Medicare Vs. Medicaid: What to Know

Medicare and Medicare are two federal medical care programs that provide health insurance for all Americans who meet the specified criteria. The programs may seem similar, but they can’t be more different. The eligibility requirements, the application process, and policies vary vastly between the two programs.

It’s essential to understand the ins and outs of each program to choose one that best fits your needs and take full advantage of the coverage available to you. Today we present everything you need to know about Medicare and Medicaid and how each program works. So if you’re interested in learning more – stick till the end to find out.

What’s the most significant difference? 

The most significant difference between Medicare and Medicaid is that the coverage provided by both programs doesn’t target the same groups. Medicare is an individual insurance plan that doesn’t cover families. In contrast, Medicaid is an assistance program that provides coverage to eligible low-income families that extends to women, the elderly, children, and anyone with disabilities.

Can you qualify for both?

Dual eligibles are those who meet the requirements for both Medicare and Medicaid. Having both Medicare and Medicaid will likely cover all of your medical expenses. You can use Medicaid to pay for services and medications that Medicare does not cover and vice versa.

Although different rules and regulations police each program, it’s possible to qualify for both. For example, veterans are eligible for Medicare and Medicaid and can get financial assistance for rare cancers like peritoneal mesothelioma caused by asbestos exposure.

What is Medicare?

Medicare, a government-funded insurance program, provides medical coverage and financial assistance. The program provides coverage in parts A, B, and C. A and B are called Original Medicare, with part C being Medicare Advantage.

• Part A covers hospitalization costs, including inpatient, emergency, and hospice care.
• Part B covers copays for emergency outpatient care.
• Part C combines the coverage of parts A and B into one comprehensive insurance policy for Medicare recipients. It offers benefits beyond those of Original Medicare.

What is the eligibility criterion for Medicare?

Medicare is for U.S citizens over the age of 65 who have trouble affording health care services. This program provides financial coverage for medical treatment for seniors and their family members with medical needs. Medicare coverage also extends to the vast majority of Social Security recipients.

The eligibility criteria include the following:

• U.S citizen or permanent resident of the U.S.
• Senior citizens over the age of 65. 
• Individuals younger than 65 with documented disabilities.
• Individuals in the last stages of Renal disease.
• Individuals eligible for Social Security: widow or widower over 50.
• Child of a government employee who paid medicare taxes and was in service for several years.

The number of years of Medicare tax payments counts toward qualifying for lower premiums and coverage options.

What does Medicare cover?

Original Medicare covers everything from part A: hospitalization and hospice care to part B: outpatient and mental health services. However, it doesn’t provide coverage for vision, hearing, or dental services or covers prescription medications. There’s also a part D of Medicare that you can opt for to cover prescription costs.

As for Medicare Advantage, it has all the benefits covered by Original Medicare and more. It includes dental and vision insurance, hearing aids, and wellness programs. However, these benefits differ from one plan to another.

How to apply?

You can apply for Medicare as early as three months before turning 65. The average waiting period before coverage begins is exactly a month after you sign up. 

You can sign up by calling the Social Security hotline during the application timeline from 8 a.m to 7 p.m. or submit a digital application online at SSA.gov. You can also apply in person by visiting your local Social Security office.

What are the costs?

People eligible for Medicare coverage must pay for medical expenses via deductibles, such as hospitalizations. In addition, Medicare requires low monthly payments for medical costs incurred outside of hospitals, such as doctor’s visits and preventative treatment. Some expenses, such as the cost of medication, may be the patient’s responsibility.

What is Medicaid?

Medicaid is a federal-state partnership that provides medical coverage to low-income individuals and families. Anyone who meets the eligibility criteria can qualify for the program based on their income bracket and assets. The program covers major medical procedures, treatments, and preventative care services. The coverage extends to seniors, children, pregnant women, and special-needs individuals.

What is the Eligibility criterion for Medicaid?

In thirty-nine states (counting Washington), people under 65 falling under the income bracket of 138% of the poverty threshold qualify for coverage. In addition, pregnant women or individuals with disabilities with higher incomes can be eligible for the program in these states.

For the other twelve states, you are only eligible for coverage if you’re a parent, pregnant, or have a qualifying disability. Regardless of how low your income is, if you are an adult without children, special needs, or pregnancy, you won’t qualify for the benefits.

What does Medicaid cover?

By federal regulations, all insurance plans offer certain benefits regardless of the state, including coverage of inpatient, outpatient, emergency, laboratory, and hospice care, routine medical checkups, and emergency medical transport. 

States may also provide the following benefits: prescription meds, mental health services, treatment for breathing problems, optometric and dental care, and treatment of communication disorders.

How to apply?

You can apply for coverage through your state Medicaid agency or the official website at www.healthcare.gov. You can apply and enroll at any time during the year.

What are the costs?

Most of the time, Medicaid recipients pay nothing for approved expenses, but in rare instances, they may be required to make a modest copayment. The federal government will cover most expenses, while states may collect minimal premiums and signup fees. It applies to the following:

• Individuals with income below 150% of the national poverty threshold, except pregnant women and children.
• Individuals with special needs with income above 150% of the national poverty threshold.
• Employed individuals with special needs under the 1999 work incentives act.
• Individuals with medical needs.

Bottom line

Medicare and Medicaid are federal insurance programs that make health care accessible to vulnerable communities and individuals. However, they target different groups. For example, Medicaid’s eligibility focuses on individuals who fall under the low-income bracket. In contrast, Medicare provides insurance coverage to seniors and those with special needs. We hope you found this article helpful. Consider the above-discussed points to choose a program that best fits your needs.