Everything You Need to Know About Medicare and Medicaid

Medicare and Medicaid are two different programs. Besides targeting a specific group of people, each program has specific laws and policies. If you are looking to select between Medicare and Medicaid, it is essential to know the differences to make the right choice.

What’s Medicare?

Medicare is federal health insurance for people who are 65 years or older. Although Medicare is a program designed to help senior citizens access medical care and treatment, young people living with certain disabilities can benefit from the program. For example, people with permanent kidney failure and require dialysis or kidney transplant are eligible for Medicare benefits. 

What’s Medicaid?

Medicaid is a federal and state program that helps low-income households with healthcare costs such as routine medical care, treatment, and hospitalization. Medicaid is designed to help people who do not have other medical coverages and cannot afford medical care.

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1. Cost 

If you are on the Medicare program, you must pay monthly premiums to cover treatment outside the hospital. Although you might have to incur some out-of-pocket costs, such as prescription drugs, you must pay for the program via deductibles for things like hospital stays and other Medicare benefits.
If you are on the Medicaid program, you do not have to pay for any covered expenses. However, sometimes a co-payment is required to access certain services.

2. Eligibility

You must meet certain requirements to enroll in Medicare or Medicaid. 

• Medicare 

Age is the primary factor used to determine whether one is eligible for Medicare. If you are a citizen or permanent resident of the US and have attained 65 years of age, you can enroll in Medicare. However, your Medicare plan and premiums depend on the number of years you have paid your Medicare taxes. The only exception to Medicare qualification is if you have certain documented disabilities, for example, ERSD. 

• Medicaid

Medicaid eligibility is mainly determined by the level of income and family size. There is a minimum income threshold one should meet to qualify. 

3. Coverage 

• Medicare 

Medicare program has separate parts that cover different healthcare aspects: 

• Medicare Part A (hospital insurance) – if you meet the eligibility requirements and you (or your spouse) have paid Medicare taxes for a minimum of 40 calendar quarters in your life, you qualify for Medicare Part A automatically. Hospital insurance is offered without premiums. Some of the services you can get using Part A include hospital services, home healthcare, nursing care, and hospice services. If you do not qualify for Medicare Part A, you have the option of purchasing it.
• Medicare part B (Medical Insurance) – with this coverage, you can get physician services, outpatient health care, and other medical services covered in ordinary health insurance policies. 
• Medicare Part C –run by private insurers, Part C is also referred to as Medicare Advantage. This program covers all the benefits offered by Medicare Parts A & B. Click Here to Enroll in a Part C Plan!
• Medicare Part D – this has approved plans that help users buy prescription drugs, and avoid Part D penalties. You can find Affordable Drug Plans Here!

• Medicaid 

Medicaid benefits vary from one state to another. However, basic benefits in every program include:

• $0 Copay's
• At Home Care
• OTC Cards
• Transportation

Along with other valuable resources to help if you are low income, Contact Us to See If You Qualify!

4. Disability 

Disabled people and some of their family members are eligible to receive Social Security Disability Insurance benefits. Although this program includes the Medicare insurance program, one may have to wait for at least two years. Remember, to qualify for this program; you must have been working paid your Social Security taxes. 

The Supplemental Security Income program (SSI) includes the Medicaid health program. SSI program makes cash payments to qualifying disabled and limited income people.

Can You Have Both Medicare and Medicaid?

If you qualify for Medicare and Medicaid, you can have both programs, i.e., Medicare Parts A & B. You can have Medicaid to help you cover other drugs and medical care not included in the above named Medicare Parts. If you have serious health problems, having both Medicare and Medicaid can help you reduce medical costs while covering your medical needs.

Now that you understand the main differences between Medicare and Medicaid insurance programs, it is easier to make a decision. Remember, researching online and seeking help from experts can help you make a sound decision, especially if you have severe medical needs. Contact our office, and we can give you our professional advice on your Medicare Coverage and Medicaid eligibility.

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