Medicare Vs. Medicaid

Medicare Vs. Medicaid

Medicare and Medicaid are often used in the same way in the same sense in conversation.

There is, however, a real difference between the two systems.

While they are both government programs that help with health care costs, did you know that you might be eligible for both of them at once?

And that being eligible for either Medicare or Medicaid can help to reduce your medical bills?

Let’s take a look at the two of them and what you need to know to make the most of Medicaid Plans and Medicare Plans.

The Highlights Of The Differences Between Medicare And Medicaid

The Highlights Of The Differences Between Medicare And Medicaid

Before we look at the specifics of either plan, let’s look at the top-level differences between them.

Medicaid services are provided by your state and state Medicaid programs are provided based on your income. That is Medicaid exists solely to support low-income households that cannot afford private insurance companies and who still need healthcare coverage.

Medicare, on the other hand, is a federal program where entitlement is based on either your age or specific circumstances (such as particular disabilities).

What Is Medicare? (Federal Government)

What Is Medicare? (Federal Government)

Medicare is a federal program that operates on federal guidelines. It is a fully national program to provide low-cost health insurance to those who might otherwise not be able to take advantage of the incredible health care that the US has to offer.

Medicare coverage is typically available to those of 65 years of age or above – people whom the private companies in the health insurance sphere would be unlikely to obtain coverage.

It is also available to those under 65 who have a special situation or a particular disability. To determine if you have such a situation or disability, you would need to discuss the matter directly with a Medicare representative.

Medicare supplement insurance is offered in four parts and each of those parts provides you with certain levels of coverage and certain covered services. The idea is that this means you can choose the coverage that is best for you and your individual needs.

These four parts are:

Hospital Insurance (Part A)

Part A of Medicare is designed to cover the healthcare costs that are associated with hospitalization.

There are usually no premiums to pay for Part A, but Medicare eligibility criteria state that someone must have worked and paid taxes for Medicare services for at least 10 years prior to joining this program. If you are married, your spouse must all have worked and paid taxes for 10 years.

While Medicare pays most of the costs associated with hospitalization if you are hospitalized, you may be required to pay a deductible and you will be expected to carry coinsurance to get the full benefits from this health coverage.

Medical Insurance (Part B)

Part B coverage covers outpatient medical services and doctor’s visits and treatment.

In essence, it pays for the kind of care that you cannot have covered under Part A.

Part B, unlike Part A, is optional coverage and it’s important to note that Part B only covers care that is “medically necessary”. So, you won’t be able to have a face lift or a tummy tuck under Part B.

This area of the plan also covers preventative services – such as lab tests, examinations, etc. that help to prevent you from becoming ill and making a claim in the first place.

Medicare premiums are charged for Part B and while most people pay a standard amount for the premium, there is an income-based assessment for this benefit and you might be contacted by Social Security to require that you pay more if your income is too high.

One thing everyone should know about this part of the coverage is that if you don’t take it when you first become eligible for it, you may be required to pay a “late fee” for enrolling on the plan at a later date.

Medicare Advantage Plan (Part C) – Bundled Plan

Part C is often known as Medicare Advantage or sometimes as “Original Medicare”.

Medicare Advantage is a combination of parts A and B and occasionally may include prescription drug coverage too. (This is always true on Original Medicare but only on some Medicare Advantage plans).

We would note that you can often get plans from a private insurance company that allow you to get benefits over and above those covered by parts B and C, though they may not cover prescription drugs.

Prescription Drug Coverage (Part D)

Coverage for prescription drugs is in Part D of Medicare and it’s the most complex kind of coverage.

At face value, the idea is simple, you pay a premium and when you need drugs, they are provided either free of charge or at a discount.

Yet, in practice, this only applies to drugs in the list of Medicare-covered drugs and most of these are generic drugs not the brand name version. There are also several “tiers” of drugs involved and each of them involves a different copayment from you when the time comes to pay your pharmacist.

That doesn’t mean that this coverage is bad value, but it does mean that, by and large, you need to really dig down into it before you decide to take it on and make sure it’s right for your medical needs.

What Is Medicaid? (State Program)

What Is Medicaid? (State Program)

Medicaid coverage is a means of accessing health care at either a lower cost than usual or, occasionally, at no cost at all.

Because this program is run by each individual state and funded by those states – Medicaid eligibility requirements will vary from place to place.

In fact, a state Medicaid program doesn’t even have to be called “Medicaid” and sometimes, it won’t be!

That means you will need to find out whether you qualify for medical services from your local state administrator from Medicaid.

Typically, Medicaid benefits: children, women who are pregnant, adults that have a qualifying disability, adults who are elderly, and those with low incomes. Therefore it’s always worth enquiring as a senior to find out if you and your spouse are entitled to be Medicaid recipients.

Can You Get Both Medicare And Medicaid?

Yes, you can qualify for both Medicare and Medicaid. These combined are known as a dual health plan.

You must be dual eligible for the two services but if you are, you can get a special version of the Medicare Part C plan that provides more benefits and has a reduced (even free) premium!

These are different from dual special needs plans which are offered by private insurers. You can, if you wish, combine private insurance with your Medicaid and Medicare medical coverage.

Final thoughts On Medicaid And Medicare

Medicaid and Medicare savings programs are a huge benefit of getting older and if you want to enjoy health care at a reasonable cost, you should always ensure that you check your eligibility for these programs and sign up as soon as you are allowed to do so.

Taking care of your health becomes even more important after retirement.

We have some other health-related articles that you might enjoy on this site including, Can You Test Your Hearing Online For Free?, Best Hobbies For Seniors With Arthritis, and The Best Large Piece Puzzles For Seniors. We hope that you find them useful and informative.

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