Medicare and Medicaid are two government healthcare programs that sound similar, so if you get them mixed up, you're not alone. However, there are some big differences between these programs--especially when it comes to how much they cost and who they cover--so it's important to learn how they differ. Here's an overview of what sets Medicare and Medicaid apart from each other, as well as what you need to know before you apply for either program.
Medicare is a federal program that offers health insurance to senior citizens who are at least 65 years old, and adults of any age who have certain disabilities. If you fall into either of these categories, you can apply for Medicare, regardless of your income.
However, you will have to pay a monthly premium for certain plans, and you will also have to pay deductibles and coinsurance, so this program is not free to participate in. There are several Medicare options to choose from. Most people get Medicare Parts A, B and D together, but Part C (Medicare Advantage) is one plan that combines them all.
More specifically, Part A covers many of your fees if you have to be hospitalized. You will pay a deductible, but days 1 through 60 of your hospital stay will be covered by Plan A. For days 61 to 90, you'll pay $341 in coinsurance for each day you're still in the hospital. And at 91 days and beyond, you'll pay $682 per day in coinsurance. Additionally, while semi-private rooms, food, and general nursing treatment are covered, you'll have to pay extra for a private room, a phone, or TV in your room. Though most seniors qualify for Medicare Part A with no monthly premium, you will have to meet the $1,364 deductible every benefit period.
Part B of Medicare covers any outpatient care you need, including doctor appointments. Both preventive services and medically necessary treatment are covered by Part B, which means if you need a flu shot, a screening for a disease, or a walker, this part of your plan will pay for it. You will just have to pay 20 percent of the amount and meet an annual deductible of $185 as of 2019. Also, the monthly premium for Medicare Part B is $135.50.
In addition, Part D provides prescription drug coverage. The monthly premium for Part D varies depending on your Medicare plan. Note that you can only add on Part D if you also have Part A and B.
The alternative to getting Parts A, B, and D is to get Part C, which is called Medicare Advantage. This combines all the coverage you get from the other parts of Medicare, plus supplemental benefits, including dental, vision, and transportation to appointments. Medicare Advantage is provided by private insurance companies, so the costs vary.
On the other hand, Medicaid is a program that's supported by both the state and federal government, and it offers health coverage to low-income residents. Unlike with Medicare, you don't have to be a specific age or have disabilities to qualify for Medicaid. However, you do have to prove that your income is below a certain threshold, which is a little different for every state, since it's the state and local governments that run this program.
Unlike Medicare, there are typically few or zero costs that Medicaid patients have to pay in order to get health coverage. With Medicaid, the plan pays for hospitalization, doctor appointments, labs, x-rays, home health care, preventive care, and maternity care. In addition, Medicaid provides dental and vision coverage for children in all states. However, many states do not require Medicaid to provide dental or vision care for adults.
The exact eligibility requirements for Medicaid vary by state. But in general, if you're below 100 percent of the federal poverty level, you qualify for Medicaid. Many states have expanded coverage to allow eligibility up to 133 percent of the poverty level, and if you're pregnant, elderly, or disabled, you can typically qualify up to 200 percent of the federal poverty level.
As you can see, these programs are different in many ways, which is good to know before you apply for coverage. In general, the major differences include eligibility and costs. But another big difference is that you have a limited period of time to enroll in Medicare, while you can apply for Medicaid any time. In particular, Medicare's open enrollment period is from October 15 to December 7. In addition, you get three months after you turn 65 to enroll.
If you believe you qualify for Medicare and need to enroll, you can visit any Social Security office in your area. You can also apply online. If you want to apply for Medicaid, the process is slightly different in every state, so you'll need to find your state's application information here. You can also fill out a form on the Health Insurance Marketplace. If you have questions about the process for either program or need help enrolling, feel free to contact us!