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What is the Difference Between Medicare and Medicaid?

Medicare is a federal program that provides individuals with health coverage if you are 65 years of age and older or have a disability. Becoming eligible has nothing to do with your income. Medicare consists of four different parts: Part A, Part B, Part C and Part D.

Medicaid is a state and federal program that provides health coverage for low-income families and/or individuals. Each state sets the rate of payment for services, establishes its own eligibility standards, determines the type, amount, duration, and scope of services, as well as administers its own programs.

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What is Dual Eligibility?

People who qualify for both Medicaid (supports low-income individuals and families) and Medicare Part A/Part B are known as dual eligible. What does this mean? It means that you may qualify for benefits that are run through the state called “Medicare Savings Programs.” These programs provide coverage for certain premiums, copays, and deductibles. The benefits ultimately depend on an individual’s income level and Medicare Savings Program, but sometimes Medicaid can cover all out-of-pocket expenses. Individuals who qualify for the Qualified Medicare Beneficiary (QMB) Program may qualify for the Extra Help Prescription Drug Program.

When dual eligible individuals receive Medicare and Medicaid benefits, some can vary by state. To learn more about what benefits your state covers, click here.

Dual eligibility can also be categorized as “full-benefit” or “partial-benefit.” Full-benefits mean that the individual would receive full coverage of Medicaid benefits. However, those with partial-benefits do not receive the full Medicaid services, but Medicaid will cover their Medicare premiums.

Dual Eligible Beneficiaries

Dual eligible beneficiaries are individuals who are currently enrolled in both Medicare and Medicaid. These individuals are enrolled in Medicare Part A and/or Medicare Part B and receive full Medicaid benefits or assistance with Medicare premiums or cost sharing.

Individuals receive these benefits and assistance through one of these Medicare Saving Programs:

  • Specified Low-Income Medicare Beneficiary (SLMB) Program – Helps pay for Medicare Part B premiums
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  • Qualified Medicare Beneficiary (QMB) Program – Helps pay for Medicare Part A and Part B premiums, coinsurance, deductibles and copays
  • Qualified Disabled Working Individual (QDWI) Program – Pays Part A premiums for individuals who are disabled and working
  • Qualifying Individual (QI) Program – Helps pay for Medicare Part B premiums
 
  • To learn more about Medicare Extra Help for Prescription Drug Plans, click here.
  • To learn more about Medicare Part A and Part B, click here.

1Featured Dual Eligible Resources 2017 3-2013 13-Total 225- Sort by Relevance | Sorting by Date-March Brief-August Sheet-2017 Infographic 8-June Brief-February Brief-2016 Report 1-December Brief-November Sheet-September Brief-September Brief - www.kff.org/tag/dual-eligible/

 

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About e-TeleQuote and easyMedicare.com

e-TeleQuote Insurance, Inc. the owner and operator of easyMedicare.com, is an independent digital insurance agency providing consumers the ability to purchase Medicare insurance from the comfort of their homes. The company diligently researches available plan options from multiple insurance carriers, helping consumers choose a plan that best suits their needs. e-TeleQuote provides consumers personal consultation through experienced licensed insurance agents who suggest plan coverage options based on a customer’s particular needs. The company has proudly served tens of thousands of consumers across the United States.