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Medicare Vs. Medicaid: What’s The Difference?

Medicare — and all the trimmings that come with it — can be confusing and difficult to navigate, even for the experts.  Finding the right coverage for the right budget, finding out what, if any, savings you may qualify for, and staying up-to-date with changes to your policy can seem like an overwhelming task.  Here we will break down two commonly confused terms: Medicare and Medicaid, and help you determine some key differences when it comes to finding out what program is right for you.  

What Is Medicare?

Medicare is a federal health insurance program offered to U.S. citizens who are 65 and older.  Younger people with disabilities, as well as  as well as some younger people with disabilities who are on Social Security Disability Insurance (SSDI) (although eligibility typically happens after a 2 year waiting period following enrollment in SSDI).  People with renal disease who require dialysis are also eligible.  

Medicare Parts

Medicare comes broken into parts: Part A, B, C, and D.  Each part covers different things, and comes with different enrollment procedures and costs.  Here’s a basic breakdown: 

Medicare Parts:What It Covers:Average Premium:Average Deductibles and Coinsurance:
Part Acovers more expensive, long-term, and specialized healthcare needs, such as hospital in-patient stays, the costs of nursing homes and hospice, and sometimes in-home care.Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A“). If you buy Part A, you’ll pay up to $458 each month in 2020. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.$1,408 deductibleDays 1-60: $0 coinsurance Days 61-90: $352 coinsurance Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90Beyond lifetime reserve days: all costs
Part Bcovers more routine care, such as doctors’ services, medical supplies, check ups, outpatient services, and preventative care. The standard Part B premium amount is $144.60 (or higher depending on your income).$198. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services. 
Part CMedicare part C is a bit different, as it’s a Medicare Advantage plansimilar to a Medigap plan, but it includes a prescription drug plan and it usually comes at little or no cost.  N/A
Part Dcovers prescription drugs, as well as shots and vaccinations.The Part D monthly premium varies by plan (higher-income consumers may pay more). On average, your Medicare Part D plan pays out around $4,020 as of 2020 before the gap begins.  

What Is Medicaid?

If you find yourself struggling to afford the cost of your healthcare, you may qualify for federal and state subsidies.  This often comes in the form of Medicaid.  Medicaid is a program provided by the federal government for those who qualify due to disability or low income.  It covers some or all of the costs of Medicare.  Medicaid can help cover services that Medicare doesn’t cover, or only partially covers, such as: 

  • Nursing home care
  • Personal care 
  • Transportation to medical services 
  • Home- and community-based services 
  • dental, vision, and hearing services 

How Do I Know If I Qualify?

According to medicare.gov, you may be eligible for Medicaid if you have limited income and are: 

  • 65 or older 
  • A child under 19 
  • Pregnant 
  • Living with a disability 
  • A parent or adult caring for a child 
  • An adult without dependent children (in certain states)

What Does Medicaid Cover?

When you enroll in Medicaid, you may be able to get access to health care benefits such as: 

• Doctor visits 

• Hospital stays 

• Long-term services and supports 

• Preventive care (such as immunizations, mammograms, colonoscopies, etc.)

• Prenatal and maternity care 

• Mental health care 

• Necessary medications 

• Vision and dental care (for children) 

Can I Have Both Medicare and Medicaid?

It’s possible to qualify for both Medicare and Medicaid.  If you qualify for both Medicare and Medicaid, it’s referred to as having “Dual Eligibility”.   People who have both Medicare and full Medicaid will likely have all of their healthcare costs covered.  

For More Information, Visit HealthCare.gov/medicaid-chip/getting-medicaid-chip to learn more about Medicaid. Visit Medicare.gov/contacts, or call 1-800-MEDICARE to get the phone number for your State Medical Assistance (Medicaid) office. 

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Disclaimers: Outside of the Medicare Annual Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible. Plan availability varies by region and state. Callers will be directed to a licensed insurance agent with a third-party partner of MedicareGap.org who can provide more information about Medicare Advantage plans offered by one or several Medicare-contracted carrier(s). Enrollment in any plan depends on contract renewal. Medicare has neither reviewed nor endorsed the information contained in this advertisement. Not connected with, or endorsed by, the U.S. government or the federal Medicare program. This information is not a complete description of benefits. For a complete listing of Medicare plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult www.medicare.gov.