Medicare and Medicaid

What's the difference?

Medicare and Medicaid are both government programs that help people pay for health care. They each have distinct eligibility standards, potential benefits and costs, as well as future implications. A person may also be dual eligible, if he or she qualifies for both Medicare and Medicaid. 

Governance & Eligibility

Medicare is a federal insurance program that is generally for people who are older or disabled, regardless of income. You should be eligible if you are: over 65, under 65 with certain disabilities, or of any age and have End Stage Renal Disease (ESRD). 

Many people are enrolled in Part A (hospital insurance) and Part B (Medicare insurance) automatically, when they turn 65. 

Medicare is run by the Centers for Medicare & Medicaid Services, an agency of the federal government, and is basically the same no matter which state you live in.

Here is the government’s Medicare eligibility tool: http://www.medicare.gov/eligibilitypremiumcalc/

Medicaid is a joint federal and state assistance program for some people with limited income and resources, pregnant women, the elderly, and those with disabilities. Eligibility depends on the rules in your state.

Each state creates and governs its own Medicaid program (within federal guidelines), and offers both mandatory benefits and optional benefits. Some states may expand Medicaid coverage under the Affordable Care Act.

Here is the government’s Medicaid eligibility website: https://www.healthcare.gov/medicaid-chip/eligibility/

Coverage & Cost

Medicare coverage and cost depends on what you choose (there are different ‘Parts’).  

Part A: care and services received as an inpatient in a hospital or skilled nursing facility
Part B: Doctor visits, care and services received as an outpatient, and some preventive care
Part D: Prescription drugs
Part C: Medicare Advantage plans, which combine Part A and Part B coverage and often include Part D coverage in one plan

You may be eligible for premium-free Part A if you are over age 65 and you or your spouse worked and paid Medicare taxes for at least 10 years. You may also be able to buy Part A. Everyone must pay for Part B, if they want it. 

Everyone with Medicare has access to Part D. For more information about prescription coverage, go to http://www.medicare.gov/part-d/index.html 

Medicaid has mandatory and optional coverage, the latter of which individual states determine. Costs depend on your income and the rules in your state.  Certain groups are exempt from most out-of-pocket costs.

Contact your local State Medical Assistance office (Medicaid) and/or your local Social Security Office (Medicare) to see if you qualify or if you have additional questions. 

Final Thoughts

Keep in mind that your retirement assets may impact your Medicaid eligibility (both asset and income level requirements), and the outcomes vary based on your state’s rules.

Please consult with expert(s) to determine how your retirement savings are linked to your government insurance options.

 

Additional Links

Medicare http://www.medicare.gov

Medicaid http://www.medicaid.gov

Will you save? https://www.healthcare.gov/lower-costs/