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Medicare vs Medicaid

What is Medicare versus Medicaid?

If you’re wondering about the difference between Medicare and Medicaid, you’re likely not alone. While the two are sometimes confused for one another, there are distinct differences. Let’s parse these out.

In this article:

What is Medicare?Jump to
What is Medicaid?Jump to
What if I Have both Medicaid and Medicare?                                   Jump to

What is Medicare?

Medicare coverage provides health insurance for those who are 65 years or older or who have a disability. It is made up of four distinct parts:

  • Part A (hospital insurance): helps cover inpatient care in hospitals, hospice care, skilled nursing facilities, and home health care.
  • Part B (medical insurance): helps cover services from doctors and other providers, home health care, preventive services, outpatient care, and durable medical equipment such as wheelchairs and walkers.
  • Part C (Medicare Advantage plans): these privately sold plans often offer extended benefits such as dental, vision, and hearing care in addition to prescription drug coverage.
  • Part D (drug coverage): helps cover costs associated with prescription drugs, including many recommended vaccines and other shots.

Eligibility for Medicare does not have anything to do with income. Rather, the criteria are:

  • Those 65 or older
  • Younger people with disabilities
  • People with End Stage Renal Disease, or permanent kidney failure that requires transplant or dialysis

While most people will not pay monthly premiums for Part A, they often will for Part B. In 2022, the Part B premium is $170.10.

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What is Medicaid?

Medicaid programs offer health care coverage assistance for low-income beneficiaries of every age, including families and children, the elderly, pregnant women, and people with disabilities. A federal-state program, Medicaid coverage varies by state and sometimes covers all adults who fall below a given income level.

To qualify for Medicaid, you need to meet a certain set of criteria that varies within states. Eligibility depends on factors including:

  • Household income
  • Family size
  • Age
  • Disability

To get full benefits, you must be a U.S. citizen, a U.S. national, or have a satisfactory immigration status. You can apply for Medicaid (or the Children’s Health Insurance Program) in one of two ways:

  • Through the Health Insurance Marketplace , which will forward your information to your state agency and contact you about enrolling. Additionally, you’ll be able to find out if you might qualify for an individual insurance plan with income-based savings.
  • Through your state Medicaid agency

You can apply year-round as neither Medicaid nor CHIP has an Open Enrollment Period.

What if I Have Both Medicare and Medicaid?

If you’re entitled to both Medicare and Medicaid, you can enroll in a Dual-Eligible Special Needs Plan (D-SNP). This is a type of Medicare Advantage Plan offered by private insurance companies.

Like all Medicare Advantage Plans, D-SNPs replace your Medicare to provide all-in-one coverage for medical and hospital services. They usually also cover prescriptions, vision and dental care. Some come with extra benefits like:

  • Fitness memberships
  • Podiatry services
  • Acupuncture services
  • Post-hospitalization meal benefits
  • Transportation to and from medical appointments
  • Monthly allowances for over-the-counter drug store items

Learn more about D-SNP for dual-eligible Medicare and Medicaid beneficiaries here.

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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.

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Denise Austin, 65, Ensurem Ambassador

Best-Selling Author, Creator of Fit Over 50 Magazine

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