Medicare and Medicaid are both government-funded healthcare programs, but there are some important differences between the two. In this blog post, we will discuss the key differences between Medicare and Medicaid. We will also explain how each program works, and who is eligible for coverage. By understanding the difference between Original Medicare and Medicaid, you can make the best decision for your healthcare needs!
Little But Big Differences
In the United States, there are currently two government-provided health insurance policies that citizens can enroll in Medicare and Medicaid.
While they both provide general health insurance benefits, there are eligibility difference between original medicare and medicaid and coverage that are crucial to identify and be aware of. The largest being that Medicare is available to adults who are over 65 years old. Medicaid is only available to low-income families.
Medicaid is usually cheaper than Medicare. It provides those who are near or below the poverty line with free or low-cost coverage. In contrast, Medicare is open to all income levels and usually costs a few hundred dollars per month.
Medicare and Medicaid are both health insurance programs offered to U.S. citizens and permanent residents. However, there are two key differences between the two programs: coverage and the types of services that are eligible for reimbursement.
Understanding Coverage
In general, Medicaid is a more comprehensive health insurance policy. It has a single plan providing broad coverage across medical, hospitalization, and prescription drug needs. There are some states, Medicaid also covers vision and adult dental.
In contrast, Medicare is made of several parts, each providing different coverage. Original Medicare, which includes Parts A and B, has many gaps in coverage that can be filled if you are willing to purchase additional Medicare plans such as Part D or Medicare Advantage.
But the most notable coverage difference between original medicare and medicaid is that only Medicaid covers long-term care such as nursing homes.
What is Original 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.
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. 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.
Medicare Advantage
Medicare Advantage, or Part C, is a newer health insurance policy that groups together all the parts of Original Medicare. Plans set their deductibles and out-of-pocket maximums. They will usually provide additional coverage benefits such as dental, hearing, and prescription drugs.
It is important to note that when comparing difference between original medicare and medicaid, Medicare Advantage policies are offered through private health insurance companies such as UnitedHealthcare and Aetna and are not provided by the government. This gives you the ability to compare policies between providers and find the best Medicare Advantage policy that will fit your situation.
You Can Be Covered By Both
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 F, which is offered by private health insurance companies.
If you have questions on what you may qualify for. Please reach out we would be glad to help you.