Do you need to know the difference between Medicaid vs Medicare? Are you wondering who qualifies for Medicare vs Medicaid and which one is better for your situation?
You aren’t alone. Both Medicaid and Medicare provide coverage for an average of 12 million people in the United States each year. And those numbers keep increasing.
It’s essential to know how to plan your long-term care costs and any special needs you have. Medical care is expensive!
Both Medicare and Medicaid help to pay for your medical costs. But what is the real difference between them when it comes to seniors? Keep reading this guide to find out what you need to know!
Medicare vs Medicaid Coverage
Medicare and Medicaid are both programs provided by the U.S government that have been around since 1965.
Medicare is a federal insurance program available to you if you’re over 65, regardless of your income.
Medicaid is an assistance program that is for low-income people of any age. Medicaid is both a federal and state program. So this means it varies from state to state as it is run individually under federal guidelines.
If you are eligible for both programs, you can use both once you turn 65 as long as you continue to meet eligibility requirements!
Medicare vs Medicaid Benefits and Details
Let’s start by getting into the details about Medicare. Medicare is meant to help American citizens who are 65 years and older. Usually, these people will have trouble covering their costs for medical care and treatments.
If you’re under the age of 65 but live with certain types of disabilities, you can also be eligible for Medicare benefits. Somebody will evaluate your case on an individual basis to see if it meets Medicare eligibility requirements.
Medicare has two main parts to it, which are:
Original Medicare or Part A is the option most older people in the United States use as their primary insurance. It covers the costs of:
- Inpatient hospitalization
- Hospice care
- Some skilled nursing care
- Home health care services
Original Medicare or Part B also covers different outpatient medical services. Outpatient medical services include seeing your primary care doctor and falls under preventative and diagnostic treatment services.
It also covers:
- Lab tests
- Outpatient surgery
- Vaccinations and screenings
- Wheelchairs and walkers
The other part to Medicare is called Medicare Advantage, or Part C. This is an option for you if you want Medicare coverage, but with more options. You can get access to Medicare Advantage through private insurance companies.
Medicare Advantage offers prescription drug coverage, vision and dental care that you can’t get with Original Medicare.
With both parts of Medicare, you will have to pay a small monthly premium and copayments for other services.
The Medicaid program is more of an assistance program. You can access it at any age, as long as you have a low income. You typically don’t pay anything out of your pocket for medical care costs.
Depending on the state you live in, the eligibility requirements can be different. So check out the Medicaid website to verify if you’re eligible or not. Most pregnant women and other people living at or slightly above the poverty level will qualify.
Medicaid also provides programs for children of families that make too much to qualify for traditional Medicaid.
Though there are differences for each state, Medicaid will generally cover services like:
- Being hospitalized
- Lab tests
- Doctor visits
- Family planning services
- Nursing services
- Services in a skilled nursing facility
- Midwife and nurse practitioner services
Some states have options for more benefits like prescription drug coverage, vision, dental, physical therapy, assistive devices, and transportation to medical appointments.
People also use Medicaid to pay for their long-term care that isn’t covered by Medicare or other insurance policies. As of 2020, Medicaid will also pay for telehealth services.
Medicare vs Medicaid Differences
For each program, you have to meet specific criteria to be able to enroll. For Medicare, you have to be:
- 65 years or older
- A citizen or permanent resident of the United States
- There are no income criteria needed to qualify
- If under 65, have a disability like end-stage kidney disease, or ALS
For Medicaid, no matter what you live in, qualification is based on your income and family size and how that relates to federal poverty levels.
According to HealthCare.gov, this amount is $12,880 for individuals and $26,500 for a family of four.
Medicaid has programs to help meet immediate needs like pregnant women and children, where Medicare does not.
The most significant difference between Medicaid and Medicare benefits is for the elderly and long-term care. Medicare has limited benefits for personal care needs, such as a home care aid to help you with food and tasks around your house.
Medicare also limits how many skilled nursing days they will cover after you leave the hospital.
Medicaid is state-run and will pay for nursing home care, personal care, home care, and homemaker services like laundry and grocery shopping.
Medicaid vs Medicare Reimbursement
The other most prominent difference between Medicare and Medicaid is how they pay money or reimburse hospitals and doctors for the services they provide.
Medicare will pay hospitals and doctors for their services at a specific rate they set. Usually, Medicare pays about 80 percent of the costs. Doctors can choose if they want to accept Medicare rates or not.
Medicaid pays hospitals and doctors the same way as Medicare does but does it through a program that sends payments to the providers. For a doctor to be a Medicaid provider, they have to accept whatever Medicaid pays as payment in full.
Medicare vs Medicaid
There is so much to know when it comes to Medicaid vs Medicare. And now you have the information you need. You can start taking steps to plan for your long-term care.
Contact Smith Barid, LLC for help with your estate and care planning needs today. We have been in business since 2006 and have the experience you can benefit from.
So make sure you contact us today. We look forward to hearing from you!