The terms Medicaid and Medicare are widely recognized, yet many Americans struggle to differentiate the two. Luckily, several resources exist to help you and your loved ones navigate the intricacies of both programs. Below, we have compiled brief explanations of both the Medicaid and Medicare programs to help you distinguish between them.
According to medicaid.gov, “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities,” As of the April 2020 national enrollment deadline, Medicaid covers more than 65 million people across the country. Medicaid is a federally regulated program; however, individual state governments administer coverage. Open enrollment periods vary by state, most are open for a few months each fall-winter.
In 2014, the Affordable Care Act (ACA) allowed states to expand their Medicaid services to a broader population. Under the ACA, individuals under the age of 65 whose family income falls below 133% of the Federal Poverty Line and who would otherwise have access to other Health Insurance Marketplace coverage are eligible for Medicaid services. This allows families whose income may fluctuate above and below the previously recognized eligibility level access to affordable coverage and improved insurance continuity.
For more information regarding Medicaid, visit https://www.medicaid.gov/.
Medicare provides coverage for adults over age 65, as well as some younger individuals with specific disabilities. Medicare is broken up into sections labeled Part A through D. While Medicare Advantage plans combine Parts A and B with other benefits, Original Medicare plans must be acquired separately.
Medicare Advantage plans are typically offered through private insurance companies who contract with the federal government to provide Part A and Part B benefits, while Original Medicare provides Parts A and B directly through the government. Part A is covered in social security benefits, but beneficiaries need to pay a monthly premium for Part B coverage.
Medicare Part A provides seniors with hospital coverage, which includes services like inpatient hospital care, hospice, surgery, and lab tests. Medicare Part B provides medical coverage, which consists of doctor’s visits, outpatient care, and some preventative medical services, among other benefits.
While some individuals are automatically covered by Medicare benefits, others must apply near their 65th birthday, during a yearly General Enrollment Period, or during a Special Enrollment Period if they qualify. Some seniors qualify to apply during a Special Enrollment Period if they or their spouse are still employed, or if they are covered by a group health plan via their employer or a union based on their employment. Part C and Part D, or Medicare Advantage and drug plans, can be added to a policy anytime between October 15 and December 7 each year.
Occasionally, an individual qualifies for dual-eligibility for both Medicare and Medicaid. Call our Medicare agents today to see if you are dual-eligible at (888) 446-9157.
For more information regarding Medicare, visit https://www.medicare.gov/.
Health Insurance Questions?
We hope this information on the differences between Medicaid and Medicare is helpful.
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