Medicare vs Medicaid

Medicare is a government healthcare program for those with disabilities or based on age. Medicaid is also a government program that instead offers financial support.

What is Medicare?

Simply put, Medicare is a federal health insurance option for those eligible. Compared to other fully-privatized options, Medicare has lower prices for better coverage, though you do not have to enroll even if you’re eligible.

There are 5 main categories of Medicare—Parts A, B, C (Advantage), D, and supplements. Each of these plans functions differently, with various benefits and price points. The most basic coverage that you must have before any of the other options, however, are Parts A and B.

Original Medicare (Parts A and B) only charge a set monthly premium, yearly deductible, and certain out-of-pocket copayment and coinsurance fees. Most people even qualify for premium-free Part A.

The other plans (C, D, and supplements) will vary based on the insurance provider you purchase from. While they are all regulated by the government (meaning that prices are kept at a reasonable level and enough benefits are provided), particular factors may vary. You can choose one or more of these plans to either complement or replace your Original Medicare plan.

What is Medicaid?

Similarly, Medicaid is also a federal program—instead of medical insurance benefits, however, it provides financial help. Individual states will establish the exact benefits offered through the program, but these are some of the most common plans, services, etc.:

  • Alternative Benefit Plans
  • Autism Services
  • Behavioral Health Services
  • Dental Care
  • Early and Periodic Screening, Diagnostic, and Treatment
  • Hospice Benefits
  • Mandatory & Optional Medicaid Benefits
  • Prevention
  • Telemedicine

Medicare Eligibility

Not everyone who qualifies for Medicare will also qualify for Medicaid—eligibility, then, is one of the biggest, most important differences between the two.

More often than not, people qualify for Medicare based on their age. At 65 years old, everyone regardless of health and financial status is eligible for Medicare. And, if you have worked at least 10 years while paying Social Security taxes, you will be automatically enrolled, and be eligible for premium-free Part A.

You can also get Medicare under age 65 if you have End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS). And, if you have received Social Security Disability benefits for at least 24 months, you can also enroll.

Medicaid Eligibility

You can also be eligible for Medicaid if you are enrolled in Medicare, regardless of age. Medicaid eligibility is based on your Modified Adjusted Growth Income (MAGI). While eligibility varies across states, the government has some mandatory groups that must be considered eligible in all states. Here are three:

  • Low-income families
  • Qualified pregnant women and children
  • Individuals receiving Supplemental Security Income (SSI)

Medicare and Medicaid Together

You can have Medicare and Medicaid together. If you are eligible for both, you can enroll in what is referred to as a Dual-Eligible Special Needs Plan (D-SNP). Medicaid beneficiaries are likely familiar with these terms—you are eligible for a D-SNP if:

  • You receive Full Medicaid benefits
  • You are a Qualified Medicare Beneficiary (QMB) without other Medicaid (QMB Only)
  • You receive QMB Plus
  • You are a Specified Low-Income Medicare Beneficiary (SLMB) without other Medicaid (SLMB Only)
  • You receive SLMB Plus
  • You are a Qualifying Individual (QI)
  • You are a Qualified Disabled and Working Individual (QDWI)

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