COMPLIANCE

Medicare vs Medicaid

Medicare vs Medicaid

These two terms sound similar and it is hard to keep them straight. Especially, if you are looking to see what insurance will cover different services for yourself or a loved one. So, what is the difference? Medicare is a federally funded program that offers coverage to individuals 65years old or older, as well as individuals with certain disabilities. Medicaid is a state and federally, offering free or low-cost health care to lower income individuals or families. These two programs are different but, can be used together or independently depending on each situation.

 

What is Medicare?

Adults become eligible for Medicare when they turn 65years old. You may be eligible for and automatically enrolled in the program if you have been receiving disability benefits for more than 24 months. If you are automatically enrolled, you will be enrolled in Medicare part A and B. If you are not interested in Medicare part B benefits you will have to contact Medicare directly. There typically are premiums attached when enrolled into the part B benefits.

If you are not automatically enrolled, you will need to enroll during your enrollment window. You can enroll online at Medicare.gov or on the phone or in person with your local Medicare office.

 

Medicare Part A:

Part A is primarily for hospital coverage. However, it also covers short-term skilled nursing care, hospice, and home healthcare. If you and or your loved one have been paying into Medicare through your employer for 10 years or more, Part A is free. If you have not be paying into Medicare for the 10-year minimum you there will be premiums attached.

 

Medicare Part B:

Part B covers medical services such as medical equipment, doctor’s appointments, ambulance services, and outpatient care. Generally, most individuals choose to have at least Medicare Part A and B. However, there are often co-pays and deductibles to meet with part B and you will likely have to pay a premium to have part B.

 

Medicare Part D:

Part D covers prescriptions medications. This is optional coverage through Medicare and has monthly premiums which varies depending on the plan you select.

Hint: when selecting which prescription drug plan is right for you. Have a list of all the medications you are on to see how much your prescriptions will cost you and if the plan covers your prescribed medications.

 

Medicaid:

Medicaid insurance offers low-income individuals at any age to have coverage. To enroll in this insurance option there are strict income requirements. You and/or your loved one can enroll or apply through your local Medicaid office or through the Health Insurance Marketplace during open enrollment. Medicaid will cover most health services; hospitalizations, clinical treatment, lab services, and more. Once you turn the age of 65 if you already had Medicaid you will still qualify for Medicaid and will also be eligible to enroll in Medicare. Medicaid would then pay for your Plan B premiums. It can also be used to cover long-term care for individuals with exhausted resources.

 

It is very important to read and know the basics of your plan and what you are enrolled in. Insurance can be very complicated, be sure to ask lots of questions.  

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