Although these two terms are widely used, many people may find it difficult to tell them apart. As healthcare costs rise, it is essential to understand the benefits, coverage and eligibility requirements of each of these programs.
Here are the three things they have in common:
- Both Medicare and Medicaid are spelled with “MEDI” at the beginning!
- Both Medicare and Medicaid are government-run programs
- Both Medicare and Medicaid provide basic healthcare benefits and coverage
The differences between the two programs are:
- Medicare is a federal health insurance program serving individuals:
- Age 65 or older
- Under 65 with certain disabilities
- With End Stage Renal Disease “ESRD” (permanent kidney failure requiring dialysis or transplant)
- There are two ways to get Medicare: Original Medicare or Medicare Advantage (also known as Part C)
- Patients may pay deductibles and/or coinsurance for hospital costs and other costs. Patients may also pay a monthly premium.
- Original Medicare is typically the same coverage everywhere in the United States.
Medicare has FOUR main parts:
• Part A covers hospital stays, nursing home stays, some home care, and hospice care. Most people don’t pay a monthly premium for Part A, but there is a deductible.
• Part B covers medical services such as doctor visits and outpatient care. You pay a monthly premium for Part B, plus additional medical service costs.
• Part C covers Medicare advantage plans
o Private health plans approved by Medicare, administered by a third party
o Benefits can vary but must offer all services that Original Medicare covers
o May require a monthly premium
o May include Part D (prescription) benefits
• Part D covers prescription drugs. The cost of a Part D plan varies depending on the type of plan you choose. Part D can be included with a Part C plan or purchased separately as a stand-alone Part D plan.
As for the eligibility, you qualify for Medicare if you or your partner have worked for no less than ten years in a Medicare-covered industry, and you’re at least 65 years old. You also need to have permanent resident status or status of a citizen of the United States.
It is paramount to keep some dates in mind when applying for Medicare:
Initial Enrollment Plan is when you can first apply to Medicare and that is during the 7-month period that:
- Starts 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
October 15 – December 7 is the Annual Enrollment Period (AEP) and it is the time when individuals can add or change health coverage for the upcoming calendar year.
January 1 is when the coverage begins.
January 1 – March 31 is when you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.
Medicaid is a joint federal and state program that:
- Helps with medical costs for some people with limited income and resources
- Offers benefits not normally covered by Medicare, like nursing home care and personal care services
- Provides service to an individual or an entire family household
- Patients usually receive covered medical services at no cost, except a small co-payment is sometimes required
- Medicaid is the last payor after Medicare. Medicaid never pays first for services covered by Medicare. It only pays after Medicare, employer group health plans, and/or Medicare Supplement (Medigap) Insurance have paid.
Click here to get a quote on Medicare or call our licensed agents on TEL 833-219-5829. At Marketplace Insurance Services we will compare plans from major health insurance providers and provide informed and impartial guidance on affordable and reliable healthcare solutions.