Do you know the difference between Medicare and Medicaid? The words are very similar and often confused. Both are government programs, both help people pay for health care however that’s where the similarities end.

MEDICARE

  • Defined as a federal health insurance program for people who are 65+ years old. It is broken down into 4 parts to cover different available services.

  • Part A = Hospital stays (inpatient hospital, nursing facilities, hospice, etc)

  • Part B = Medical services (doctors’ visits, outpatient, supplies, and preventive care)

  • Part C = Medicare Advantage (provides benefits to Part A and B, offered by private companies)

  • Part D = Prescription drug coverage

MEDICAID

Defined as: Insurance program to help cover adults with low income, children, pregnant women, seniors and those with disabilities

  • Each state is responsible for administering their own programs.

  • Mandatory benefits are included. Such as most hospital services, doctor’s visits, lab and x-ray services, and health services.

  • Medicaid will calculate a person’s MAGI (Modified Adjusted Gross Income) and looks at the taxable income and filing status. They also take into effect a person’s residency, citizenship, and others.

What does it mean to be dual eligible?

People who qualify for both Medicare and Medicaid are said to be “dual eligible.” If you qualify and enroll in both programs, then sometimes the two can work together to cover most of your health care costs.

For information about dual eligible programs, you can call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday, or contact your state Medical Assistance or Medicaid office.

Medicare Savings Programs are state-run Medicaid programs designed to help with the cost of Medicare. There are four different programs with slightly different qualifications and benefits. Qualifying income and resource levels are set by the federal government, but each state decides what counts when calculating this for an individual.

About Alicia Gibbons

Alicia is a Senior Office Administrator in the Medigap industry and has 10 years experience. She is a one stop shop for answers, information and support for Medicare clients. When shes not writing you can find her in the garden.