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Medicare vs. Medicaid: What Seniors, Loved Ones, and Caregivers Should Know

By Jason Carrasco February 24, 2021 Health and Fitness

Although their names sound similar, Medicare and Medicaid are two different types of healthcare programs offered by the United States government. While both cover healthcare costs, the eligibility requirements for each program are different.

From the government’s perspective, the collective goal is to provide healthcare coverage to American citizens and residents age 65 and older, to those who have a disability (regardless of age), or to low-income individuals and families.

If you fall into any of these categories, depending on which category you fall under, you will want to either enroll in Medicare, Medicaid, or both. Bear in mind, Medicare and Medicaid do not offer automatic enrollment, and each program has different costs, benefits, and coverage.

The following guide provides an overview of Medicare and Medicaid and lists their key differences, in addition to answering a few common questions. Since both programs tend to be a bit confusing, I encourage you to leave comments and ask questions!

Medicare Coverage

Medicare is a federal program that primarily focuses on providing healthcare coverage for adults over 65. However, Medicare also provides healthcare coverage to disabled people and to those with permanent kidney failure (End Stage Renal Disease).

Medicare is available through a four-part program. The healthcare coverage you receive depends on which plan you select. Here’s a quick breakdown of Medicare’s four-part program:

  • Part A: Helps cover hospitalization, including inpatient services and care received from a skilled nursing facility.
  • Part B: Helps cover outpatient services such as: doctor visits, services from physicians, and some preventative care services. (Please note: Parts A & B, a.k.a. “Original Medicare,” are provided through the Federal Government.)
  • Part C: Referred to as “Medicare Advantage Plans,” these combine Medicare Parts A, B and D, as well as other services, into one plan. These plans are offered through private insurance companies.
  • Part D: Helps pay for prescription drug coverage.

Understanding specifically what Medicare covers and the costs involved is a deeper topic which I will address in future articles.

Medicaid Coverage

The Medicaid program primarily concentrates on the healthcare needs of low-income families and individuals as well as those with disabilities. Medicaid is jointly funded by the U.S. states and the federal government. Therefore, Medicaid coverage differs by state.

Medicaid benefits generally include the following:

  • Care and services from a hospital or skilled nursing facility
  • Home health care services
  • Care from a federally qualified health center
  • Long-term care
  • Doctor and nursing services
  • Lab services and X-rays

Medicaid is, in fact, the largest single source of long-term care funding in the country. 

To learn more about Medicaid in your state, do a simple Google search. Just type, “[your state] Medicaid.” For example, if you live in Florida, you’d type, “Florida Medicaid.”

What Are the Main Differences Between Medicare and Medicaid

The key difference between Medicare and Medicaid is who is eligible for each program. There are different rules for eligibility, and there may be circumstances where you qualify for Medicaid but do not qualify for Medicare, and vice versa.

Another difference is that Medicaid covers long-term care services and support, while Medicare will often limit this form of coverage.

Can You Be Enrolled in Medicare and Medicaid at the Same Time

With Medicare, you must be age 65 or older to qualify for coverage. However, with Medicaid, anyone is eligible regardless of age, as long as you meet the low-income requirements. Therefore, it’s possible to meet the requirements for both programs.

If you are eligible for both programs, then you are deemed, “dual-eligible.” When you’re dual-eligible, Medicaid pays for your Medicare costs under the Medicare Savings Programs. The amount that Medicaid covers depends on your income level.

Next Steps

Now that you have a better understanding of Medicare and Medicaid, the first question you may have is what if I already have health insurance through an employer? This is a great question. The short answer is that if you’re happy with your employer’s healthcare coverage, and it extends into your retirement, then you don’t need to enroll.

For everyone else who needs healthcare insurance into retirement, put together a list of your healthcare needs. What types of doctors do you visit? How often? What types of prescription drugs do you use? Are you in need of any special medical equipment?

If you need Medicare coverage, you have to sign up during certain enrollment periods which amount to a seven-month window:

  • Three months before you turn 65;
  • The month you turn 65;
  • Three months after you turn 65.

If you miss this window, you must wait for the next enrollment period.

With Medicaid, there aren’t specific dates or deadlines. You can apply any time of the year. However, you still must apply. Even if you think you don’t qualify, you should apply anyway. You may quality for your state’s program at the very least.

Are you enrolled into Medicare or Medicaid, or do you have an employer based health care insurance? Have you considered applying for one of the government health care programs? Which ones do you think you are eligible for? Please share your comments and questions below.

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The Author

Jason Carrasco is the Medicare expert for Time for 65. Jason loves sharing his expertise and knowledge with older adults, loved ones and caregivers who may be new to, or who simply have a difficult time understanding the ins and outs of, Medicare.

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