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Medicare vs. Medicaid

Understanding the Differences and Your Options

Medicare and Medicaid are two government-established programs designed to provide healthcare coverage to those in need. Although they sound similar, they serve different groups, operate separately, and are funded in different ways.

Medicare Basics

  • Medicare is a federal health insurance program primarily for:

    ⦁ Individuals age 65 and older.
    ⦁ Younger individuals with a serious or permanent disability.

    ⦁ Eligibility is based on age or disability, not income level.

Medicaid Basics

  • Medicaid is a joint federal and state health insurance program designed for:

    ⦁ Individuals and families with low income.
    ⦁ Eligibility is determined by income level and varies by state.
    ⦁ Certain individuals with disabilities.

    ⦁ For more details, visit: ⦁ www.medicaid.gov

Key Differences Between Medicare and Medicaid

Category

  • Who It Serves

  • Coverage

  • Program Management

  • Long-Term Care

  • Providers

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Medicare

  • Seniors (65+) and younger individuals with disabilities

  • Hospital, medical, and limited prescription drug coverage

  • Federally administeredLimited coverage

  • Providers nationwide who accept Medicare

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Medicaid

  • Low-income individuals and familiesCoverage

  • Broad medical services, often including dental, vision, and long-term care

  • Administered by each state

  • Covers nursing homes and long-term care services extensively

  • Providers who participate in the state’s Medicaid program.

Understanding the Differences and Your Options

⦁ You can be enrolled in both programs.
⦁ Enroll in Medicare Part A and Part B first to start receiving coordinated benefits.
⦁ Medicare Savings Programs (MSP) help dual-eligible individuals by covering healthcare costs based on income level.
⦁ Some dual-eligible individuals may owe little to no copayments.
⦁ Medicare pays first, and Medicaid pays second, helping with:

If You Already Have Medicaid


⦁ You should still enroll in Medicare Part A and Part B.
⦁ Medicare will be your primary payer, with Medicaid providing secondary coverage.
⦁ Medicaid may assist with your out-of-pocket Medicare costs.
⦁ You may be eligible for a Special Needs Plan (SNP) or Dual Special Needs Plan (D-SNP):

  • These Medicare Advantage plans are designed specifically for individuals with both Medicare and Medicaid.

  • They often offer extra benefits not typically included in standard Medicare or Medicaid plans.

  • Availability depends on your location.

    ⦁ Additionally:

  • Dual-eligible individuals are automatically enrolled in the Extra Help program to assist with prescription drug costs.

  • Medigap insurance is generally not necessary for individuals with Medicaid.

    (In fact, it is illegal to sell a Medigap policy to someone known to have Medicaid, except in very limited circumstances.)


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