Understand the differences between Medicare and Medicaid and find out if you can qualify for both.
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Have you wondered about the difference between Medicare and Medicaid? They’re very different programs. Although both are government-run and federally funded health insurance programs, the similarities end there. Medicaid benefits are available if you have low income, while Original Medicare eligibility kicks in when you turn 65 or have a qualifying disability.
If you are below the federal poverty level, a Medicaid plan can be an essential resource for covering medical expenses that Medicare does not. But not everyone can qualify for Medicaid, so you can enroll in Original Medicare when you reach retirement age.
Both federal programs are designed to offset the costs of medical services. Medicaid offers additional coverages that Medicare does not. If you’re “dual eligible,” you can qualify for Medicaid and Medicare and get coverage from both.
Learn more about the differences between Medicaid and Medicare.
|Who qualifies||Adults 65 and up or younger people with qualifying disabilities||People with low income who meet state eligibility|
Hospital and medical insurance
Options for adding prescription drug coverage and other benefits
Secondary coverage if you have Medicare
Major medical insurance
Additional services, such as nursing home care, personal care, dental, vision, and hearing
|What it costs||
Part A is free for most people
Premiums are required for Parts B, C, and D.
|Free or low cost|
Although they sound similar, Medicare and Medicaid aren’t the same. The only similarity is that both government run programs help cover medical expenses for low income Americans.
“Medicaid is designed for people that fall into a certain income bracket while Original Medicare is for elderly people over 65 or for those that have been on disability for two years,” explains Grant Dodge, a broker at Health Benefits Associates Inc., in Reno, Nevada.
Medicaid doesn’t have an age requirement, so adults of all ages and dependent children can enroll. In 2021, there were 75.4 million people covered with Medicaid. Medicaid plans are administered by the states but funded jointly by the state and federal government. Medicare is a federal program managed by the United States Centers for Medicare and Medicaid Services (CMS). The U.S. Social Security Administration (SSA) handles Medicare enrollment and premium payments. You must be over 65 unless you’ve been on disability for 24 months or have specific medical conditions. “Once you have both parts of Medicare from the federal government (Part A and Part B), you can sign up for additional coverage with private insurance companies to fill in the gaps of Medicare,” explains Dodge. This is also called a Medicare Supplement plan, a Medigap plan.
Both federal programs are crucial in helping low income Americans afford medical expenses. Medicaid benefits are based on financial need and are more widely available for people of all ages. It also provides more complete coverage than Original Medicare, as it pays for some drugs and additional services such as nursing home care, personal care, dental, vision, and hearing. If you don’t meet your state’s Medicaid eligibility, Medicare is a significant government benefit if you qualify.
In some cases, you can be eligible for both Medicaid and Medicare ― it’s referred to as “dual eligible.” With both Medicare and Medicaid coverage, the programs will work together to cover practically all of your health expenses.
For those who qualify for both, Medicare provides health coverage first. Medicaid pays second for anything that isn’t covered. Medicare can cover your Part D prescription drugs while Medicaid may cover prescription drug coverage and other care not covered by Medicare.
Some states have a Medicare-Medicaid Plan (MMP) which coordinates your Medicare and Medicaid benefits. Depending on your eligibility, you may qualify for a Dual Special Needs Plan (D-SNP) with some state-covered health care costs.
Just because you’re eligible for one doesn’t mean you qualify for the other. “Medicare status is determined by age or disability while Medicaid status is determined by income,” says Dodge. “It is important to check both since you may qualify for better benefits and reduced out-of-pocket expenses if you do.”
It’s free to sign up for Medicaid, and coverage is typically free or low cost. If you have both Medicare and Medicaid, it’s possible to find a plan through private health insurance companies with no premiums and little to no out-of-pocket expenses at the doctor, says Dodge. “These plans also typically cover extra services like dental, vision, and hearing aids,” he adds.
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans (also called Medicare Part C).
Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.
He’s passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.