If you’re confused about the requirements and benefits of Medicare or Medicaid, you are not alone.
Both Medicare and Medicaid are health insurance programs sponsored by the government. However, there are big differences between the two programs.
Depending on which program you may qualify for, your health care could cost you quite a bit more or less than you think. The two programs operate separately, but both are run by CMC, the Centers for Medicare and Medicaid Services. This article offers a brief overview of the two programs, resources, and a class you can attend so you can make more informed choices.
What’s the difference between Medicare and Medicaid?
- Medicare delivers healthcare coverage for those age 65 and over, and also people under age 65 who are legally disabled or with end-stage renal diseases. U. S. citizens qualify and permanent residents who have lived in this country for five years and may also qualify. There are no income and asset restrictions that apply to Medicare.
- Medicaid is driven by income level. It delivers shared federal and state healthcare coverage to low-income adults and seniors, pregnant women, and children.
- some people are eligible for both programs. Learn more about dual eligibility here.
UNDERSTANDING 2022 MEDICARE
Online Class Wednesday, October 5, 12:00pm-1:00pm EDT
If you need Medicare or are already enrolled in the program, you can learn more about your options at our Medicare Power Hour Class with guest speaker, Robert Charnas Licensed Representative, United Healthcare. Sign Up and Learn More
What is Medicare?
Medicare Consists of Multiple Parts:
- Part A, Hospital Insurance coverage: for inpatient hospital stays, skilled nursing facilities, certain home health services and hospice.
- Part B, Medical Insurance coverage: for outpatient care such as doctor visits, laboratory tests, certain medical supplies, in-home health services, and routine preventive care. The federal government pays for 80% of your health care costs, and you’re responsible for the remaining 20%.
- Part C, Optional Medicare Advantage private insurance coverage: includes all Part A and B benefits and depending on the policy may provide Part D, prescription drug coverage and other perks.
- Part D, Prescription Drug private insurance coverage: for doctor prescribed medications. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you're first eligible, and you don't have other creditable prescription drug coverage, you may pay a late enrollment penalty.
How Does Medicare Work?
Medicare offers multiple options for how you receive coverage. When you enroll, you will need to make decisions on which to select.
Here are some general options:
Keep the Original Medicare part A and B listed above which covers many costs associated with medical services and supplies.
Add additional coverage:
- If you want coverage for prescription drugs, you can add part D prescription drug coverage to your plan
- You may also choose to add Medigap insurance which covers medical expenses such as deductibles, copayments, and coinsurance. Medigap policies may cover emergency medical care abroad as well as services not usually covered under Original Medicare guidelines.
Replace Original Medicare with a Medicare Advantage Plan part C listed above
- A Medicare Advantage Plan is private coverage for health and prescription drugs as an alternative option to Original Medicare parts A and B mentioned above.
- If your plan is “bundled”, it includes Medicare Parts A, B and D.
- Medicare Advantage plans often include items which are not covered by Original Medicare such as dentistry, hearing, or vision care. Advantage plans may cap your out-of-pocket expenses or offer perks such gym memberships.
- Medicare Advantage Plans are governed by Medicare’s coverage rules and administered via individual healthcare company contracts with Medicare every year. Please note! Out-of-pocket expenses AND policy costs can vary between Medicare Advantage Plans. You may also encounter different rules regarding delivery of services and which perks are offered.
How Does Medicaid Work?
For those who qualify, Medicaid covers a wide range of health-related costs such as doctor and hospital visits, prescriptions, and routine preventative care. It may also provide long-term care for those who are qualified.
Because Medicaid also receives funding from states, coverage and eligibility requirements can vary between states. Most states require U.S. citizenship or legal resident status as well as specified income and asset level requirements. The 2010 Affordable Care Act allows most eligible Americans at approximately 133% of the Federal Poverty Level (FPL) under age 65 to enroll in Medicaid.
How Do I Apply for Medicaid or Medicare?
You can contact licensed Medicare representatives locally to discuss Medicare Advantage Plans or visit Medicare.gov. For Medicaid, contact your local state Medicaid office or regional Social Security office with questions and they can guide you through eligibility and the enrollment process.
References & Resources:
Download 2023 Medicare & Me, official U.S. Government Medicare Handbook
To learn more about Original Medicare, click here.
To learn more about Medicaid, click here and look up your state.