What is the Difference Between Medicare and Medicaid?
Are you unsure of the difference between Medicare and Medicaid? Don’t worry; you’re not alone. While the programs are commonly confused with one another, they are two very different programs. For example, Medicaid and Medicare are both government health insurance programs. However, the two programs provide coverage to separate groups of people. They also offer different insurance benefits to those who qualify.
To make a more informed decision on your healthcare, make sure to take the necessary time to research each program. While you may be eligible for only one program, some individuals may be eligible to receive benefits from both.
Understanding the Medicare Health Insurance Program
In the United States, Medicare is the second-largest health insurance program. For those who are at least 65 or older, this government assistance program provides them with the necessary health insurance benefits they need. Typically, this program is reserved for seniors. However, it also provides insurance to younger individuals with certain disabilities. For example, those under 65 that suffer from mental illness or diseases such as Parkinson’s, Multiple Sclerosis, or Alzheimer’s may qualify for Medicare benefits.
Medicare eligibility is primarily based upon your age and disability status. This program is not income-based, which means you can qualify regardless of your gross income. During the enrollment period, you can build your own insurance plan by choosing the “parts” of Medicare that you wish to enroll in.
- Care Plans – Part A: Covers inpatient hospital, hospice, and skilled nursing facility care.
- Medical Service Plans – Part B: Provides medically necessary services, including visits with primary care and specialty doctors and laboratory services.
- Advantage Plans – Part C: Provides a combination of Part A, Part B, and Part D benefits.
- Prescription Drug Plans – Part D: Offers prescription drug coverage benefits to any Part A or Part B plan.
If you currently receive disability benefits through Social Security Disability Insurance (SSDI), then you can qualify for this program based on your disability status.
Understanding the Medicaid Health Insurance Program
Medicaid is the largest source of health insurance in the United States. This program currently serves over 72.5 million low-income Americans. These state programs provide low-income households access to affordable healthcare. Coverage, benefits, and eligibility requirements vary between state programs. Therefore, requirements may include the following:
- Income
- Household size
- Citizenship or immigration status
- Age, disability status, parental status, and other state-imposed eligibility requirements
Moreover, if you receive SSDI benefits, you will meet state-imposed qualifications.
Dually Eligible: Qualifying for Both Medicaid and Medicare
There are currently twelve million seniors and disabled persons enrolled in both Medicaid and Medicare. If you are dually eligible, you will receive extra coverage benefits and may receive help paying for out-of-pocket Medicare expenses. Some of these expenses may include:
- Part A and Part B premiums
- Coinsurance
- Copayments
- Deductibles
Depending on your state’s Medicaid program, you may be eligible for additional insurance benefits. This program is income-based. Therefore, the amount of help you can receive for your out-of-pocket healthcare expenses is based on your gross income.
Get Help with Your Applications
While these two federal programs are very different, you may be eligible for one or even both. Most importantly, it is vital to apply for benefits as soon as you become eligible. You can apply for Medicare online by visiting your local Social Security office, or over the phone. Applying for Medicaid can be done through your state agency or the health insurance marketplace.
Do you need help with how to apply for SSA disability benefits but not sure where to start? The helpful staff at Disability Support Services can answer any questions you may have. Contact DSS today!
