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The Difference Between Medicare and Medicaid


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It may be easy to confuse Medicare vs Medicaid because they are both health insurance programs sponsored by the government. However, the benefits and eligibility requirements are different for Medicare vs. Medicaid. In some cases, you may be eligible for both, which is called “dual eligible.”

How do I qualify for Medicare vs Medicaid?

Medicare is for U.S. citizens and permanent legal residents of at least five years who are either:

  • 65 or older
  • Disabled under certain conditions or with certain medical conditions

You can qualify for Medicare through disability if you:

  • Have received at least 2 years (24 months) of Social Security disability benefits or a disability pension from the Rail Road Retirement Board (RRB).
  • You have end-stage renal disease (ESRD) and need routine dialysis or a kidney transplant.
  • You have Lou Gehrig’s disease. (If you have Lou Gehrig’s disease there is no waiting period to get Medicare benefits after you start getting disability benefits)

One way to qualify for Medicaid is through income. Unlike Medicare, you don’t necessarily have to be a certain age or have a disability to qualify for Medicaid. According to healthcare.gov, some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. The exact income you have to have to qualify for Medicaid varies by state. Some states may have more Medicaid coverage for families with children, women who are pregnant, and people who have disabilities.

Coverage: Medicare vs Medicaid

Some Medicaid benefits may overlap with Medicare, but Medicaid may also cover services that Medicare doesn’t.

Basic Medicare Coverage Basic Medicaid Coverage
Medicare is organized into different parts.

Medicare Part A covers hospital stays

Medicare Part B covers doctor visits and durable medical equipment

Medicare Part D covers prescription drugs

Medicare Part C (Medicare Advantage) covers hospital stays, doctor visits, durable medical equipment as well as usually prescription drugs. Medicare Advantage is an alternative way to get your Part A and Part B benefits through a private insurance company approved by Medicare.

Medicare Supplement covers costs that Medicare Part A and Part B don’t generally cover such as copayments, coinsurance, and deductibles.

 

Medicaid has mandatory benefits, which states are required to provide under federal law, and optional services that states may cover if they decided to.

 

Mandatory Medicaid benefits include (but are not limited to):

·       Inpatient and outpatient hospital services

·       Nursing facility services

·       Home health services

·       Physician services

·       Laboratory and X-ray services

·       Family planning services

·       Nurse midwife services

 

 

When you compare Medicare vs. Medicaid, Medicaid potentially offers more benefits.

Extra  Medicare Coverage Extra Medicaid Coverage
If you stay with Original Medicare (Part A and Part B) you generally will NOT have coverage for:

·       Long-term care

·       Most dental care and dentures

·       Routine vision care

·       Routine hearing care and hearing aids

·       Routine foot care

Some Medicare Advantage plans may cover some of these things.

 

Optional Medicaid benefits include (but are not limited to)

·       Prescription drugs

·       Physical therapy

·       Podiatry services

·       Dental services and dentures

·       Eyeglasses

·       Chiropractic services

·       Private duty nursing services

·       Personal care

·       Hospice

 

 

How do I enroll in Medicare vs Medicaid

You may be automatically enrolled in Medicare when you become eligible if you are already receiving Social Security benefits.

You can also enroll in Medicare Part A and Medicare Part B:

  • Online at www.SocialSecurity.gov.
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM.
  • In-person at your local Social Security office.

If you want a Medicare plan offered by a private insurance company, such as Medicare Part D, Medicare Advantage, or Medicare Supplement you will need to contact the company that provides the plan you are interested in or go through an insurance broker like eHealth. Keep in mind that Medicare enrollment is subject Open Enrollment Periods. Medicare Open Enrollment is October 15- December 7 every year.

You may apply for Medicaid at any time of the year. One difference between Medicare and Medicaid is that Medicaid does not have Open Enrollment Periods. To enroll in Medicaid, you can fill out an application on Healthcare.gov. When you submit the Marketplace application, you can also find out if you qualify for Medicaid. You also can apply through your state Medicaid Agency.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits may change on January 1 of each year.

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eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.