The Difference Between Medicare and Medicaid

If you’ve ever wondered what the difference is between Medicare and Medicaid, you’re certainly not alone. It’s one of the most common questions we hear from patients.

While they may sound similar, there are many differences between Medicare and Medicaid. Let’s break down the essential details about each plan and how they differ in who or what they cover.

What is Medicare?

Medicare is a federally funded healthcare program for individuals over 65 or younger people with a qualifying disability. People with end-stage renal disease also qualify for Medicare.

There are different types of Medicare, including:

  • Original Medicare (Part A and B) administered by the U.S. government
  • Medicare Advantage (Part C) administered by Medicare-approved private insurance companies
  • Prescription Drug Plans (Part D) administered by private prescription drug companies

People who qualify for Medicare can choose coverage under Original Medicare or a Medicare Advantage Plan. A Medicare Advantage Plan offers additional coverage for care that Original Medicare does not cover, such as prescription drugs and hearing, vision, and dental services.

What is Medicaid?

Medicaid covers healthcare services for people who meet certain low income and family size eligibility requirements or certain individuals with disabilities. These eligibility requirements vary by state.

Both the federal and state governments fund Medicaid, but state governments administer the plans. There are two main types of Medicaid plans:

  • Traditional care plans – These are fee-for-service plans where the member can go to any doctor or hospital that accepts Medicaid.
  • Managed care plans – In a managed plan, the member receives all care from a specific organization (Managed Care Organization) or insurer that has partnered with the state.

How Does Coverage Differ?

Medicare coverage differs depending on the plan. Medicare Advantage Plans, for example, cover many services that Original Medicare does not.

Medicaid coverage also varies depending on the plan. Coverage differs between traditional fee-for-service plans and managed care plans.

Can I Qualify for Both Medicare and Medicaid?

Certain people can be eligible for Medicare and Medicaid at the same time. This is called dual eligibility. Individuals who are dual-eligible qualify for Medicare because of age or disability and meet low income requirements.

Most people who are dual-eligible use Medicare for their primary coverage and have Medicaid as supplemental insurance. In some cases, Medicaid may cover certain services that Medicare does not.

What Does it Cost?

The cost for Medicare varies depending on the type of plan you have. Although some Medicare Advantage Plans have $0 premiums, most people will pay premiums, deductibles, and copays. States offer Medicare Savings Programs to help cover these out-of-pocket costs.

Most people who receive Medicaid don’t have to pay anything for healthcare services. However, certain Medicaid expansion programs can come with added costs.

How Do I Apply?

You can apply for Medicare through the Social Security Administration as soon as you are eligible, which is three months before you turn 65. If you only need Original Medicare, you won’t need to re-apply. However, Medicare Advantage Plan members need to enroll every year.

Applying for Medicare can be done through healthcare.gov or your state’s Medicaid website. You must re-apply every year to show that you still meet the Medicaid eligibility requirements.

Next Steps

If you still have questions about Medicare, we’re ready to help. Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.

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As you prepare for Medicare, you’ll be faced with many important decisions. LEON Health wants to help you select the best options for your needs.

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