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 are 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, what dual-eligibility is, and how Medicaid works with supplemental 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 considered a “senior.” 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 administered by the federal government. The Medicare model is similar to the typical type of insurance that you may receive from your employer.
Premiums are paid monthly, and depending on your plan, a co-pay may be required.
You qualify for Medicare if:
- US citizens 65 years and older
- Anyone collecting disability for 24 months regardless of age
- Those diagnosed with end-stage renal failure or Lou Gehrig’s disease
Medicaid is provided 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 extended 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. Cards are usually received within two weeks.
If you’re not an American citizen, you won’t be reported if you apply for benefits. Typically Medicaid benefits are extended only to US citizens, however, children of undocumented aliens can receive benefits.
If you receive Social Security Supplemental benefits, you’ll automatically qualify for Medicaid.
Some additional benefits that Medicaid has where Medicare doesn’t include vision, dental, and long-term custodial care.
Dual Eligibility for Both Medicare & Medicaid
Beneficiaries can collect both Medicare and Medicaid, this is called “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. The QMB program has an extremely low out of pocket costs and offers the highest level of coverage.
The Medicare Savings programs are Medicaid programs for those with Medicare.
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’ll be required to present a number of documents. 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 extended to primarily the elderly, Medicaid covers low-income individuals and children.
A smart consumer is an informed consumer. Be sure to understand the types of coverage, eligibility and what you’re entitled to.
Medicaid and Medicare Help
As stated above, Medicaid and Medicare are not that similar. Medicare is available to all individuals 65 and older. Medicaid is extended 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.