Medicare vs. Medicaid
Medicare and Medicaid both provide necessary coverage. But Medicare focuses on health benefits for the retired and disabled, and Medicaid provides benefits for those with financial needs.
- Medicare is a federal program that provides health coverage if you are at least 65 or under 65 and have a disability, no matter your income.
- Medicaid is a state and federal program that provides health coverage if you have a very low income.
Medicare Explained
You’re already familiar with the eligibility requirements for Medicare — age (65+ years old), disability (at least 24 months of Social Security Disability Insurance), and also certain health conditions (End-Stage Renal Disease or Lou Gehrig’s Disease).
There are 5 main parts of Medicare:
- Part A — Short-term hospital and nursing home care, including some hospice and home healthcare.
- Part B — General medical coverage for physician services, outpatient care, durable medical equipment (DME), lab and X-ray services, home health services, and many preventive services.
- Part C — Medicare-approved private insurance companies provide all Original Medicare (Part A and Part B) coverage, as well as other potential benefits like prescription drug coverage and other supplemental benefits.
- Part D — Medicare-approved private insurance companies provide prescription drug coverage.
- Medicare Supplement (Medigap) — A private insurance option that covers Original Medicare costs like premiums, copayments, and other benefits.
Medicaid Explained
You’re eligible for Medicaid if you fall within a certain income level. While Medicare is determined on a federal level with regulated private plan options, Medicaid is a joint federal and state program, meaning that both state and federal planning come into play.
Each state administers its own program, following broad national federal guidelines, statutes, regulations, and policies. Each state:
- Establishes eligibility standards.
- Decides type, amount, duration, and scope of services.
- Sets payment rates.
How the Two Work Together
Medicare and Medicaid can both provide coverage for qualifying individuals. No matter how you qualify for Medicare, there is a combined Medicare-Medicaid plan you can receive if you also qualify for Medicaid.
These plans make Medicare more affordable by covering some of its basic costs. Qualification depends on where your Social Security income falls on the Federal Poverty Level (FPL):
- Qualified Medicare Beneficiary (QMB) Program — Pays Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB) Program — Pays only the Part B premium.
- Qualifying Individual (QI) Program — Pays only Part B premium (individuals enrolled in this program have no other Medicaid eligibility).
- Qualified Disabled Working Individual (QDWI) Program — Pays only Part A premium for certain individuals under age 65 with disabilities who have returned to work.
Navigating Your Personal Coverage
Medicare enrollment is better when you work with a caring team. Call Priority Health Insurance Services at 626-966-1098 or email info@priorityhealthins.com.
