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  7. What’s the Difference Between Medicare and Medicaid?

What’s the Difference Between Medicare and Medicaid?

Medicare and Medicaid are two phrases that are regularly used in discussions about health insurance coverage. Many individuals appear to use them interchangeably, despite the fact that the two programs are fully distinct. Medicare is a health insurance program, whereas Medicaid is a public assistance program. Therefore, what are the distinctions between the two? Several significant distinctions include qualifying conditions and coverage fundamentals. Continue reading to learn more about each program, what it covers, how to apply for either, and the significant distinctions between the two. Additionally, we’ll explain what to do if you qualify for both programs. Let we begin.

How Are Medicare and Medicaid Differ?

To begin, let us examine the programs’ underlying structure. Medicare is a federally financed program that provides health insurance coverage to those 65 years of age and older, younger disabled individuals, and people undergoing dialysis treatment. The program’s history demonstrates that the majority of people obtain health care coverage through their employment, and that following retirement, individuals were unable to obtain adequate coverage on their own. As a result, Medicare was established to assist in bridging this divide and providing coverage for those folks. The same is true for disabled individuals who are no longer able to work.

Medicaid, on the other hand, is a federal-state partnership program. As a result, when individuals inquire about how Medicaid is supported, the answer is that both the federal and state governments contribute to its funding. While each state has the authority to establish its own Medicaid laws, there are some similar characteristics across all states. Medicaid’s overall goal is to assist in providing healthcare to individuals and families in financial need, regardless of age. This is in accordance with Medicare, which assists seniors regardless of their financial level. Let’s look at the eligibility conditions for each program in greater detail.

Medicare has no eligibility limitations based on income. Medicare eligibility can be accomplished in one of three ways. To begin, by age alone. Individuals 65 years of age and older are eligible for Medicare. Additionally, if the Social Security Administration has determined that you are disabled, you may qualify for Medicare. There is normally a 24-month waiting period between the start of your disability and the start of Medicare coverage. Finally, those with end-stage renal disease (ESRD) or who are on dialysis are immediately eligible for Medicare.

To be eligible for Medicaid, an individual or family must earn less than 138 percent of the federal poverty threshold (about $14,500 for individuals and $29,700 for a family of four). Each state has its own set of rules regarding precise eligibility criteria, but low income is the primary criterion. Numerous states have recently increased Medicaid eligibility, so even if you have previously been denied, you might try reapplying if you believe you qualify.

Another significant distinction between these two programs is the premium and service costs. Due to the fact that Medicaid is a needs-based program, there are no premiums. Health care services are frequently offered at no cost to the recipient. However, in some areas, certain services may demand minor copays or deductibles.

Medicare is only available for persons 65 and older who have accumulated sufficient work credits to qualify. Individuals receiving SSDI benefits and those over 65 with insufficient employment history are typically obliged to pay monthly premiums for their coverage. These Medicare premiums can range from $200 and $450, depending on the individual’s work credits. For the majority of medical procedures, Medicare needs a minimal copayment or deductible.

Finally, the coverage levels of the two programs differ. Original Medicare, or Medicare Part A, provides coverage for hospitalization. It includes hospitalization, inpatient services, hospice care, and care in a skilled nursing facility. Recipients may elect to purchase additional coverage under Part B, Part C, or Part D. Part B expands coverage to include physician appointments, outpatient care, medical equipment, and preventative or wellness care visits. Part C, sometimes referred to as Medicare Advantage Plans, combines Parts A and B into a single policy run by commercial insurance companies under contract with Medicare. Finally, Part D is an optional coverage option for prescription drugs. Many Medicare beneficiaries also choose to purchase a Medicare supplement, or Medigap, coverage plan to assist cover out-of-pocket expenses such as copayments and deductibles.

 

Medicaid provides coverage for a broad range of medical treatments. When you join in Medicaid, you gain access to hospital coverage, doctor visits, X-rays, essential medicine, long-term care, preventative care, mental health treatment, maternity care, and coverage for children’s dental and eye care. If you have any questions about your eligibility or coverage, you should contact the Medicaid office in your state.

Can You Have Medicare and Medicaid at the Same Time?

Yes, you can be eligible for coverage through both programs concurrently. This is referred to as being “dual eligible.” This often applies to individuals over the age of 65 or who are disabled and have a very restricted income. You may still enroll in either Original Medicare or a Medicare Advantage Plan. When a person qualifies for both programs, the majority of their medical expenses are covered in full by one or both of the programs. Generally, drugs are covered by a Medicare Part D prescription drug plan, however Medicaid may pay additional prescriptions or other medical treatments not covered by Medicare.

If you qualify for both government programs, it is often prudent to enroll in both. Enroll in Medicare and Medicaid. When a person enrolls in both programs, he or she often incurs very few out-of-pocket expenses.

What Are Medicare’s Four Sub categories?

Medicare coverage is divided into four components. These are the benefits of Original Medicare, often known as Medicare Part A. Additionally, Medicare Part B, Medicare Part C, and Medicare Part D are available. Each of these sections addresses a distinct aspect of health care expenditures, and each has a different price tag. Let’s take a closer look at each of them.

Part A of Medicare

Additionally, this is referred to as Original Medicare. It is supplied free of charge to individuals 65 years of age who meet the minimum work history requirements. In a nutshell, Part A offers coverage for hospitalization and other long-term care to its participants. Even if your spouse does not have sufficient job credits, you may qualify for premium-free coverage. Part A is comprised of the following categories of items:

  • Hospital inpatient care
  • Professional nursing care in skilled nursing facilities
  • Palliative care
  • Health care at home
Part B of Medicare

Part B is comparable to a regular health insurance plan in terms of physician visits and outpatient services. Part B includes optional benefits for which a monthly premium may be paid. A person registered in Part A is not required to obtain Part B coverage. Part B discusses the following:

  • Visits by a physician Outpatient services
  • Orthopedic treatment (outpatient)
  • Visits to the wellness center
  • Medical gadgets or medical equipment that is designed to last a long time
Part C of Medicare

Part C is essentially a synthesis of Parts A and B. Private insurance companies that deal with Medicare provide Part C coverage. You may enroll in a Part C plan if you are eligible for both Parts A and B. Medicare Advantage Plans are also referred to as Part C plans. This enables individuals to consolidate their hospital and standard insurance policies into a single policy, simplifying the process of maintaining and tracking their coverage and spending.

Part D of Medicare

Prescription medications are covered under Part D. This includes recommended vaccinations and injections. As with Parts B and C, Part D is administered by private insurance firms and is available as an add-on. This can be obtained independently of your other health insurance policies and helps keep medication costs down. If your income is limited, you should contact the Medicare office at Medicare.gov or 1-800-MEDICARE (1-800-633-4227) to inquire about additional services that may assist with health care expenses. Call 1-877-486-2048 if you are using a TTY.

Who Qualifies?

As previously stated, Medicare and Medicaid have distinct qualifying requirements. Medicare eligibility is mostly determined by age, whereas Medicaid eligibility is determined by income. Consider the needs for each.

Medicare eligibility can be accomplished in one of three ways. Income is not a factor in determining eligibility for Medicare services. The following requirements apply:

  • 65 years of age or older
  • Under the age of 65 and disabled
  • Anyone of any age with ESRD (requiring dialysis or kidney transplant)

Medicaid eligibility is a little different. Age is not a significant factor in determining who is eligible for Medicaid. Income is the primary criterion for qualification. Enrollment is open to citizens of the United States of America and lawful, permanent residents who meet the income requirements. If your income and resources are extremely limited, you may qualify if you meet any of the following criteria:

  • 65 years of age and older
  • Pregnant
  • Individuals under the age of 19 who are disabled
  • An adult providing care for a kid
  • Adult who is not a parent (in certain states)

What Is Included?

We’ve already discussed briefly the services that Medicare and Medicaid insurance cover. As previously stated, Medicare is divided into four distinct components, each of which covers a different set of services. For the purposes of this section, we shall assume that a person is enrolled in all four portions of Medicare, or all available coverage. Therefore, let us get into the specifics.

Medicare coverage is fairly thorough for someone who is enrolled in all components of the program. The following is a partial list, but not exhaustive:

  • Hospitalization
  • Visits to the physician
  • Services provided on an outpatient basis
  • Orthopedic treatment
  • Prescription medications
  • Medical supplies
  • Palliative care
  • Professional nursing care in skilled nursing facilities

Medicare does not cover dental or eye treatment. If an individual chooses to participate in those services, they must be acquired outside of the Medicare system. Certain individuals may also be eligible for Medicare Savings Programs, which are state-run programs that assist Medicare recipients with limited financial resources with copays and deductibles.

After learning about Medicare, you’re probably wondering, “How does Medicaid work?” Medicaid, like Medicare, provides substantial coverage. It covers the majority of normal medical services and essentials. Several items are addressed under the program, including the following:

  • Services provided by hospitals
  • Visits to the physician
  • Care throughout pregnancy
  • Mental health treatment
  • Preventive medicine
  • Immunizations and Vaccines
  • Prescription medications
  • Dental surgical services

Unlike Medicare, Medicaid in some jurisdictions does cover routine dental and vision care for children.

 

How Do I Submit an Application?

After learning about the distinctions between the two programs, who qualifies, and what is covered, you’re undoubtedly asking how to apply. To begin, let us discuss Medicare. In many circumstances, enrollment in Original Medicare (Part A) is automatic. If you are already receiving Social Security retirement payments and reach the age of 65, you will be automatically enrolled in Medicare. Additionally, you will be automatically registered after receiving SSDI benefits for 24 months. If you do not get retirement benefits, you may enroll for Part A coverage and immediately begin receiving benefits upon payment of the premiums. You can apply for Medicare online or by phone.

If you wish to postpone enrollment, you may do so during the annual Medicare open enrollment period. If you wait too long, you may be required to pay a late enrollment penalty in order to acquire coverage. Additionally, if you wish to apply for Part B, C, or D coverage, you should speak with your insurance company or agent about your alternatives. Due to the fact that these plans are operated by private companies, they each have their own enrollment and price policies.

You can apply for Medicaid either by contacting your state’s Medicaid office or by visiting Medicaid.gov. Your application will be reviewed by a caseworker who will ascertain your eligibility status. Generally, if you get SSI benefits, you are automatically eligible for Medicaid. The Affordable Care Act, which was passed into law in 2010, increased the number of people covered by Medicaid. Therefore, even if you have previously been denied coverage, you should consider reapplying because you may be authorized under the new guidelines.

FAQ

Are Medicare and Medicaid synonymous?

No, these are two unique and separate projects. Medicare is a federal program that supports older adults in obtaining healthcare coverage, whereas Medicaid is a joint federal-state program that assists low-income individuals and families.

Is Medicare A free program?

If you or your spouse have earned enough work credits, you or your spouse will receive free Medicare A coverage. If you lack sufficient job experience, you may choose to acquire this coverage.

Can you have Medicare and Medicaid at the same time?

Yes, you can be “dual eligible” for both programs. Individuals enrolled in both plans are often covered for the majority of medical services and experience low, if any, out-of-pocket costs.

Is there a penalty for failing to enroll in Medicare?

There is no penalty for not joining up, but there may be a penalty if you subsequently decide to sign up. If you miss your automatic enrollment period, you may still enroll during a subsequent enrollment period, but a late registration fee will apply.

How do I obtain a replacement for my Medicare card?

Obtaining a replacement Medicare card is straightforward. You can obtain one by logging onto your Medicare account at Medicare.gov, contacting the Social Security Administration, or visiting your local Social Security Administration office.

Conclusion

Terms associated with Medicare and Medicaid might be scary and perplexing to individuals unfamiliar with the programs. Many people believe that these two programs are interchangeable; nonetheless, they are extremely distinct. These programs vary in terms of cost, scope of coverage, eligibility criteria, and funding. It is even feasible for an individual to be eligible for and enrolled in both programs concurrently. Now that you are aware of the distinctions between these two programs, you can determine your eligibility and whether you should apply for one or both. Educating yourself about accessible programs is the first step in ensuring that you have enough health care coverage and are taking advantage of all available perks.