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Medicare vs. Medicaid

October 6, 2016

What are the differences between Medicare and Medicaid?

Because there are some similarities and potential overlap between the Medicare and Medicaid programs, it may be a good idea to learn the basics of each program. We hope this article will help you understand how these programs are different.

Both Medicare and Medicaid are federally funded health insurance programs under the Centers for Medicare & Medicaid Services (CMS). Eligibility, coverage, and costs differ depending on a variety of factors. The following table compares both programs side by side.

MedicareMedicaid
Brief DescriptionFederal health insurance program available to United States citizens and permanent legal residents of 5 or more continuous years who are 65 and older. Also available to those who qualify before age 65 due to disability, end-stage renal disease, or amyotrophic lateral sclerosis (ALS).Federal and state administered health insurance program available to individuals and families with limited income and resources who satisfy federal and state residency requirements
Government OversightFederal governmentFederal and state governments
CoverageOriginal Medicare includes Part A (hospital insurance) and Part B (medical insurance). Many people are automatically enrolled in Original Medicare when they become eligible.

Some beneficiaries add prescription drug coverage through an optional stand-alone Medicare Part D Prescription Drug Plan.

You may also apply for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of these costs, such as copayments, coinsurance, and deductibles.

 

Yet another option is to get your Original Medicare coverage through a Medicare Advantage plan. You must continue paying your monthly Medicare Part B premium.

Each state determines what its Medicaid program will cover, but there are mandatory benefits that every state program must include. Here’s a partial list of these benefits.

·      Inpatient and outpatient hospital services

·      Physician services

·      Home health services

·      Certain scans and screenings, such as x-rays

·      Certain nursing facility services

·      Transportation related to medical care

CostsDepending on the type of Medicare coverage you have, you may be responsible for certain out-of-pocket costs such as monthly premiums, annual deductibles, copayments, and co-insurance.Depending on which state you live in, and your income and resources, you may be responsible for out-of-pocket costs such as premiums, deductibles, copayments, and coinsurance up to a maximum amount. Depending on the state, some people, such as children and pregnant women, are not responsible for paying out-of-pocket costs.
Eligibility/EnrollmentMany people are automatically enrolled in Medicare Part A and Part B when they turn 65 or enter their 25th month of receiving disability benefits. Those who are not automatically enrolled can apply through Social Security.Eligibility requirements vary by state. Call the Medicaid office in your state to see if you qualify and when you can enroll.

 

Some people may be “dual eligible,” meaning that they qualify for both Medicare and Medicaid. Medicare Savings Programs are state-run Medicaid programs, and eligible income and resource levels are determined by each state. There are four types of Medicare Savings Programs, each with different eligibility requirements:

  • Qualified Medicare Beneficiaries (QMB): Helps pay Medicare Part A and Part B premiums, deductibles, co-payments, and co-insurance
  • Specified Low-Income Medicare Beneficiaries (SLMB): Helps pay Medicare Part B premiums only
  • Qualifying Individuals (QI): Helps pay Medicare Part B premiums only
  • Qualified Disabled and Working Individuals (QDWI): Helps pay Medicare Part A premiums only

To learn more about Medicaid, or to apply for Medicaid assistance, you can contact your State Medicaid office or visit the Medicaid.gov website. To apply for Medicare, you can call Social Security at 1-800-772-1213 (TTY users call 1-800-325-0778) or visit the Social Security website. Representatives are available Monday through Friday, from 7AM to 7PM.

If your retirement benefits will come from the Railroad Retirement Board, contact the agency at

1-877-772-5772 (TTY users call 1-312-751-4701) Monday through Friday, 9AM to 3:30PM.

To compare Medicare plans in the area where you live, just enter your zip code in the form on this page to get started.