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Medicare vs Medicaid

The two terms can easily cause confusion amongst Americans, but is there a major difference? The answer is yes.

Medicare

What is Medicare?

Medicare is a federal health insurance program for people who are:

  • 65 years of age or older
  • Under 65 years of age with disabilities
  • Of any age that have End Stage Renal Disease (ESRD) or ALS

Who Governs Medicare?
The Federal Government

How Much Does Medicare Cost?
It all depends on which plan coverage you choose. Costs may include deductibles, premiums, copays and coinsurance.

What Does Medicare Cover?
Depending on the Medicare coverage you choose, it may include:

  • Care and services (inpatient) in a hospital or skilled nursing facility (Part A)
  • Doctor visits, care and services (outpatient), and possible preventative care (Part B)
  • Prescription Drugs (Part D)

Medicare Advantage (Part C) plans will combine both Medicare Part A and Part B, and often include prescription drug (Part D) coverage as well - all together in one plan.

Am I Eligible for Medicare?
Once you turn 65 years old, you are most likely eligible for Medicare Part A. To confirm that you are eligible for Medicare, contact your local Social Security office for more information.

What is Medicaid?

Medicaid is a federal and state program that helps pay health care costs for individuals and/or families with low assets and incomes.

Medicaid

Who Governs Medicaid?
The Governments of Individual States

How Much Does Medicaid Cost?
It all depends on your current income and specific rules of the state that you are living in.

What Does Medicaid Cover?
Each state has different Medicaid programs that follow the federal structure. There are mandatory benefits as well as optional benefits. These are the mandatory benefits:

  • Care and services received in hospital or skilled nursing facility
  • Care and services received in a federally-qualified health center, birth center or rural health clinics
  • Doctor, certified pediatric, nurse, midwife, family nurse practitioner services and more

Am I Eligible for Medicaid?
Each state is different when it comes to eligibility. You can call your local Medicaid office to see if you qualify for coverage.

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.

  • To learn more about Dual Enrollment, click here.
  • To learn more about Medicare Extra Help, click here.
  • To learn more about Medicare Part A and Medicare Part B, click here.
  • To learn more about Medicare Advantage Plans, click here.