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Michael T Braden November 2, 2023 MEDICARE VS MEDICAID
MEDICARE IS NOT MEDICAID
Medicare is not Medicaid and Medicaid is not Medicare.
I wanted to write this article for anyone, but especially for those who are going to be turning 65 in the next year. You see, it seems that there is a big misunderstanding around Medicare and Medicaid with many people thinking they are one in the same. In reality, they are not similar at all. Hopefully this article will help to explain and educate everyone on the differences between Medicare and Medicaid.
Most people are confused and believe that Medicare and Medicaid are the same thing. SImilar to Medicare Supplements andMedigap being the same. However, there iss a stark difference. Medicare is the National Health Insurance Program for Americans age 65 and over and those with ALS, Renal Failure or thiose who have been issued a Disability designatoion from the Social Security Administration. Medicaid, operates at the state level and they help provide Healthcare and other vital services to low income individuals, seniors, single mothers and children.
Medicare and Medicaid are very different programs the U.S. government created to cover the medical bills of two distinct groups of Americans.
Medicare is the National Health Insurance Program for Americans age 65 and older along with individuals diagnosed with a Disability, those with ALS and anyone diagnosed with End Stage renal Disease.
Medicaid is a Government Assistance Program for Low Income Individuals of any age. Although they do receive subsidies and funding from the Federal Government, Medicaid is run by each state, so even the the programs will be similar, each state has their own way of doing things, for example in California their Medicaid Program is referred to as Medi-Cal.
In order for an individual to qualify for for benefits under Medicaid, they must fall below the income guidelines.
ELIGIBILITY GUIDELINE FOR MEDICARE & MEDICAID
One of the biggest differences between Medicaid and Medicare is who qualifies for coverage. Here’s all you need to know about how Medicare and Medicaid eligibility differs.
MEDICARE IS NOT MEDICAID
Who qualifies for Medicare? People who are 65 or older qualify for Medicare as long as they’re both naturalized U.S. citizens and Resident Aliens who have Green Cards and have been granted Full-Time Citizenship Status. that have a or lawful permanent residents.
MEDICAID IS NOT MEDICARE
As for who qualifies for Medicaid, that differs from state to state, but it always provides health coverage to individuals who:
Have extremely Low Incomes (with or without children).
Individuals who have been classified as having one or more disabilities.
Women who are Pregnant.
Seniors
Many states extend Medicaid coverage beyond what federal law requires. For example, most have expanded their programs to cover nearly all low-income residents. Other state Medicaid programs cover people receiving home- and community-based services and children in foster care.
Did you know that Medicare serves well over 60 Million American's but Medicaid has nearly 73 million beneficiaries nationwide?
DUAL ELIGIBLE DEFINITION
Individuals who are referred to as being Dual Eligible are those people who meet the qualification for both Medicaid and Medicare.
You might be surprised that according to the United States Government,there are more than 12 Million people in America, who are "Dual Eligible Members". 12 Million! That is a lot of people.
Typically, an individual meets the requirements for Dual eligibility by being classified and a Low Income Senior Citizen (Senior Citizens are those age 65 and older). Or anyone of any age who has received a person with a Full-Time Disability from the Social Security Administration.
If you have Medicare and Medicaid coverage, Medicaid may help with your Medicare premiums and out-of-pocket expenses, such as your deductible amounts, and co-payments. Additionally, there are additional benefits for Skilled Nursing Care that goes beyond Medicare's Skilled Nursing Care Limit of 100 Days.
For anyone who meets the definition as a Dual Eligible person, Medicare always pays first and then Medicaid would be the secondary payor, at least up until you reach any limits for each individual state.
ENROLLMENT IS DIFFERENT FOR MEDICAID AND MEDICARE
YOUR MEDICARE ENROLLMENT
If you want Medicare coverage, you have to sign up during certain enrollment periods.
Most people first become eligible for Original Medicare, which is another name for Medicare Part A and Part B, during something called the initial enrollment period, or IEP. This seven-month window of time includes:
The three months before you turn 65
The month you turn 65
The three months after you turn 65
People who miss signing up for Medicare Parts A and B — or for a Medicare Advantage plan — during the IEP have to wait until the next general enrollment period rolls around to do so. The Medicare general enrollment period goes from Jan. 1 to March 31 every year.
Another way to get Medicare after the IEP is to qualify for a special enrollment period.
Will you start receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before your 65th birthday? If so, you don’t need to worry about the dates above. You'll automatically get Original Medicare.
If you want Medicare but you don’t get Social Security or RRB benefits four months before you turn 65, you can apply online or at a local Social Security office.
Most people enroll in Medicare prescription drug coverage during the enrollment periods detailed above, too, if they decide to enroll in prescription drug coverage at all.
You can choose not to enroll in a prescription drug plan when you first become eligible for it. If you do that, though, you’ll pay a late penalty for not enrolling in a Medicare Part D Prescription Drug Plan within 63 Days of your Part B Eligibility Date. And, to make matters worse, this penalty never goes away. On average they add on .38 cents per month for every month you did not have a Prescription Drug Plan in force, and that amount is added to each months premium. So instead of lets say a $7.40 Premium each month, and you went 3 years without credible coverage, (36 x .38 = $13.68), you will pay $13.68 in penalties forever, meaning your $7.40 premium is now $21.28 each month!
YOUR MEDICAID ENROLLMENT
With Medicaid, there are NEVER any penalties to worry about and you will not ever need to worry about any dates or deadlines.
You do have to apply and qualify for this health coverage, though. And you qualify for Medicaid based on your income. These income requirements vary a little bit from one state to another. You should contact your state's Medicaid Department for the exact qualifications where you live.
We recommend that you contact your state Medicaid agency to apply for this kind of coverage. Another way to apply for Medicaid is through the health insurance marketplace set up by the Affordable Care Act, or Obamacare.
BENEFITS AND COVERAGE ARE VASTLY DIFFERENT
Both Medicare and Medicaid cover a lot of medical procedures and costs. They do so in different ways and to different extents, though.
YOUR BENEFITS UNDER MEDICARE
Medicare coverage is a lot more complicated than Medicaid coverage. Medicare is made up of four main parts: A, B, C and D.
MEDICARE PART A
Medicare Part covers your In-Patient Costs and Benefits.Medicare Part A helps pay for hospital costs, first and foremost.
MEDICARE PART B
Medicare Part B covers your Out-Patient Care and Services.
MEDICARE PART C = MEDICARE ADVANTAGE
Medicare Part C also is known as Medicare Advantage. You get Medicare Advantage or Part C plans through private insurance companies. They provide the same coverage Part A and Part B provide. Sometimes they cover care Original Medicare doesn’t, like dental work, hearing tests and prescription drugs.
MEDICARE PART D (PRESCRIPTION DRUG COVERAGE)
Medicare Part D covers prescription drugs. Not all Part D plans cover all drugs, though. Some plans may cover the medications you take, while other plans won't. Because of this, it's important to review a plan's list of covered drugs, or "formulary,” before you join it.
YOUR COMMON BENEFITS WITH MEDICAID
Medicaid coverage is more straightforward than Medicare coverage, but that doesn’t mean it’s always easy to understand. That’s because although all state Medicaid programs have to provide certain benefits, they can choose whether or not to provide others.
Here are some of the Medicaid benefits every state must offer:
Inpatient and outpatient hospital services
Doctor visits
Lab tests
X-rays
Family planning services
Home health services
Nursing facility services
And here are some of the optional Medicaid benefits states can offer:
Chiropractic care
Dental care
Eyeglasses
Prescription drugs
Physical therapy
Speech, hearing and language disorder services
Other diagnostic, screening, preventive and rehabilitative services
TYPICALLY BENEFICIARIES SPEND LESS MONEY ON MEDICAID THAN THEY DO IN MEDICARE
Another key difference between Medicare and Medicaid is how much they cost.
The main difference between the two programs is people who get Medicare pay a larger part of the costs for covered procedures and services than Medicaid recipients do.
In fact, people who get Medicaid usually pay no part of the costs for covered medical care. Sometimes they’re charged a small copay, but that’s about it.
Medicare recipients, though, often have to pay premiums, deductibles and other out-of-pocket costs for coverage. And not only that, but they often pay them for multiple Medicare “parts.”
For example:
Most Americans don't pay a premium for Part A. Those who do pay up to $437 each month.
The majority do pay a premium for Medicare Part B. The standard amount is $164.90 per month, though it could be higher depending on your income.
Medicare Part D recipients usually pay monthly premiums, too. How much they pay depends on the drug plan they choose.
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