| Tue, Jun 16, 2020 @ 09:00 AM

The Differences Between Medicare and Medicaid

Posted by Medicare Made Clear

The words “Medicare” and “Medicaid” are so much alike that it’s easy to get confused. To add to the confusion, both are government programs that help people pay for health care. But that’s where the similarities end.

See below for more information about each program and how they compare.

What Is Medicare? What Is Medicaid?

Medicare is a federal program generally for people who are 65 or older or have a qualifying disability or medical condition. Medicare Part A and Part B are provided by the federal government, and Medicare Part C and Part D, while federally governed, are provided by private insurance companies.

Medicaid is a state government program that helps pay health care costs for people with limited income and resources, and different programs exist for specific populations. Medicaid plans vary from state-to-state but follow federal guidelines for benefits.

infographic detailing the differences between medicare and medicaid, which is also explained below in plain text.

What Do Medicare and Medicaid Cover?

Medicare Part A is hospital insurance and Part B is medical insurance. Medicare Part D is prescription drug coverage, and Part C (Medicare Advantage) is an all-in-one coverage option that combines Parts A, B and D, as well as other benefits that may include items like dental, vision, fitness and hearing. Medicare Part A and Part B coverage is standard, but Part C and Part D will vary based on terms of coverage provided depending on the plan, the insurance provider and your location.

Medicaid programs include federally mandated benefits and optional benefits. Each state decides what optional benefits to include.

How Much Does Medicaid Cost? How Much Does Medicare Cost?

Both Medicare and Medicaid may include premiums, deductibles, copays and coinsurance. For Medicare, how much you pay will vary based on when you enroll, what coverage options you select and what health services and items you use throughout the year. For Medicaid, the amount you pay depends on your income and the rules in your specific state. Additionally, some specific groups under Medicaid are exempt from many out-of-pocket costs.

There are also four different Medicare Savings Programs, which are designed to help with the cost of Medicare. If you meet the conditions to qualify for one of these programs, you could get help paying for your Medicare premiums, and in some cases, also get help paying Medicare Part A and Part B deductibles, coinsurance and copayments.

Can You Have Both Medicare and Medicaid?

Yes, some people can have both Medicare and Medicaid. People who qualify for both Medicare and Medicaid are called “dual eligible.” If you qualify and choose to enroll in both programs, the two can work together to help cover most of your health care costs. You may also be eligible for a special kind of Medicare Advantage plan called a Dual Special Needs Plan.

How to get Medicare

To get Medicare Part A and Part B, you’ll need to enroll with Social Security directly. The exception to this rule is if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare, generally at age 65. In this case, you’ll be automatically enrolled in Medicare Parts A and B. To get Medicare Part C or Part D, you’ll need to enroll directly with the private insurance company providing the plan you want.

How to get Medicaid

Eligibility for Medicaid depends on the rules in your state. To see if you qualify, and to begin enrollment, contact your State Medical Assistance (Medicaid) office. You can visit www.medicaid.gov to find a local office and learn more about Medicaid eligibility and enrollment.

Medicare and Medicaid are two very different health care programs, so it’s important to understand the differences between them, and if you’re dual eligible, how they can work together to your benefit.