Trying to understand your healthcare options but still confused about the difference between Medicare and Medicaid?
Medicare is the federal health insurance program for people 65 or older, certain younger people with disabilities, people with End-Stage Renal Disease, (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease). Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits. Medicare Part B (Medical Insurance) helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover.
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare Part D is Prescription Drug Coverage. Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage.
Medicare eligibility starts three months before turning 65 and ends three months after turning 65. Some people get Medicare automatically. The Social Security Administration handles Medicare eligibility and enrollment.
Medicaid is a joint federal and state health coverage assistance program for children, adults, pregnant women, people with disabilities, and seniors who qualify due to low income or other criteria. In all states, Medicaid gives health coverage to some individuals and families, including children, parents, pregnant women, elderly people with certain incomes, and people with disabilities. In some states, the program also covers other adults below a certain income level.
Typically, you must live in the state you apply to and meet your state income and resource requirements. However, some states let you “spend down” the amount of your income that is above the state’s Medicaid limit. You do this by paying non-covered medical expenses and cost sharing (like premiums and deductibles) until your income is lowered enough to qualify you for Medicaid.
If you have Medicare and qualify for full Medicaid coverage:
-Your state will pay your Medicare Part B (Medical Insurance) monthly premiums.
Depending on the level of Medicaid you qualify for, your state might pay for:
- Your share of Medicare costs like deductibles, coinsurance, and copayments.
- Part A (Hospital Insurance) premiums if you must pay a premium for that coverage.
- Medicaid may pay for other drugs and services that Medicare does not cover.
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