Medicare Vs Medicaid: Key Differences In Coverage And Benefits
- What are the differences between Medicare and Medicaid? How do they work together, and can the same person use both for full health insurance plancoverage?
Healthcare in the United States can be confusing for new beneficiaries. This is especially true for Americans who may qualify for Medicare and/or Medicaid health coverage.
People who are currently, or who soon will be, eligible for Medicare need to know about the differences between the Medicare and Medicaid programs, including the benefits that are offered by each type of coverage.
Medicare Vs Medicaid Coverage
Medicare and Medicaid are both programs provided by the U.S government that have been around since 1965.
Medicare is a federal insurance program available to you if youre over 65, regardless of your income.
Medicaid is an assistance program that is for low-income people of any age. Medicaid is both a federal and state program. So this means it varies from state to state as it is run individually under federal guidelines.
If you are eligible for both programs, you can use both once you turn 65 as long as you continue to meet eligibility requirements!
Medicare And Medicaid Coverage Explained
By Bethany K. Laurence, Attorney
Medicare and Medicaid are very different. Medicaid is a federal program for low-income, financially needy people, set up by the federal government and administered differently in each state.
Medicare was created to deal with the high medical costs that older citizens face relative to the rest of the population — especially troublesome given their reduced earning power. However, eligibility for Medicare is not tied to individual need. Rather, it is an entitlement program you are entitled to it because you or your spouse paid for it through Social Security taxes.
Although you may qualify for and receive coverage from both Medicare and Medicaid, you must meet separate eligibility requirements for each program being eligible for one program does not necessarily mean you are eligible for the other. If you qualify for both, Medicaid will pay for most Medicare Part A and B premiums, deductibles, and copayments.
The information below provides the basics of each program.
Read Also: Psychiatrist In Nyc That Take Medicaid
Who Can Get Obamacare Coverage
If youâre a legal resident of the United States, you can buy an Obamacare private health insurance plan through your state’s ACA health insurance exchange as long as youâre not enrolled in Medicare.
Subsidy eligibility: If your household income is in the subsidy-eligible range and you’re not eligible for Medicaid, Medicare, or an employer-sponsored plan that provides affordable, comprehensive coverage, you may qualify for a subsidy that helps pay part of your monthly health insurance premiums.
For several years, subsidy eligibility had an income cap equal to 400% of the federal poverty level. But that income cap was eliminated for 2021 and 2022, under the American Rescue Plan. The Build Back Better Act, under consideration in Congress in late 2021, would extend that provision through 2025.
Expanded Medicaid exception: Under the ACA, your household income has to be at least 100% of the poverty level in order to qualify for a premium subsidy. But subsidies are not available if you’re eligible for Medicaid, and in states that have expanded Medicaid under the ACA, Medicaid is available to people with income up to 138% of the poverty level. So the lower threshold for ACA subsidy eligibility is 139% of the poverty level in those states. As of 2021, Medicaid has been expanded in 38 states and DC, so the lower eligibility level for premium subsidy eligibility is 139% of the poverty level in the majority of the country.
Who Pays For Medicare And Medicaid
Payroll taxes and SS income deductions fund Medicare parts A and B. Participants in the Medicare program pay out-of-pocket for parts C and D. As for Medicaid each individual state has the option to charge a monthly Medicaid premium and to have out-of-pocket requirements. However since Medicaid is a form of public aid that is paid for by tax dollars, recipients usually pay next to nothing for healthcare.
Read Also: Does Medicaid Cover Long Term Care Facilities
Which One Is Better
Both Medicare Advantage and Medigap provide advantages and disadvantages.
Some advantages of Medicare Advantage include:
- More coverage and benefits, which can include services like gym memberships, long-term care, and disability equipment
- Lower premiums
- An all-in-one plan which covers Medicare Part A, B, and D
Some disadvantages of Medicare Advantage include:
- Having to make sure your preferred provider is in your plan
- No coverage while traveling
- A likelihood of higher out-of-pocket and emergency costs
Some advantages of Medigap plans include:
- Fewer out-of-pocket expenses
- Access to all providers who accept Medicare
- Coverage while traveling overseas
Some disadvantages of Medigap plans include:
- Higher monthly premiums
- Having to navigate the different types of plans
- No prescription coverage
Medicare Vs Medicaid: Whats The Difference
Medicare and all the trimmings that come with it can be confusing and difficult to navigate, even for the experts. Finding the right coverage for the right budget, finding out what, if any, savings you may qualify for, and staying up-to-date with changes to your policy can seem like an overwhelming task. Here we will break down two commonly confused terms: Medicare and Medicaid, and help you determine some key differences when it comes to finding out what program is right for you.
Don’t Miss: Will Medicaid Pay For Portable Oxygen Concentrator
What Do The Different Medicare Components Cover
Medicare has three different components, and every recipient isnt necessarily entitled to use all of them:
- Hospital: Medicare Part Aprovides hospitalization coverage as well as paying some hospice, nursing home and home health care costs.
- Medical: Medicare Part B works like most private insurance policies and covers doctors visits, lab work, and visits to the emergency room.
- Prescription Drugs: Medicare Part D helps cover prescribed medication costs. Medicare Part A and B participants are eligible for Part D .
Is Medicare The Same Thing As Medicaid
Although they sound similar, Medicare and Medicaid arent the same. The only similarity is that both government programs help cover health care costs for Americans.
Medicaid is designed for people that fall into a certain income bracket while Medicare is for people over the age of 65 or for those that have been on disability for two years, explains Grant Dodge, a broker at Health Benefits Associates Inc., in Reno, Nevada.
Medicaid doesnt have an age requirement, so adults of all ages and dependent children can enroll. In 2021, there were 75.4 million people covered with Medicaid. Medicaid plans are administered by the states but funded jointly by the state and federal government. Medicare is a federal program managed by the United States Centers for Medicare and Medicaid Services . The U.S. Social Security Administration handles Medicare enrollment and premium payments. It has an age requirement unless youve been on disability for 24 months or have specific medical conditions. Once you have both parts of Medicare from the federal government , you can sign up for additional coverage with private insurance carriers to fill in the gaps of Medicare, explains Dodge.
Don’t Miss: How To Get Approved For Medicaid In Florida
Qualifying For Both Medicare And Medicaid
Some seniors rely on Medicaid as well as Medicare benefits. In these cases, Medicaid helps Medicare beneficiaries pay for things that arent covered by Medicare, such as some personal care and nursing home care.
Medicare typically pays first for services that are covered by Medicare Part A or Part B. Medicaid can then help the beneficiary pay for costs like Medicare deductibles, coinsurance or copays.
Medicaid beneficiaries automatically qualify for Medicare Extra Help, which is a program that helps pay for Medicare prescription drug costs and makes prescription drugs much more affordable for beneficiaries. Medicaid also covers some prescription drugs that Medicare doesnt cover.
If someone is eligible for Medicare and Medicaid, they are sometimes referred to as dual-eligible.
Continued Coverage Vs State Budgets
As of now, states are required to keep people on the Medicaid rolls during the public health emergency unless they move out of the state or ask to be removed. When the public health emergency ends, states will have 12 months to go through enrollment and determine everyones eligibility status.
The Centers for Medicare and Medicaid Services reported that from February 2020 to May 2021, enrollment in Medicaid and the Childrens Health Insurance Program, or CHIP, grew by 11 million people, or more than 17 percent, the largest increase over 18 months in the programs history. Federal spending on the program grew by 9.2 percent to $671.2 billion in 2020 because of the growth in enrollment.
But when the emergency expires, Medicaid recipients could be disenrolled from the program for an infraction as seemingly minor as not updating their personal information something they havent had to do since March 2020 or missing a letter in the mail about their changing status.
This is of particular concern because many people moved during the pandemic, and a large number of those who receive Medicaid were also caught up in the eviction crisis, said Stan Dorn, director of the National Center for Coverage Innovation at Families USA, a left-leaning consumer health advocacy group.
You May Like: How To Obtain A Medicaid Provider Number
How To Get Medicaid
Medicaid differs from Medicare because it is based on finances and not age. These factors are looked at when seeing who qualifies for it:
- Income.
- Disability.
- Family status.
People who may be eligible for Medicaid may include: people who are pregnant, teenagers living alone, parents of sick children, people with high medical costs, blind or disabled people, or people and families with low incomes.
Each state decides on who qualifies financially for the program. Some states that have expanded Medicaid include higher income levels in their eligibility criteria than states who have not expanded it.
You can find out if your state is growing Medicaid and see if you qualify for it based on income or if you can get any other savings on health care.
Medicaid Through Private Companies
Although Medicaid is a government program, in most states, Medicaid services for the majority of enrollees are provided through a private health insurance company.
If you receive a Medicaid ID card from UnitedHealthcare, Humana, Kaiser, or Blue Cross, you might mistakenly assume you’re receiving private Obamacare health insurance, when it’s actually just the company your state has contracted with to provide Medicaid benefits.
Even though a private company is managing the Medicaid coverage, the benefits themselves are still Medicaid and the money to pay for those benefits ultimately comes from federal and state taxpayer funds.
Don’t Miss: Does Medicaid Give You A Free Breast Pump
Unitedhealthcare Connected For Mycare Ohio
UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.
Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .
Dual Eligibility: Qualifying For Both Medicare And Medicaid
People who qualify for both Medicaid and Medicare Part A and/or Part B are known as dual eligible.
When someone is dual eligible, Medicaid will pay for Medicare costs under 4 types of Medicare Savings Programs. The amount thats covered by Medicaid depends on income level.
For example, if someone has both Medicare and full Medicaid coverage, their health care costs are usually fully covered, including prescription drugs they wont have to pay anything out-of-pocket.
You May Like: Is Everyone Eligible For Medicaid
Medicare Vs Medicaid: Cost
Medicare: People who have worked 40 qualifying quarters , and their spouses or qualifying ex-spouses, pay no premiums for Medicare Part A, which covers hospitalization. But Medicare recipients typically do have out-of-pocket costs, including deductibles and copays. Medicare Part B, which covers doctors visits, and Part D, which covers prescriptions, also require paying premiums.
Medicaid: Medicaid is typically free. Some people may have to pay small copays. Medicaid can also make a claim against peoples assets after they die, but most people receiving Medicaid have few or no assets.
How To Choose The Right Coverage For You
Although you may be eligible for both programs, in some cases, you might be in a position to choose between Medicare and Medicaid.
If youre eligible for Medicare, you have to choose between Original Medicare or Medicare Advantage, based on your preferences. But how do you decide? Take a look at some of the key differences.
Also Check: Medicaid Albany Ny Phone Number
Having Medicaid Or A Medicare Savings Program
Medicare covers many services, but it doesnt cover long-term care benefits and can leave its enrollees with large cost-sharing expenses. Medicaid pays for some services that Medicare doesnt cover for enrollees whose incomes and assets make them eligible. If you have Medicaid or a Medicare Savings Program a program where Medicaid pays for Medicare premiums and cost-sharing then your enrollment options are different than if you only had Medicare.
Some Medicare Advantage plans specialize in covering low-income Medicare beneficiaries. These are known as Dual Eligible Special Needs Plans , and are available in every state. If you have Medicare and Medicaid, you should have few out-of-pocket expenses if you see providers enrolled in both programs regardless of whether you enroll in a D-SNP. Receiving coverage through a D-SNP requires you to see only providers who participate with the D-SNP insurer.
Some D-SNPs offer additional services, such as home care, dental or vision benefits. D-SNPs can also help coordinate all of the health services you receive. But low-income Medicare beneficiaries are better off with Original Medicare paired with regular Medicaid as secondary coverage if their providers accept those programs, but not D-SNP plans. In many states, the fee-for-service Medicaid benefit also covers dental or vision care.
Here is more information about programs available to Medicare beneficiaries with limited incomes and assets.
How Does The Funding Of Medicaid Differ From The Funding For Medicare
Medicare is federally administered and covers older or disabled Americans, while Medicaid operates at the state level and covers low-income families and some single adults. Funding for Medicare is done through payroll taxes and premiums paid by recipients. Medicaid is funded by the federal government and each state.
You May Like: What Is Medicaid Buy In Program
Medicare Vs Medicaid: Key Differences You Need To Know
In a nation of aging baby boomers, many with disabling conditions, the need for comprehensive and effective medical assistance is paramount. To solve this problem, the federal government has created two programs: Medicare and Medicaid. There are many similarities between these two programs and many differences.
Medicare Vs Medicaid Ap Gov
Medicare Vs Medicaid Ap Gov. As you consider what health coverage is best for you, benefits.gov wants to help you understand some of the key differences between medicare and medicaid. Medicaid is an assistance program.
They will work together to provide you with health coverage and. In the context of long term care for the elderly, medicare’s benefits are very limited. 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.
You May Like: How To Apply For Medicaid In Houston
Medicaid Vs Medicare Reimbursement
The other most prominent difference between Medicare and Medicaid is how they pay money or reimburse hospitals and doctors for the services they provide.
Medicare will pay hospitals and doctors for their services at a specific rate they set. Usually, Medicare pays about 80 percent of the costs. Doctors can choose if they want to accept Medicare rates or not.
Medicaid pays hospitals and doctors the same way as Medicare does but does it through a program that sends payments to the providers. For a doctor to be a Medicaid provider, they have to accept whatever Medicaid pays as payment in full.
Which Program Applies To You
It should be easy to know which one you qualify for mostly dependent on your income. It is also possible to qualify for both. You are dual eligible if you qualify for Medicaid by the means test and for Medicare Part A and/or Part B by age or disability.Many states run Medicare Savings Programs and if you are dual eligible you may qualify for benefits through this program. MSP will take care of premiums, copays, and deductibles to further reduce your costs. It will vary based on income, but some people will receive all out of pocket expense paid. These people are considered Full Benefit Dual Eligible . Persons in an MSP automatically receive Medicare Extra Help eliminating most if not all prescription copays..
Also Check: Washington State Medicaid Residency Requirements
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 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 in 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.
