September 11, 2017
by:
Margie Johnson Ware, Aging and Health Specialist
You have probably heard the terms Medicare
and Medicaid many times, whether it be on your local news station,
internet searches, or when talking to your friends. While most people know
these two terms are associated with health care, they may not understand what
they are.
Medicare and Medicaid are two separate health
insurance programs that were created in 1965 and designed to provide coverage
for vulnerable populations. Currently, there are over 120 million people
covered by Medicare and Medicaid. But what is the difference between these two
programs? What do they cover, and who can enroll?
1. What’s the
difference between Medicare and Medicaid?
The main difference between Medicare and
Medicaid is that Medicare is health insurance based on age/disability, and
Medicaid is based on income.
To be eligible for Medicare,
you must be age 65 or older, OR between the ages of 18-64 and qualify for
Social Security Disability Insurance (SSDI) or have End Stage Renal Disease.
Medicaid covers a wide range of individuals
with low incomes, including families, pregnant women, children, persons with
disabilities, and individuals receiving Supplemental Security Income (SSI).
A person can qualify for both Medicare and
Medicaid. This is sometimes called being a “dual” or “dually eligible” for the
programs. Roughly 10 million Americans are enrolled in both programs.
2. What services do
Medicare and Medicaid cover?
Both Medicare and Medicaid cover inpatient and
outpatient care, which includes hospital, doctor, emergency services, and
preventive care. Medicaid also covers long-term care services, such
as in-home and nursing home care, whereas Medicare only covers short-term home
health or skilled nursing facility services, such as rehabilitation
following a hospital stay.
Medicare and Medicaid may also offer a range of
other services if you purchase additional coverage (such
as Part C/Medicare Advantage, Part Ddrug plans, and Medigap supplemental
insurance) under Medicare or if your state chooses to cover them under
Medicaid.
3. When & how can
I enroll in Medicare/Medicaid?
In order to enroll in Medicare, you
must apply during one of three enrollment periods. The most common time to
enroll is during your Initial Enrollment Period (IEP), the 7-month
window surrounding your 65th birthday. If you miss your IEP, you can also
enroll during the General Enrollment Period (Jan-March each year), or during
a Special Enrollment Period, if you qualify. There is also an annual Open Enrollment Period (Oct.
15- Dec. 7) during which you can join/switch/drop a Medicare Advantage or Part
D prescription drug plan.
You apply
for Medicare through Social Security. If you receive SSDI
because of a disability, you do not have to apply; you will be automatically
enrolled in Medicare once you have been on SSDI for two years.
Medicaid does not have a specific enrollment
period, so you can apply to receive coverage at any time of the year. Each state has its own income rules,
however, so you must see if you qualify and apply through your state Medicaid
agency.
4. What do Medicare
and Medicaid cost?
While the costs for both Medicare and Medicaid
can vary, the reasons for variations greatly differ.
Everyone with Medicare will pay for a portion
of their expenses, but what you pay depends on the type of coverage you have –
Parts A & B, Part C/Medicare Advantage, Part D and/or Medigap. The costs of
Medicare include premiums, deductibles, and copayments/coinsurance. You can
learn more about the specific cost for Medicare coverage on our page “Make Sense of Medicare Costs.”
For people who have trouble affording Medicare, there are some programs to help pay those costs.
Medicaid costs depend on your income and
individual state’s payment for a particular service. Costs can include
premiums, deductibles, and copayments/coinsurance. Out-of-pocket costs typically
apply to all Medicaid enrollees, but most are limited to very small amounts
except those exempted by law. Learn more about Medicaid costs.
It is your right to access any health program
for which you meet the requirements; never assume that you don’t qualify for
Medicare or Medicaid. The following resources offer free professional advice on
enrollment, costs, and more:
- Your local State Health Insurance
Assistance Program (SHIP) is federally funded to provide
free, unbiased counseling on Medicare.
- Your local Area Agency on Aging or Aging and Disability
Resource Centercan provide information and assistance with
health insurance options.
- Our Medicare Questionnaire will give you
an in-depth assessment of your situation and personalized recommendations
for next steps.
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