private care coordination (through independent geriatric care managers) is typically not covered by insurance and costs $150–300 per hour.

Yes, with an important distinction. Medicare covers palliative care services when they're provided alongside curative treatment — this means your parent can receive pain management, symptom relief, and supportive care while still pursuing treatment for their condition. This is different from hospice, which requires a terminal diagnosis and the decision to stop curative treatment. Medicare Part B covers palliative care consultations, and if your parent is enrolled in a care management program, their Hero coordinates palliative services with their existing care team.

Medicare covers a wide range of services that many families don't know about. Beyond hospital stays and doctor visits, Original Medicare covers chronic care management (a dedicated coordinator for seniors with two or more chronic conditions), home health services (skilled nursing, physical therapy, and occupational therapy in the home), durable medical equipment (walkers, wheelchairs, hospital beds), and preventive care (annual wellness visits, certain screenings). Medicare does not cover long-term custodial care, assisted living, or most home aide services (bathing, dressing, meal preparation). However, a care manager can often help families access Medicaid or state programs that do cover these services.

Medicare does not cover memory care facilities. Memory care is classified as custodial care, which Medicare explicitly excludes. In New York City, memory care costs $8,000–$15,000+ per month out of pocket. Medicaid may help cover costs, but typically only after a family spends down assets to qualify.

What Medicare does cover: care management for seniors with dementia living at home. Through Chronic Care Management, your parent gets a dedicated Hero who coordinates neurologist visits, manages medications, arranges specialized day programs, and helps navigate Medicaid applications for home attendant coverage — at $0 for most families.