If you don’t know the difference between Medicare vs Medicaid health plans, you’re not alone. The two names are so close to one another, yet they’re completely different health plans.
In 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act into law. Below, we’ll go over the difference between Medicare and Medicaid. Also, we discuss dual-eligibility and Medicaid with Medicare options.
Difference Between Medicare vs Medicaid Coverage
Although the two programs share a similar prefix “medi” and offer similar types of medical coverage, Medicare and Medicaid are two different products.
Nearly every American will eventually qualify for Medicare, but Medicaid is available only to low-income individuals and to children below the federal poverty levels.
When you think Medicare, think “care” for those who are 65 and older; also, those receiving disability for at least 24 months. Think of Medicaid as “aid” to assist those who are in need.
Medicare offers insurance to US citizens who are 65 and older at reduced rate premiums. Medicaid is free. Medicare is not free.
Medicare is a federal program. The Medicare model is similar to the typical type of insurance that you may receive from your employer.
Premiums are due monthly; although depending on your plan, a co-pay may be a requirement.
You qualify for Medicare if:
- US citizens 65 years and older
- Anyone collecting disability for 24 months regardless of age
- Those with end-stage renal failure or Lou Gehrig’s disease
Medicaid is free to individuals in need, mostly children. Medicaid is a joint program between federal and state governments. Unlike Medicare, the rules vary from state to state.
Medicaid covers the following:
- Doctor visits
- Inpatient and outpatient hospital care
- Lab tests
- Home health care
- Hospice care
- Medical equipment and supplies
- Non-emergency medical transportation services
- Dental care (up to age 21)
- Long Term Care
Just because Medicaid is free doesn’t mean it’s available to everyone.
There are certain eligibility criteria that vary from state to state. In general, women who are pregnant who meet state and federal guidelines generally receive same day Medicaid.
Women who do not have insurance and who are suffering from breast or cervical cancer are also eligible for Medicaid. Approval time for Medicaid can take up to 60 days.
Typically Medicaid benefits are only available to US citizens; however, children of illegal immigrants can receive benefits.
If you receive Social Security Supplemental benefits, you’ll automatically qualify for Medicaid. Also, Medicaid has benefits Medicare doesn’t; this includes vision, dental, and long-term custodial care.
Dual Eligibility for Both Medicare & Medicaid
Beneficiaries can collect both Medicare and Medicaid, this is “dual eligibility.” Medicare will pay out before Medicaid. Therefore, your Medicaid will act like supplemental insurance.
To Qualify for Dual-Eligibility:
- Meet the income requirements in your state for Medicaid
- Eligible for Medicare due to aging in or disability
If you think you may be dual eligible, contact your state health department for information on how to apply.
How Supplemental Medicare Options Work with Medicaid
There are many different Medicaid qualification levels, and each state has multiple Medicaid programs. For those with the lowest income, they qualify for the QMB program.
QMB stands for Qualified Medicare Beneficiary. Also, the QMB program has extremely low out of pocket costs and offers the highest level of coverage.
For those enrolling in a Medicare Advantage plan, you need a Medicare Special Needs Plan specifically for those with dual eligibility. The Medicare Savings programs are Medicaid programs for those with Medicare.
Medicaid Guarantee Issue for Loss of Coverage
In certain states, with certain companies, losing Medicaid means gaining eligibility for Guaranteed Issue (GI) Rights. GI rights allow beneficiaries to select Medigap coverage without underwriting; so, a beneficiary with health issues can qualify for coverage without fear of denial or higher premiums.
You must have Medicare Part B to enroll in a Medigap policy. Not all policies are available to all beneficiaries, with every company.
Those with Medicare in Texas, losing Medicaid eligibility, can qualify for GI rights with Aetna, Bankers Fidelity, Central States Indemnity (CSI), Cigna, Combined Insurance, Gerber, GPM, Manhattan Life, Medico, Mutual of Omaha, New Era, TransAmerica, United American, and United Healthcare(UHC).
Additionally, Aetna can assist qualifying individuals needing Medigap coverage in Maine, Oregon, Utah, Wisconsin, and Montana. CSI has plans with GI rights available to eligible applicants in the following states; Utah, Maryland, Nebraska, Oregon, Wisconsin, and California.
Oregon Beneficiaries have plan options through Gerber, GPM, Manhattan Life, TransAmerica, United American, and United Healthcare. However, California has options available through UHC, United American, TransAmerica, and MOO.
The state you live in has a huge impact on availability and eligibility. Contact one of our brokers to find the best coverage for your needs.
How Medicaid vs Medicare Works for Nursing Homes
The biggest difference is that Medicaid covers nursing home care, while Medicare doesn’t fully cover it.
Part A will cover up to 100 days of Skilled Nursing facility care, days 21-100 you must pay a copayment of $170.50 per day. However, if you have a Medigap Plan, then that copayment will be covered.
How to Apply for Medicaid
You can apply for Medicaid in person at your local office, online or through the mail. You must present a number of documents; however, not all these documents will pertain to you.
- Driver’s License
- Bank statement, annuities, IRA’s, brokerage accounts, pension statements, mortgage
- Civil service, Veteran Administration and disability statements
- Prepaid Burial plot
- Social security letter
- Supplemental health insurance card
- Life insurance card
- Power of attorney
- Your Medicare card
Medicare and Medicaid coverage differs from one another. Medicare is primarily for the elderly, Medicaid covers low-income individuals and children.
Be sure to understand the types of coverage, eligibility, and options before enrolling.
Medicare and Medicaid Help
Medicaid and Medicare are not that similar. However, Medicare is available to all individuals 65 and older. Medicaid is available to individuals and families living below the poverty level.
Once you have clarity on the facts regarding Medicare vs Medicaid, you can make the right decisions. Qualifying for each program is possible.
If you have questions about your Medicare options, contact us today. Our senior Medicare agents are here to help inform you of all your Medicare options. You can also compare rates online here.