Medicaid and Medicare: What’s the Difference?

Feeling confused about Medicare? Are you trying to figure out the difference between Medicaid and Medicare? Do you need healthcare but don’t have an employer’s insurance plan? If so, you’re not alone. 

The glut of information on health insurance schemes is jammed with different plans, coverage choices, and rules. Trying to get your head around all the medical jargon is enough to shoot up your blood pressure and call the doc.

So, how are you going to get that all-important check-up, scan, or procedure if you can’t afford it? The good news is that there are government programs to help people just like you. The key to knowing what you’re eligible for is knowing precisely what Medicaid and Medicare are. 

You might be among some of the millions of Americans who don’t have any health insurance. Some news reports indicate that 27.5 million people in the U.S. go without health insurance. And, it seems the number of uninsured adults is rising. 

The article aims to cut the confusion and answer your questions about Medicaid and Medicare. You’ll also find out how to get the healthcare you’re entitled to.

Medicaid and. Medicare: The Difference

First, let’s get clear about the difference between these two government-run health programs. 

  • Who can apply for Medicare? The federal healthcare program “Medicare” provides health coverage for people 65 and over and is not based on income. This program also includes health care if you receive Social Security Disability Insurance (SSDI). 
  • Who can apply for Medicaid? Medicaid provides healthcare for you and your family if you are on a low income. Because Medicaid is both a state and federal program, eligibility varies from state to state.

There is another difference between Medicaid and Medicare. You can apply for Medicaid at any time when your circumstances change. Medicare has a specific enrolment period. This period is three months before and after you turn 65. You can get penalized if you apply for the program outside that period. 

But that’s just the basics. There is more to these programs you need to know about to check your eligibility. 

Let’s look in more detail at both of these programs. 

Medicare 101

You qualify for Medicare when you turn 65 or 24 months after receiving SSDI benefits

Medicare is a four-part insurance program that covers various aspects of your health care. 

Medicare Part A: Hospitalization Coverage 

To qualify for free hospitalization coverage, you need to have worked for at least ten years and paid Medicare taxes. If you’ve got “credits,” you don’t pay any premium. However, you still have to pay deductibles and any copayments for health services. 

If you haven’t paid enough Medicare taxes, you will have to pay a monthly premium. You can find information about Part A premiums at the Medicare website.

Medicare Part B: Medical Insurance

If you are eligible for Medicare Part A, you also get Medicare Part B. This part of Medicare includes doctor’s visits, flu shots, lab work, scans, and screenings. There is a premium to pay for Part B, but this usually is deducted from Social Security payments. 

“Medicare Part A” and “Medicare Part B” are called Original Medicare. Both parts are absolutely necessary if you don’t have any private health insurance. 

Medicare Part C: Supplemental Insurance

Also referred to as Medicare Advantage, Medicare Part C is add-on insurance offered by private companies. Part C helps to cover healthcare, such as dental treatment, eyesight health, hearing, and wellness programs. 

Medicare Part C is not necessary. Depending on your health, you may not even need it. You still have out-of-pocket costs to pay for the services that Part C covers. 

Medicare Part D: Prescription Drug Coverage 

This optional part of Medicare can help reduce the cost of taking certain drugs. If you qualify for Part A, B, and C, you generally qualify for Part D. This insurance plan involves paying a yearly deductible, monthly premiums, and also copayments. 

Medicare Part D can be helpful, depending on what type of prescription drugs you regularly take. But to avoid wasting your money, it’s good to check to see if you really need Medicare drug coverage.

Medicaid 101

What can you do if you’re on low-income and private health insurance is out of reach financially? In this case, you might be eligible for Medicaid. 

What do you need to know about the benefits offered by Medicaid? Read on to find out. 

How to qualify for Medicaid

Qualifying for Medicaid is based on your income, savings, size of household, and family status. Other people who can apply for Medicaid include pregnant women, people with disabilities, and teenagers living alone. If you have to care for a sick child, then you may be able to sign up for Medicaid. 

Unlike Medicare, Medicaid is both a state and federal health insurance program. So, getting Medicaid can depend on where you live. You can find out more information on your eligibility at the Medicaid.gov website.

Benefits of Medicaid

The biggest plus of Medicaid is that it provides cheap and free healthcare to many people who can’t afford the high cost of medical treatment

The healthcare benefits of Medicaid include hospitalization, lab services, doctor’s visits, clinic treatment, and X-rays. Depending on where you live, you can also benefit from low-cost or free prescription drugs, eyeglasses, physical therapy, and dental services. 

One of the differences between Medicaid and Medicare is that Medicaid can also pay for long-term health care, such as the cost of nursing facilities. 

Medicaid and Medicare: FAQs

Here are the answers to more questions you might have about Medicaid vs. Medicare. 

Can you have Medicare and Medicaid at the same time?

Yes. Depending on your income, you may qualify for both Medicaid and Medicare. If you are eligible for Medicaid when you’re over 65, you’ll get help paying for Medicare deductibles, copayments, and premiums. 

Do Medicaid and Medicare cover the same services?

Both programs provide health insurance for basic healthcare costs. This includes hospital stays, doctor visits, and essential medication. However, Medicaid provides more extensive coverage. This extra coverage includes things like dental treatment, eye care, and the cost of assisted living facilities. 

Could I lose Medicare coverage if I move between states?

Unfortunately, this is possible if your new state has different eligibility rules from where you live just now. 

When does a person automatically qualify for Medicaid and Medicare?

If you qualify for Supplemental Security Income (SSI), you automatically get Medicaid. 

If you receive Social Security Disability Income (SSDI), you can get Medicare 24 months after receiving your first benefit payment. 

To qualify for Medicare when you turn 65, you need to apply during the enrollment period.