Many of the clients we help ask us about the difference between Medicare and Medicaid. Both help to cover the cost of healthcare expenses, but they do this in different ways. The differences in eligibility, cost, and coverage are especially important to understand for people who may qualify for both programs.
For most people, Medicare eligibility begins at age 65. Individuals who receive disability benefits can be eligible for Medicare Parts A and B before turning 65. While you can qualify for lower Part B premiums or Extra Help based on your income, it is not a deciding factor in your overall Medicare eligibility.
Medicaid eligibility varies slightly from state to state. For states without expanded coverage, you may be eligible for Medicaid based on factors like limited income, disability, and household size. People living in states with expanded Medicaid coverage can qualify based on their income alone.
Some people are eligible for both Medicare and Medicaid coverage. This isn’t the case for everyone, but dual-eligible individuals sometimes see an overlap in what each program covers. In these instances, Medicare pays first and Medicaid will pay towards any remaining balance. The combination can be especially helpful for people who would otherwise have difficulty paying for their healthcare.
Medicare Part A is provided at no monthly cost when enrollees have worked and paid US taxes for at least 10 years. Other types of Medicare coverage do come with a monthly premium. This monthly cost can depend on your income and the type of coverage you’ve chosen. Like private insurance, Medicare plans also have deductibles. You can easily compare Medicare plans to find coverage that meets your needs and budget.
Because the program is designed for people with limited resources, the cost of Medicaid is generally very low. States make decisions individually on how much Medicaid enrollees must pay in monthly premiums and out of pocket costs for their care. There are also select groups and services that are exempt from out of pocket costs entirely.
Medicare is a federal health insurance program, but the government does not directly provide your coverage. Instead, private insurance carriers offer insurance plans that meet the requirements that Medicare has set. You must apply during a Medicare Enrollment Period to receive coverage.
Medicaid coverage comes from a partnership between the state and federal government. Private insurance carriers do provide coverage for some Medicaid programs, but other programs pay your provider directly. Unlike Medicare, you can apply for Medicaid coverage at any time.
Medicare can cover a variety of hospital, medical, and prescription drug costs. The specific covered services largely depend on the type of plan you’ve chosen. Insurance companies that offer Medicare coverage must meet certain basic coverage requirements, but some offer extra benefits like vision, hearing, and dental. Hospital indemnity insurance is also available to cover expenses you incur during a hospital stay.
Like Medicare, Medicaid programs are federally required to cover certain health expenses. These include hospital services, labs and imaging, and family planning services. States can choose whether to offer additional benefits like prescription drug coverage, physical/occupational therapy, and vision services. Medicaid also covers nursing home and personal care services, something Medicare usually does not.
Just like any other health insurance, simply having coverage doesn’t guarantee you’ll be able to see a particular provider. Doctors are not required to accept Medicare or Medicaid for services they provide. Be sure to confirm that your coverage is accepted by a provider ahead of time to avoid unexpected out of pocket costs.
Senior Insurance Advisors can help at any step in your insurance journey. Whether you’re new to Medicare or have seen your supplement plan rates change, we’re here for you! We’ll listen to the kind of coverage you’re most likely to need and confirm what programs provide the best match for your unique situation. Give us a call or attend an upcoming event to put our expertise to work for your health.
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We are licensed and represent plans and carriers in AZ, CO, IA, KS, MN, MO, NE, SC, SD, TX, and WA. The following disclaimer is for Lancaster county in Nebraska, where we reside.
We do not offer every plan available in your area. Currently we represent 8 organizations which offer 53 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options.Not affiliated with or endorsed by the government or federal Medicare program. Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. By providing the information above, I grant permission for a licensed insurance agent to contact me regarding my Medicare options including Medicare Supplement, Medicare Advantage, Prescription Drug plans.