Though Medicare and Medicaid are often confused and the two government based programs have similar names there are many differences between the two. It is important to understand these differences so that those who wish to apply will know what to expect in the terms of benefits as well as which plan to apply for. The first striking difference between Medicare and Medicaid is where applicants apply.
Medicaid is a joint state and federal program for low income individuals and those who need to apply do so through local, state government organizations. Applications may be filled out online or through a local office. Medicare is a federal government program and those who wish to apply for Medicare do so through their local Social Security office. While Medicaid is based on low income, Medicare is not. Medicare is available for seniors who are 65 years old and older, those who have suffered a permanent disability and are unable to work, and those who have suffered kidney failure or long term kidney disease. There are certain situations where someone may receive benefits from both programs regardless of age.
Medicaid is based on income levels and it is quite possible that someone may qualify for Medicare due to being over the age of 65, and also qualify for Medicaid based upon his or her income level. Pregnant woman who are considered low income, as well as children under the age of 19 who live in low income homes, may qualify for Medicaid. Those with disabilities are blind or need services such as a nursing home are often found eligible for Medicaid. It’s important to realize that Medicare if for those 65 years old or over, and those under 65 who have certain disabilities. Those with end stage renal disease (permanent kidney failure) qualify for Medicare. To qualify for Medicare you must have entered the United States legally and have been a resident for at least five years.
Medicaid is for low income individuals and family and provides health care benefits to those who otherwise couldn’t afford it. It’s important to realize that each state sets their own income levels for determining Medicaid eligibility. Those who qualify for Medicaid in one state may find they are no longer eligible in another. If you are without health insurance and are low income but unsure whether or not you may qualify for benefits you should apply regardless. If you don’t qualify for Medicaid the case worker may find another program that you are eligible for.
There are two parts to Medicare including Part A and Part B. Part A Medicare is considered hospital insurance while Medicare Part B is medical insurance. Part A Medicare helps cover the cost for hospital stays, nursing home facilities, hospice care or other long term care services such as in home health care as long as the condition meets eligibility requirements. Many individuals receive Medicare Part A for free while others may have to pay a premium in order to get the benefits.
Medicare Part B helps pay for medical services, bills and outpatient care. Sometimes Medicare Part B will cover services considered preventive. As many receive Medicaid Part A free, Medicare Part B is sold on a premium basis. Though each state sets its own rules regarding Medicaid the majority of Medicaid recipients do not pay for services. There may be certain situations, however, where due to an increase in income a Medicaid recipient may be required to pay a monthly fee to help cover costs. Some forms of Medicaid may include a co-payment as well.
In addition to Medicare Part A and Part B there is also Part C and Part D. Medicare Part C is also known as Medicare Advantage and to qualify for a Medicare Advantage Plan you must currently have Part A and Part B coverage. With a Medicare Advantage Plan you will pay a premium and copayment and your plan would be provided through an insurance company but approved by Medicare.
Medicare Part D refers to prescription drug coverage. Those who get Medicare Part D must enroll in a prescription drug plan. These plans vary in both benefits and cost.
It can be very confusing determining whether or not you need Medicare, Medicaid or both. If you have any questions regarding each program contact your local Medicaid or Medicare office.