Short answer: Millions of older Americans qualify for help but aren’t getting it. Data show low enrollment in SNAP, SSI, and Medicare Savings Programs; long waits for home care; and big holes in Medicare (dental, hearing, routine vision, long-term custodial care). Below is what the numbers say — and how to fix it today. National Council on AgingKFFMedicare

The headline finding: many seniors are missing key benefits

• Eligible but not enrolled: NCOA estimates 9 million older adults (65+) with limited incomes are eligible for programs (e.g., SNAP, MSPs, SSI) but not enrolled. Only ~30% of eligible older adults are in SNAP; ~46% are in MSPs; ~49% are in SSI. National Council on Aging Source: National Council on Aging, last checked: September 9, 2025. National Council on Aging
• Medicaid home care access: KFF’s latest survey shows ~710,000 people on HCBS waiting/interest lists in 2024, with an average wait of ~40 months. Seniors/adults with physical disabilities account for about a quarter of those waiting. KFF Source: KFF HCBS waiting lists, last checked: September 9, 2025. KFF
• Poverty context: The Supplemental Poverty Measure (SPM) for 2023 was 12.9% overall; SPM elder poverty is about 14.2%, little changed from 2022 — underscoring persistent need. Social Security remains the largest anti-poverty program. Census.gov+1

Bottom line: The gaps are real and measurable — and fixable with enrollment help and policy tweaks.

What Medicare doesn’t cover (and why that matters)

Original Medicare does not cover:

• Long-term custodial care (help with bathing, dressing, eating) — only short-term skilled care under narrow conditions. Medicare+2Medicare+2
• Most dental (cleanings, fillings, dentures/implants). MedicareCenters for Medicare & Medicaid Services
• Hearing aids and fittings. Medicare+1
• Routine vision eye exams for glasses/contacts. Medicare+1

Why this matters: these are high-cost needs for aging adults. In 2024, national median assisted living reached $70,800/year (+10% y/y). Even with Medicare, many pay out-of-pocket or rely on family — until they qualify for Medicaid. Genworth Financial, Inc.assets.carescout.com

Source: Medicare.gov coverage pages; Genworth/CareScout Cost of Care Survey 2024. Last checked: September 9, 2025. Medicare+4Medicare+4Medicare+4assets.carescout.com

Bottom line: Medicare’s design leaves dental, hearing, routine vision, and long-term care largely uncovered — which is where many seniors slip.

Eligibility vs. enrollment: the big three gaps (SNAP, SSI, MSP) + Extra Help

• SNAP (nutrition): Only about 30% of eligible older adults are enrolled nationally, per NCOA — despite food insecurity and the program’s large impact. (USDA shows 19% of SNAP participants are 60+; seniors are under-represented relative to need.) National Council on AgingEconomic Research Service Source: NCOA & USDA/ERS, last checked: September 9, 2025. National Council on AgingEconomic Research Service
• SSI (income supplement): ~49% of eligible older adults participate — leaving roughly half unserved. National Council on Aging
• Medicare Savings Programs (QMB/SLMB/QI): Only ~46% of eligible older adults enrolled; MSPs pay Medicare premiums and sometimes cost-sharing. Enrollment is historically low due to complex rules. National Council on AgingMACPAC
• Extra Help (Part D LIS): Since Jan 1, 2024, full Extra Help extends up to 150% FPL (with resource limits). Many who had partial LIS were moved to full automatically, with $0 premium, $0 deductible, and reduced copays. (HHS estimated ~300,000 would newly benefit from full LIS.) Centers for Medicare & Medicaid Services+1 Source: CMS/HHS fact sheets & memos, last checked: September 9, 2025. Centers for Medicare & Medicaid Services+1

Bottom line: Complexity + lack of awareness are keeping millions from food aid and help with Medicare costs — even after helpful LIS changes in 2024.

Medicaid & long-term care: HCBS access, duals, and the unwinding effect

• Who pays for long-term care? Not Medicare — Medicaid is the primary payer for long-term services and supports (LTSS), especially home- and community-based services (HCBS). KFF
• Waiting lists remain large: In 2024, ~710,000 people were on HCBS waiting/interest lists; average wait ~40 months. Seniors/adults with physical disabilities make up roughly 24% of those waiting. KFF
• “Unwinding” risk for older adults: As states re-checked Medicaid eligibility post-pandemic, millions lost coverage at least temporarily; dual-eligible older adults reported lost Medicaid, exposing gaps (e.g., dental, long-term services) that Medicare doesn’t cover. KFFJAMA Network

Source: KFF Medicaid/HCBS analyses; JAMA Health Forum on dual-eligible experiences, last checked: Sept 9, 2025. KFFJAMA Network

Bottom line: Access to care at home hinges on Medicaid capacity — and many wait years.

Housing assistance: only 1 in 4 eligible households get help

• Longstanding evidence shows federal rental assistance reaches ~1 in 4 eligible households due to funding limits; seniors are a large and growing share of HUD-assisted households. Center on Budget and Policy PrioritiesUrban Institute Source: CBPP & Urban Institute using HUD data, last checked: Sept 9, 2025. Center on Budget and Policy PrioritiesUrban Institute

Bottom line: Even with stable housing, health and care access improve — but supply constraints leave many seniors unserved.

Why seniors fall through the cracks (the mechanics)

1. Awareness & stigma: Many don’t know they qualify or avoid applying. (NCOA documents chronic under-enrollment.) National Council on Aging
2. Complex paperwork & tech barriers: Multi-step, online-heavy processes; variation by state/plan. (GAO cites fragmentation/overlap across programs.) Government Accountability Office
3. Coverage design gaps: Medicare excludes routine dental/hearing/vision and custodial LTC; MA varies and may use prior authorization, though new federal rules aim to streamline decisions and data sharing. MedicareFederal Register
4. Workforce & capacity: HCBS staffing shortages fuel waiting lists and long delays. KFF

Bottom line: The system is hard to navigate and not all needs are covered — especially long-term care.

Checklist — a 15-minute benefits review for older adults & caregivers

1. Screen for SNAP & SSI: Use your state portal or call local aging services (Area Agency on Aging). If income is tight, apply even if unsure — denials can be appealed. (USDA/ERS/NCOA data show low senior take-up.) Economic Research ServiceNational Council on Aging
2. Check MSPs + Extra Help: If monthly income is at/under ~150% FPL (with modest assets), you may qualify for $0 Part D premium/deductible and help with Part B premiums. Ask your State Health Insurance Assistance Program (SHIP) or apply via your state Medicaid office. Centers for Medicare & Medicaid Services
3. Know what Medicare doesn’t cover: Plan now for dental, hearing, routine vision, and long-term care. Consider MA plans with supplemental benefits or separate coverage; verify networks and prior auth rules. Medicare+2Medicare+2
4. For care at home: Join any applicable HCBS interest list today (earlier = better). Ask about available state plan personal care while you wait. KFF
5. Housing stability: If rent >30% of income, contact your local housing authority about vouchers or senior housing lists; waitlists are long but worth joining. HUD
6. Keep a paper trail: Save notices, explanations of benefits, prior-auth letters, and denials; use appeal rights.

Bottom line: A few calls and forms can unlock hundreds to thousands of dollars in yearly help.

Comparison table — programs, gaps & what to do

Program	What it covers (for seniors)	Known gap	Key data point	What to do now
SNAP	Monthly food benefit	Low enrollment among eligible older adults	Only ~30% of eligible older adults participate (NCOA)	Apply via state SNAP; ask AAA for help. National Council on Aging
SSI	Income supplement for low-income aged 65+ or disabled	~Half of eligible older adults not enrolled	49% enrolled (NCOA)	Apply via SSA; seek legal aid if denied. National Council on Aging
MSPs (QMB/SLMB/QI)	Pays Part B premium (and more for QMB)	Under-enrollment due to complex rules	~46% enrolled (NCOA; MACPAC notes historic low take-up)	Apply at state Medicaid office or through SHIP. National Council on AgingMACPAC
Extra Help (LIS)	Lowers Part D costs	Newly expanded but some still not enrolled	Full LIS up to 150% FPL since 2024; ~$0 premium & deductible	Call plan/SHIP to confirm automatic status or apply. Centers for Medicare & Medicaid Services
Medicaid HCBS	Personal care, adult day, in-home supports	Long wait times	~710k on lists; ~40 months avg wait	Join wait/interest list now; ask about state-plan services. KFF
Housing vouchers	Rent subsidy	Limited slots	Only 1 in 4 eligible households served	Get on local PHA lists; consider senior housing. Center on Budget and Policy Priorities
Medicare (Original)	Hospital/medical	Excludes routine dental, hearing aids, routine eye exams, custodial LTC	Coverage exclusions documented on Medicare.gov	Compare MA/Medigap; budget for uncovered services. Medicare+3Medicare+3Medicare+3

Sources: NCOA; CMS/Medicare.gov; KFF; USDA/ERS; CBPP/Urban. Last checked: Sept 9, 2025. National Council on AgingCenters for Medicare & Medicaid ServicesKFFEconomic Research ServiceCenter on Budget and Policy Priorities

Bottom line: Put your name on lists, apply, and re-check annually — rules and eligibility change.

Policy moves that are shrinking gaps (2024–2027)

• Extra Help expansion (2024): Full LIS up to 150% FPL (with resource limits), auto-upgrades for prior partial LIS — lowers Part D costs for low-income beneficiaries. Centers for Medicare & Medicaid Services
• Prior authorization & data-sharing rules: CMS’ 2024 interoperability/prior authorization final rule sets faster decision timelines (72 hours expedited; 7 days standard) starting 2026, improving transparency for Medicare Advantage, Medicaid, and CHIP plans. Federal Register
• HCBS visibility: KFF shows states will have to report waiting lists under new access rules starting 2027, improving accountability. KFF

Bottom line: Recent federal changes help, but on-the-ground enrollment assistance and funding remain decisive.

Sensitive facts & citations (quick references)

• NCOA gap (9M eligible not enrolled; SNAP ~30%, MSP ~46%, SSI ~49%) — Source: NCOA, last checked Sept 9, 2025. National Council on Aging
• HCBS wait/interest lists ~710k; avg wait ~40 months (2024) — Source: KFF, last checked Sept 9, 2025. KFF
• Medicare exclusions (dental, hearing aids, routine vision; custodial LTC) — Source: Medicare.gov/CMS, last checked Sept 9, 2025. Medicare+3Medicare+3Medicare+3
• Assisted living cost (2024 median $70.8k; +10%) — Source: Genworth/CareScout 2024, last checked Sept 9, 2025. Genworth Financial, Inc.
• 1 in 4 households receive housing aid — Source: CBPP (HUD data), last checked Sept 9, 2025. Center on Budget and Policy Priorities

Disclaimer

This article is educational and not legal, medical, or financial advice. Program rules change frequently; always verify with official state/federal sources, your plan, and qualified advisors.

Key takeaways

• Millions of seniors qualify for help but aren’t enrolled — especially SNAP, SSI, and MSPs. National Council on Aging
• Medicare leaves big holes (dental, hearing, routine vision, custodial LTC), making Medicaid/HCBS and housing aid critically important. MedicareKFF
• Waits for home care are long (~40 months), and housing vouchers reach only 1 in 4 eligible households. KFFCenter on Budget and Policy Priorities
• Good news: Extra Help expansion (2024) reduces drug costs for more people; new prior auth timelines (2026) may reduce delays. Centers for Medicare & Medicaid ServicesFederal Register

Next steps: Use the checklist to apply now, get on HCBS/housing lists, and book time with SHIP/AAA for one-on-one enrollment help.

FAQs

Why do so many seniors miss benefits they’re eligible for?
Complex rules, multi-agency applications, limited outreach, stigma, and tech barriers. GAO also notes fragmentation across aging services. Government Accountability Office

Does Medicare cover long-term care, dental, hearing aids, or routine vision?
Generally no: custodial LTC, most dental, hearing aids, and routine eye exams are not covered by Original Medicare. Consider MA extras or separate coverage. Medicare+3Medicare+3Medicare+3

How many people are on Medicaid home-care waitlists?
About 710,000 in 2024, with an average wait ~40 months (varies by state and waiver). KFF

What changed with Medicare’s Extra Help in 2024?
Full LIS now extends to 150% FPL (with resource limits); prior partial recipients were upgraded to full, with $0 premium & deductible. Centers for Medicare & Medicaid Services

Are seniors under-represented in SNAP?
Yes. NCOA estimates only ~30% of eligible older adults participate, despite need. National Council on Aging

Why is housing a bottleneck for seniors?
Federal rental assistance reaches only 1 in 4 eligible households; waitlists are common and long. Center on Budget and Policy Priorities