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Medicare and Medicaid: What’s the Difference?

Both Medicare and Medicaid are government-administered healthcare programs and many people get the two confused. The names aren’t all that different, so it can be easy to jumble the information. This info is worthwhile so you can know the differences and which program you may be eligible for you. Check out our article about Medicare vs. Group Retiree Medical Benefits. Every year, thousands of people turn 65 and have to make the decision, so knowing all the pertinent information becomes paramount.

What is Medicare?  

Available to US citizens and permanent legal citizens of at least five years in a row who are over the age of 65, Medicare is one of the most popular health insurance programs in the country. Younger people may qualify if they have certain health conditions (Lou Gehrig’s disease and permanent kidney failure being two) or if they have received 24 consecutive months of Social Security disability benefits, or disability benefits from the Railroad Retirement Board. There are over 59 million Medicare enrollees in America.

Many citizens become automatically enrolled in Medicare Part A and Part B when they become eligible.

Part A consists of:

  • Hospital care
  • Hospice care
  • May be premium free if you/your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters) in total

While Part B consists of:

  • Medical care from Physicians and outpatient facilities
  • Durable medical equipment and supplies
  • Preventative services
  • Comes with a monthly premium

Both of these plans have deductibles and co-insurance or co-payment amounts set at the federal level and these amounts have been known to change annually. Medicare Advantage – also known as Medicare Part C – is a newer way to get Medicare benefits from a privately-held company. Medicare Advantage plans must cover everything from Part A and Part B and often include additional benefits such as routine vision and routine dental care. With Medicare Advantage enrollees pay the Part B premium.

What is Medicaid?

To be eligible for Medicaid, you must be:

  • A low-income person
  • A low-income person with a disability

Funded at both the state and federal levels, Medicaid is intended for individuals and their families to help cover their medical costs and long-term custodial care. Requirements vary by state and some coverage may overlap with Medicare (such as doctor’s services and hospital care). Medicaid, depending on the state, may also cover routine dental and routine vision services and hearing aids. State governments have much more control over this coverage than Medicare, and has no federal-set premiums, coinsurance, or deductibles.

Medicaid also provides assistance to children: in 2015, 29.6 million (43% of all Medicaid patients) of Medicaid enrollees were children.

Can I be enrolled in Medicare and Medicaid?

If you’re a low-income person with a disability or over 65 with end-stage renal disease or amyotrophic lateral sclerosis, you may be eligible for both services.

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