Differences Between Medicare and Medicaid

Many people are confused about Medicare and Medicaid. Even those eligible for one or both get them mixed up. This short article explains the programs. Hopefully, readers will understand the differences and will benefit from them when they become eligible.

Medicare and Medicaid

Both Medicare and Medicaid are government programs. However, they have different characteristics and requirements. Some people are eligible for only one, while others might be eligible for both. What they have in common is that they are both health-related services.

Medicare: Definition

Medicare is a federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions.

Medicare Eligibility Requirements

• For the original Medicare Parts A and B eligibility:
• Age 65 or older
• Younger than 65 with a qualifying disability
• Living with end-stage kidney disease

Medicare Coverages

Usually, Medicare is a person's primary plan and covers most Medicare-eligible healthcare services. There are four different parts of Medicare for specific services.

1. Medicare Part A usually helps cover hospital or long-term care costs.
2. Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
3. Medicare Part C is a Medicare Advantage plan that provides all of Part A and Part B coverage and typically offers extra benefits such as vision, hearing, and dental care. Most also include Medicare Part D drug coverage.
4. Medicare Part D helps cover the cost of prescription drugs.

Medicaid: Definition

Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.

Medicaid Eligibility Requirements

Medicaid is often the secondary plan and may cover medical costs that Medicare doesn't cover or only partially covers.

Every state has its own rules for Medicaid, but the common ones include:

• Age 65 and older
• A child under age 19
• Pregnant
• Living with a disability
• A parent or adult caring for a child
• An adult with dependent children
• An eligible immigrant

Dual Eligibility

Some people are qualified for both Medicare and Medicaid, but they may not know how to apply for both. About 12 million Americans qualify for benefits from both programs. Therefore, they are “dual eligible,” and the coverage is called "dual eligibility."

A person must sign up for Medicare Part A and Part B through Social Security to make both retirement and Medicare choices and withhold any premiums from their benefit payments.

To apply for Medicaid, people should contact their State Medicaid Agency. Services covered by dual eligibility include:

• Medical equipment, such as crutches, canes, walkers, and wheelchairs
• Doctor visits
• Inpatient and outpatient hospital services
• Mental health services
• Prescription drugs
• Preventive care
• Dental services
• Vision care

Summary of Things to Remember About Medicare

• Federal program only
• Primary
• 65 years and older
• Younger than 65 with a qualifying disability
• Living with end-stage kidney disease
• Cost is deducted from the person's social security check

Summary of Things to Remember About Medicaid

• Joint federal and state program
• Secondary
• People with limited income and resources
• Medicaid covers a broader range of services than Medicare
• Apply through the State Department of Social Services
• Most health care costs are covered
• Medicaid can cover services not covered by Medicare, such as long-term care
• Medicaid can help with Medicare costs, such as premiums, coinsurance, and deductibles

Only Basic Information

This article provides only basic information about Medicare and Medicaid. People interested in more specific information should check with the agencies in their own state.

The information might appear confusing and complex initially, but the more you learn about the services, the less complicated they will be.