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Medicare or Medicaid: What????????s The Difference?

MEDICARE

Medicare is the national health insurance program for people age 65 and older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities, permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig????????s disease).

Medicare is financed by a portion of the taxes paid by workers and their employers. It is also financed in part by monthly premiums deducted from Social Security checks.

The Centers for Medicare & Medicaid is the agency in charge of both the Medicare and Medicaid programs, but you can sign up for Medicare Part A & B at Social Security.

Medicare has four parts: Part A, Part B, Part C and Part D.

Part A (Hospital) Most people age 65 or older who are citizens or permanent residents of the U. S. qualify for Medicare hospital insurance. While you will pay some of the cost sharing for services, most people will not pay a monthly premium for coverage. (Some people who have not worked long enough will pay a premium for Medicare Part A). People who have been receiving Social Security disability benefits for 24 months are also eligible for Medicare Part A along with those who have permanent kidney failure requiring dialysis or transplant. For what Medicare covers under Part A, visit the Medicare website at http://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html .

Part B (Medical Insurance) Anyone who is eligible for premium-free Medicare hospital insurance (see above) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay higher premiums. For more information, see www.socialsecurity.gov/mediinfo.htm .

Part C (Medicare Advantage Plans) If you have Medicare Part A and B, you can join a Medicare Advantage plan.

Medicare Advantage plans are offered by private companies and approved by Medicare. Medicare Advantage plans may offer more coverage than what you would receive from Part A and B. You might have to pay a monthly premium
for your Medicare Advantage plan because of the extra benefits it offers.

Part D (Prescription Drug Plans) Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B), or a Medicare Advantage Plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay a monthly premium for the coverage. Some beneficiaries with higher monthly incomes will pay a higher monthly premium. See www.socialsecurity.gov/mediinfo.htm . There is Extra Help available to help pay for the annual deductibles, monthly premiums and prescription co-payments related to the Medicare Part D program. You may qualify for Extra Help if you have limited income and resources. Some people will automatically qualify for the Extra Help program. People who: have Medicaid (not Medicare) with prescription drug coverage, have Supplemental Security Income, or participates in a state program that pays for the Medicare premiums will automatically qualify. You can apply online for this help at www.socialsecurity.gov/extrahelp .

If you cannot afford to pay for your Medicare premiums and other costs, you may be able to get help from your state. States offer programs for people who are entitled to Medicare and have low income. These programs may pay some or all of the Medicare premiums and also may pay Medicare deductibles and co-insurance. To qualify you must have Medicare Part A (hospital insurance) and have limited income and resources. The Centers for Medicare & Medicaid offers a publication about these programs called ??????Get Help With Your Medicare Costs?????? (Publication CMS 10126) at www.medicare.gov/publications . Only your state medical assistance agency (Medicaid) can decide if you are eligible for help under these programs. To find out if you are eligible for coverage, you can use the insurance and coverage finder at http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/#howmed .

MEDICAID

As mentioned above in the Medicare section, The Center for Medicare & Medicaid is the federal government agency that administers both Medicare and Medicaid, although people can sign up for Part A and B of Medicare with Social Security. Medicaid is administered by the state governments through a state and federal partnership (The Centers for Medicare & Medicaid). Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families with children. Also, as mentioned above, sometimes the Medicaid program can help pay for some of the Medicare costs for people with low income and resources. That means that you might know someone with low income and resources who meets the requirements to have both Medicare and Medicaid. They have been able to meet the separate eligibility criteria for each program. Being eligible for one program does not mean that you are automatically eligible for the other program. Don????????t confuse the requirements for automatically qualifying for the Extra Help (for Medicare Part D) with the requirements for the state????????s Medicaid program.

The eligibility rules for Medicaid are set by the states and vary from state to state. Medicaid provides hospital and medical coverage to people with low income and little or no resources. To find out the requirements to qualify for Medicaid assistance in Utah and what is covered, visit: http://www.health.utah.gov/medicaid/ .

WHAT????????S THE DIFFERENCE?

Medicare is a federal program. The requirements to be covered and the coverage offered have national guidelines. They do not vary from state to state. Medicare is financed by a portion of the taxes paid by workers and their employers. It is also financed in part by monthly premiums deducted from Social Security checks.

Medicaid is administered by the state governments through a state and federal partnership. Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families with children. Medicaid is jointly funded by the federal government and the states. In some states, Medicaid charges small amounts for certain services.

While the names of these two programs are very similar, there are differences in where the funding for each program comes from, what coverage is available through each program, where you apply for benefits (Social Security, Medicaid or private companies for Medicare Parts C and D), and who is eligible for coverage. Understanding these two programs will help you navigate the health care system(s) that applies to your situation.

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