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What is the Difference Between Medicare and Medicaid?

With similar names and goals, it’s easy to mix up Medicare and Medicaid. Here’s everything you need to know about the differences between Medicare and Medicaid, as well as how you might be eligible for both.

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What is the Difference Between Medicare and Medicaid?

With similar names and goals, it’s easy to mix up Medicare and Medicaid. Here’s everything you need to know about the differences between Medicare and Medicaid, as well as how you might be eligible for both.

Medicare and Medicaid are two different programs that serve two different groups of people. Medicare is a healthcare program for people over the age of 65 and those under the age of 65 who have certain disabilities. Medicaid is a healthcare program for low-income people of any age.

What is Medicare?

Medicare is a federally funded national health insurance program that generally kicks in at age 65. No matter where you live, the rules are the same. You paid into Medicare during your working years, so if you have 40 quarters of work history, you won’t have to pay for Medicare hospital benefits. Federal Insurance Contribution Act (FICA) taxes also help pay for Medicare and Social Security.

Photo by Mikhail Nilov on Pexels

If you receive Social Security disability benefits or if your doctor diagnoses you with end-stage renal disease or Lou Gehrig’s disease before the age of 65, you may be eligible for Medicare. Enrollment in Medicare is not income-based. A U.S. citizen or permanent legal resident who meets the age and work requirements is eligible for Medicare.

What does Medicare cost?

Medicare is not free, unlike Medicaid. Part A and Part B both have monthly premiums, though most people qualify for free Part A. Every year, the federal government sets the Part B premium. Almost everyone pays this standard premium. However, certain high-income enrollees may be subject to a surcharge.

The federal government oversees all four parts of the Medicare Program which includes: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (disability insurance) (prescription drug insurance). 

Insurance companies, on the other hand, offer Part C and Part D plans. These private insurance companies have an agreement with Medicare to sell the plans to the general public. When you enroll as a Medicare beneficiary, Medicare pays the plan to deliver your Medicare benefits. The federal government provides guidelines to ensure your basic benefits regardless of which parts you enroll in.

What is Medicaid?

Medicaid is a government-funded healthcare program for low-income people, primarily children. In 2015, minor children received just under half of all Medicaid dollars. It also benefits senior citizens, people with disabilities, pregnant women, and child care providers.

Medicaid is a state-run, voluntary program that is funded with both state and federal tax dollars. States can but do not have to, provide Medicaid benefits to residents because it is a voluntary program. If a state decides to participate, it must follow certain guidelines in order to receive federal funding.

Medicaid is currently available in Nebraska and all other states. Within the federal guidelines, each state sets its own income and eligibility requirements based on factors such as income, disability, pregnancy, age, household size, and household role. Medicaid covers some of the same services like Medicare, such as hospitalization and doctor visits, but it also provides some benefits that Medicare does not. Some examples include long-term care, vision, or dental.

How much does Medicaid cost?

Medicaid has no federal premium requirements or monthly premiums because it is designed for those with low incomes. However, because this program is administered at the state level, some states require beneficiaries to pay premiums and other cost-sharing payments. To learn more about Nebraska’s copayments, visit the Department of Health and Human Services’ Medicaid Copayments webpage.

What does Medicaid cover?

Medicaid covers the majority of major medical expenses, but the specific services and medications covered vary by state. Learn more about the specific coverages in our state on the Nebraska Department of Health and Human Services’ Medicaid Services page on their website.

Can I be on Medicare and Medicaid at the same time?

It is possible to qualify for both Medicare and Medicaid at the same time and enroll in both programs. When a person qualifies for both programs, they are referred to as “dual eligible” and their care is provided through Medicare Savings programs.

A person is classified as a Qualified Medicare beneficiary at the highest level, which means they will receive financial assistance with Medicare premiums, deductibles, copays, and coinsurance. This is especially helpful if the individual requires assistance with things that Medicare does not cover, such as long-term care. If you have Medicare and think you may be dual-eligible feel free to contact us and speak to our agent that specializes in Medicaid eligibility requirements. 

Medicare vs. Medicaid FAQs

We get a lot of questions about Medicare vs Medicaid because the words are so similar. Here are some frequently asked questions about Medicare vs. Medicaid:

  • Is Medicaid better than Medicare? Or vice versa?
    No, one is not better than the other–they are two distinct programs designed to help different demographics. Medicaid covers some services that Medicare does not, such as long-term care and food stamps. Medicare is only available to people over the age of 65 or who have certain disabilities. Our team can help you decide which program(s) are a good fit for you.
  • At what age would I qualify for Medicaid?
    The Affordable Care Act gave states the option to expand Medicaid to cover more low-income Americans under 65.
  • How much money can I have to still qualify for Medicaid?
    To see if you qualify for most government programs, you must first complete an asset test. You can check out the
    healthcare exchange’s tools or contact us to learn more.
  • Do I have to repay Medicaid benefits?
    You may have to spend down your assets first to qualify for Medicaid assistance with assisted living or nursing home care. Your home is an exception to this rule. The state, on the other hand, may try to recoup some of its costs of your care from your assets after you die.

As you can see, the differences between Medicare and Medicaid are considerable. Medicare assists our country’s elderly and disabled citizens, while Medicaid assists low-income individuals. It is possible to qualify for both. However, the two programs’ coordination can result in billing or provider access issues. For guidance in determining your local options, contact us to speak with our agent specializing in Medicaid eligibility or reach out to the Medicaid Contacts at the Nebraska Department of Health and Human Services’ Medicaid Services.

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