Medicare and Medicaid are two government-run health insurance programs that offer coverage to different age groups. Medicare is available for people who are 65 or older. Medicaid is available for low-income adults, children, pregnant women, and people with disabilities. In this blog post, we will discuss Medicare vs Medicaid in more detail!

What is Medicare?

Medicare is available for Americans who are over the age of 65 or younger citizens who have been diagnosed with a disability or illness. Some qualifying medical conditions include Lou Gehrig’s disease (ALS) or end-stage renal disease (ESRD).

It is key to note that eligibility for Medicare is not based on your income.

For most U.S. citizens, during their working years, they would have paid a tax into the Social Security fund. By paying into this pool of tax dollars, you can enroll in the Medicare plan when you turn 65.

However, this would only enroll you in Medicare Part A, which provides coverage for hospital care and nothing else. Therefore, you would need to select and purchase one of the many other parts of Medicare so that you would have a comprehensive plan.

Original Medicare

Whats the differences between Medicare vs Medicaid ? Good question. Individuals who want Original Medicare will usually enroll in Part A and then can choose to purchase Part B and Part D for an additional low-cost monthly premium. Most individuals do opt to purchase since there are penalties for late enrollment.

Part B provides coverage for doctors, medical tests, and some procedures, while Part D is designed to offset the costs of prescription drugs. By enrolling in Medicare Parts B and D, an individual can get closer to having a comprehensive health insurance policy.

What is Medicaid?

Medicaid is a federal and state health insurance program designed to be available for low-income Americans. To be eligible for Medicaid coverage, you would need to have an income level below the state’s threshold, which is 138% of the federal poverty line in states with expanded Medicaid.

In these states, you can qualify for Medicaid if you’re an individual who earns less than $18,754 or a family of four who earns less than $38,295.

Income eligibility criteria vary by state and by condition, such as having a disability or being pregnant. Find out if you meet the eligibility criteria in your state by using the income calculator at Healthcare.gov.

Here you can input your estimated income and find out whether you qualify. This is based on the number of individuals in your household. As you will see, when the number of dependents in your household increases, the income threshold for Medicaid will increase as well.

Can You Be Covered By Both Medicare and Medicaid?

It is possible to be eligible and covered by both Medicare and Medicaid. Within health care, it is known as being “dual eligible.” Typically, these individuals will be enrolled in Original Medicare but receive subsidized Medicaid benefits through Medicare Savings Programs such as the:

• Qualified Medicare Beneficiary (QMB) Program
• Specified Low-Income Medicare Beneficiary (SLMB) Program
• Qualified Disabled and Working Individual (QDWI) Program

All of these programs would provide extra help for covering premiums, deductibles, and coinsurance for Medicare.

If you don’t qualify for Medicaid when you are enrolled in Medicare, there are still options to help provide financial aid for Part A, B, and D deductibles. This would include enrolling in a supplemental Medigap policy such as Medicare Part G, which is offered by private health insurance companies.

How Do You Qualify For Both Medicare and Medicaid?

To be dual enrolled in both Medicare and Medicaid, you must meet the income criteria of your state’s Medicaid program while also meeting Medicare’s criteria of being age 65+ or having a qualifying disability.

Medicare Advantage

Medicare Advantage plans are an alternative to Original Medicare. These plans, also known as Part C, are offered by private health insurance companies. They must provide at least the same level of coverage as Original Medicare. In many cases, these plans will offer additional benefits such as dental, vision, and prescription drug coverage.

It’s important to note that you cannot have both Original Medicare and a Medicare Advantage plan. If you enroll in a Medicare Advantage plan, your coverage will be through the private insurance company. These plans will not go through the government.

You can learn more about how to compare original Medicare vs a Medicare Advantage Plan by using Medicare’s Plan Finder tool. Or Simply give us a call at 1-800-339-4112