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Medicare vs. Medicaid: What Is the Difference?

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Just the Essentials...

  • Though the programs are similar, Medicare and Medicaid are not the same thing and the terms are not interchangeable.

  • Medicare is a health insurance program managed by the U.S. federal government that typically covers healthcare costs related to hospital stays, doctor’s appointments, hospice, and more, for individuals who are 65 or older or have been diagnosed with certain disabilities.

  • Medicaid is a health insurance program managed jointly by the U.S. federal government and individual state governments. It is reserved exclusively for those with special cases, such as low income individuals, pregnant women, and those with certain disabilities.

  • At MedicareInsurance.com, we can help you determine which programs you are eligible for and which specific Medicare programs may be best suited for your lifestyle and healthcare situation.

Medicare vs. Medicaid

If you’re like many Americans, you may be asking yourself, are Medicare and Medicaid the same? Or maybe you’re wondering, what is the difference between Medicaid and Medicare? Not to worry! The insurance experts at MedicareInsurance.com are here to help clear things up.

The terms Medicare and Medicaid sound similar and are both government-funded health insurance programs, but the programs are not the same thing and the terms are not interchangeable.

Navigating the world of health insurance is difficult enough, and with the surprisingly low amount of information available about these two systems, it’s no wonder that things can sometimes get confusing.

Read on to learn more about the difference between Medicaid and Medicare, and let us help you discover your best available health insurance coverage options today.

What is Medicare?

Medicare is a health insurance program that is managed by the U.S. federal government. It is designed to assist older Americans (enrollment eligibility begins at age 65) and individuals with certain qualifying disabilities in paying for their healthcare costs.

Medicare consists of four main parts, each of which are specifically designed to assist you with various healthcare needs. The basic parts of Medicare are as follows:

Medicare Part A

Medicare Part A is largely responsible for the coverage of inpatient hospital-related expenses, such as hospital visits, hospice care, limited skilled nursing facility treatment, and limited home health care.

Medicare Part A makes up one half of what is known as “Original Medicare,” for which one becomes eligible at the age of 65 or upon diagnosis of certain disabilities or diseases.

Medicare Part B

Medicare Part B mostly covers outpatient medical care expenses, such as doctor’s appointments, medical equipment like wheelchairs, walkers, and hospital beds, some home health care, and many preventive healthcare needs like vaccines and health screenings.

Medicare Part B makes up the other half of Original Medicare, for which one becomes eligible at the age of 65 or upon the diagnosis of certain disabilities or diseases.

Medicare Part C

Also known as Medicare Advantage, Medicare Part C consists of additional insurance plans offered by private insurance companies. These plans can typically cover additional healthcare expenses not covered by Original Medicare, such as eyeglasses, contacts, hearing aids, hearing exams, dentures, and teeth cleanings.

Like with Original Medicare, one becomes eligible for Medicare Advantage at the age of 65 or upon the diagnosis of certain disabilities or diseases. Changes to plans may only be made during specific enrollment periods or some special enrollment periods, such as immediately following a move or if a 5-star Medicare Advantage plan becomes available in your area.

Medicare Part D

Medicare Part D is responsible for covering costs associated with prescription drugs. Often, Medicare Part D: Prescription Drug Coverage can be bundled into Medicare Advantage plans for more streamlined and comprehensive coverage.

That said, Medicare Part D plans are available as standalone options based on where you live. Eligibility occurs at the age of 65 or upon diagnosis with certain disabilities or diseases.

What is Medicaid?

Like Medicare, Medicaid is also a government-managed health insurance program. However, Medicaid is managed jointly by both the federal and individual state governments. It is designed to assist specific individuals in paying for healthcare expenses.

People with Medicaid coverage may have access to some services and treatments that Medicare does not cover or only partially covers, such as nursing home care, personal care, transportation to and from medical services, some home and community-based services, as well as dental, vision, and hearing services.

Who is eligible for Medicaid?

Medicaid coverage can vary from state to state. In order to be eligible for Medicaid coverage in a given state, you must be a resident of that state and a U.S. citizen (or possess qualified immigration status) and you must be considered a limited-income individual.

Generally, the following groups of limited-income people may qualify for Medicaid coverage:

  • Individuals aged 65 or older
  • Children under 19 years old
  • Pregnant women
  • Individuals living with a qualifying disability
  • A parent or guardian caring for a child
  • An adult without dependent children (in most states)

What does Medicaid cover?

When you successfully enroll in Medicaid, you may get access to certain healthcare benefits that are not covered or are only partially covered by Medicare. Some Medicaid program benefits are:

  • Doctor’s visits
  • Hospital stays
  • Long-term healthcare services and support
  • Preventive care (vaccines, mammograms, colonoscopies, etc.)
  • Prenatal and maternity care
  • Mental health services
  • Necessary medications
  • Vision and dental care for children

If you or a loved one are low-income and in need of healthcare services, you should apply for Medicaid as soon as possible. According to Medicaid themselves, Medicaid and the Children’s Health Insurance Program (CHIP) are responsible for providing healthcare coverage to approximately 72.5 million Americans.

If you have attempted to qualify for Medicaid in the past and were turned down, you are encouraged to try again. More parents and adults may now qualify for coverage than at previous times.

Can I be eligible for both Medicaid and Medicare?

Believe it or not, there are some circumstances where you may be eligible for both Medicaid and Medicare. This status, known as dual eligibility, may give you access to more comprehensive coverage than you otherwise would have. In this situation, most healthcare costs are likely covered.

If you are dual eligible, you can get your Medicare coverage through Original Medicare or a Medicare Advantage plan. If you have Medicare and/or full Medicaid, the Extra Help program can potentially cover some prescription drug costs. In addition, if you have both Medicaid and Medicare, you can also receive Extra Help on drugs covered by your plan.

Think you may be dual eligible for both Medicaid and Medicare? Use our live chat feature to immediately speak to a licensed insurance agent.

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