Do you know the difference between Medicare vs Medicaid?

The words are very similar and often confused. Both are government programs and help people pay for health care. However, that’s where the similarities end with Medicare vs Medicaid.

MEDICARE 

Medicare is a federal health insurance program for people who are 65+ years old. Medicare’s 4 parts a variety of services.

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

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

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

  • Medicare Part D = Prescription drug coverage

MEDICAID

An 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 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). They also take into effect a person’s residency, citizenship, and others.

What does it mean to be dual eligible (Medicare vs Medicaid)?

Generally, people who qualify for both Medicare vs Medicaid are said to be “dual eligible.”.  The programs work together to cover most of the beneficiaries health care costs.

Medicare vs Medicaid

Enrolling in Medicaid requires an application (based on income) to determine qualification to the program.  Check here to see if you qualify based on your salary.

Medicare and Medicaid Enrollment

Medicare Parts A and B

There are specific timelines to follow when signing up for Medicare. When newly eligible for Medicare, there is a seven-month enrollment period. This period starts three months before turning 65 and ends three months after including birth month.

Part A is “free,” sign up for it anytime during or after the initial enrollment period. Anyone who has paid Medicare taxes (taken out of payroll checks) is eligible.

People who missed signing up for Parts A and B during the seven-month period won’t be able to sign up again until January 1st of each year. The General Enrollment period is January 1 to March 31 every year. Sign up during this time and coverage will kick on July 1.

Need more information on Medicare vs Medicaid? Learn more about when you can sign up here.

***Social security or Railroad Retirement beneficiaries are exempt from these deadlines. People who qualify automatically get enrolled in Medicare Parts A and B. 

While Medicare Part A is “free,” Medicare Part B requires you to pay a monthly premium. Part B coverage is optional and there is a monthly premium. To decline Part B, follow the instructions on the back of your Medicare card.

If you want to sign up for Medicare you can apply at a Social Security office or online.

Medicare Advantage

Some people choose to enroll in a Medicare Advantage Plan.  This type of plan replaces Medicare Parts A and B and is purchased from a private company.  These types of plans are subject to high out of pocket exposure.

Part D

The prescription (Part D) portion of Medicare is not automatic. You have to elect to receive this coverage.  Those who fail to do so may be subject to late enrollment penalty.

Medicare Supplement (Medigap)

Choosing to get Medicare Supplement (Medigap) insurance when signing up for Medicare is another option. Typically these plans offer the most comprehensive coverage to Medicare.

Penalties

Policyholders who don’t sign up for Medicare Parts B and D might have to pay a late fee for failing to meet Medicare deadlines.

Changing your plan

Pay attention to Medicare’s dates and deadlines. For example, the Medicare Annual Enrollment Period (AEP) or the General Enrollment (GE).

Medicare and Medigap Complete Resource Library

Click Here To Download

Save Money on Medicare
Medigap Made Simple
Medigap and You 2018
T65 Checklist _Page_1
Mutual of Omaha
SMS Medicare Insurance
TransAmerica Medigap Carrier
Cigna Medigap Insurance
Aetna Medigap
United Healthcare AARP
Medicare Supplement Carrier Logo
Bankers Fidelity Medicare Supplement Carrier

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.