Some people are under the impression that Medicare and Medicaid are the same health insurance program. However, there are a few key differences between Medicare and Medicaid. This article will explain how different Medicare and Medicaid really are so that you can make more informed decisions about your medical coverage.

Medicare VS. Medicaid coverage

Medicare and Medicaid are both government programs, but they are not the same thing.

Medicaid is a federal/state partnership that pays for certain medical services for some people with low incomes as well as certain disabled people who meet financial eligibility requirements.

Medicare is a program to help older Americans pay for health care services. It covers most of the cost of hospital stays, doctor visits, and other types of medical care. You can choose any doctor you want and go anywhere in the country for treatment. There are no deductibles or co-payments (you pay only what your insurance does not cover). If you have Medicare Part B, you also have prescription drug coverage through Medicare Part D.

Eligibility

Medicaid has financial requirements tied to eligibility. Most states provide Medicaid coverage to children up to age 19 whose family income is at or below 133% of the federal poverty level (FPL). Some states may provide coverage up to 200% FPL if the child lives with a parent who receives Supplemental Security Income (SSI) benefits based on an approved claim filed by the child’s legally responsible relative (LRI).

How do you see if you are eligible for Medicaid?

It depends on where you live. Medicaid eligibility requirements vary by state and sometimes by county or city. To find out if you’re eligible for Medicaid and which programs are available in your state, visit medicaid.gov/medicaid/by-state/index.html

You can also check out this article we published on seeing if you are eligible for Medicaid.

Medicare eligibility varies depending on your age, income, disability status, and whether you or your spouse worked long enough to be eligible for Social Security benefits. Medicaid eligibility depends on income and other factors. You can find out if you qualify for Medicare or Medicaid by using the online tool at medicare.gov or medicaid.gov.

Medicare is available to anyone who has paid into Social Security or a Railroad Retirement Board. It is a federal health insurance program for people 65 and older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant.)

Costs

The cost of Medicaid depends on which state you live in, as well as your income level and whether you’re single or a family of two or more people living together. You may also need to meet certain financial requirements before you can get Medicaid coverage.

Medicaid costs are based on your income level: If your income is below 133% of the federal poverty level, then you’re eligible for Medicaid coverage with no premium payment required

Medicare is available to anyone who meets the eligibility requirements — even if you have another source of health insurance. If you receive Social Security benefits before turning 65 and your income is less than $85,000 for an individual or $170,000 for a couple (in 2019), you will automatically be enrolled in Medicare Part A. You might also be able to sign up for Part B if you are at least 65 years old and have paid Medicare taxes while working and aren’t eligible for premium-free Part A coverage because of your income or other reasons.

Medicare costs vary based on which state you live in. For example, the average monthly premium for Part B (medical insurance) in New York City is $121 per month as of 2019 — but this could be higher depending on your income level or financial situation. Part A is free to eligible beneficiaries while Part B requires a monthly premium that varies based on income level.

Medicare Advantage plans are also available, but they’re not free as they require a monthly premium as well as coinsurance, copayments, and deductibles.

Medicare Advantage plans must cover everything that Original Medicare does except hospice care. If you enroll in a Medicare Advantage plan, your out-of-pocket costs may be higher than those for Original Medicare because there are no deductibles or co-pays for services covered by Medicare Advantage plans.

Enrollment

Medicare can be obtained by enrolling in the program when you turn 65 years old (or earlier if you qualify), while Medicaid is available to those who meet specific eligibility requirements set by each state.

To sign up for Medicare, you must first apply through an enrollment application known as Form 1040-ES. You can apply for Medicare online at www.ssa.gov/medicare/. You’ll need your Social Security number, date of birth, and mailing address to apply online. If you don’t have access to the internet or want help with your application process, call 1-800-772-1213 or TTY: 1-800-325-0778 weekdays from 7 a.m.-7 p.m., Central Time

You can sign up for Medicare when you turn 65, but if you want to enroll before age 65 (for example, if you’re disabled), visit medicare.gov/earlysignup to learn more about how to enroll early.

For Medicaid, you must apply directly at your local Department of Social Services office or local Health and Human Services office in person or over the phone. You may also be asked to complete an application form before your interview takes place. The application process can take anywhere from two weeks to several months depending on how quickly the state processes applications, so be prepared to wait if your application is taking longer than expected

You can enroll in Medicare at any time during the year; however, you must enroll in Medicaid within five months after you apply (in most states).

 

Takeaways

As you can see, Medicare and Medicaid are some of the most important insurances in the country. Everyone in America should take the time to learn more about these programs, as they will be available to most people at some point during their lives. And when that time comes, it is best to understand how each program works and what you can expect from them. The best way to do this is if you have knowledge of these programs yourself so that you can make an informed decision.