Medicare vs Medicaid

Medicare vs Medicaid – What’s the difference?

Medicare and Medicaid are separate programs that frequently get mixed up. Understanding the difference between the two will help you maximize your benefits as a beneficiary. 

Medicare is the federal health insurance program for all individuals age 65 and older.   

Medicaid operates as both a federal and state-level program to provide health care coverage to individuals with very little income. Eligibility for Medicaid depends on income level.

It is possible to qualify for both Medicare and Medicaid at the same time (dual coverage). Those who do receive benefits from both programs which works to further reduce health care cost. 

Medicare Overview

Medicare is the federally run health insurance program for individuals age 65 and above. In 1972, new legislation expanded Medicare to cover individuals with disabilities and end-stage renal disease. Currently, 44 million Americans receive Medicare benefits.

Medicare is composed of four separate parts. All of which are voluntary. 

• Medicare Part A – Hospital insurance (inpatient care)
• Medicare Part B – Doctors insurance (outpatient care)
• Medicare Part C – Medicare Advantage
• Medicare Part D – Prescription Drug

Original Medicare provides both Part A & Part B. While Part C and Part D provide ways to customize and expand your benefits. 

All individuals eligible for Medicare can enroll in all four parts during one of the Medicare Enrollment Periods. 

Customizing Your Benefits

There are two ways for Medicare Beneficiaries to expand and customize their coverage.

Medicare Advantage plans are private health insurance policies that expand your benefits to include vision, dental, hearing, and prescription drug coverage. Your Original Medicare benefits get bundled together with these expanded benefits for one comprehensive policy. 

Medicare Supplement Insurance (Medigap) – are also private health insurance plans that add a secondary layer of financial protection.  Within Original Medicare (part A & part B), there are several gaps in which medicare beneficiaries have out-of-pocket expenses in the form of deductibles, coinsurance, and copayments. Medigap policies fill in these financial gaps that loom inside of Original Medicare, which reduce or eliminate out-of-pocket Medicare costs. There are ten different Medigap plans — each plan covering a different set of financial gaps.  

Although Original Medicare provides excellent health care coverage, it’s far from complete. As a result, 8 out of 10 Medicare beneficiaries choose to enroll in either Medigap or Medicare Advantage. Our team of independent agents is here to help you customize your benefits.

Medicaid Overview

Medicaid is both a state and federally-run health insurance program that provides coverage to low-income individuals. The Medicaid program differs between states. Each state determines financial guidelines that determine who is eligible for Medicaid benefits. The four main groups that Medicaid serves are:

• Seniors Citizens
• People with disabilities
• Parents
• Mothers

Medicaid spend-down program – Various states across the country allow individuals to deduct their medical expenses from their income to qualify for Medicaid. Contact your local Medicaid office for more information.  

All states allow for possible dual coverage for both Medicaid and Medicare. 

Medicare vs Medicaid Next Steps

If you qualify for Medicare, Medicaid, or both, what should you do next?

If you have further Medicaid questions regarding Medicare vs Medicaid, we recommend speaking with your local Medicare or Medicaid office.  

Individuals looking to explore their Medicare options for Medigap or Medicare Advantage can get started today by filling out the form on your screen.

Our team of independent agents provides unbiased advice and support to help you get the most out of your Medicare benefits.

Our services are free.  And there’s never any obligation when speaking with one of our agents. See why thousands of seniors chose us to help them customize their Medicare benefits.

Get started today.