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Do You Know The Differences Between Medicare and Medicaid?



Both of the words are too similar, and individuals that are looking to enroll in one or the other end up confusing the two. The confusion is not only limited to just the names. Both programs are government programs that help people pay for health care services, but that’s where the similarities end.


Overview of Medicare


Medicare is a program by the federal government for individuals who are at the age of 65 or above or have qualified for the program under disability or medical conditions. Medicare Part A and Medicare Part B are both provided by the federal government. Although Medicare Part C and Part D are governed at a federal level they are offered by licensed private insurance companies.


Overview of Medicaid


Where Medicare is a program run by the federal government, Medicaid is a program that is provided by state governments. It helps those individuals that have a limited income or resources pay for health care costs. Different Medicaid programs are offered for specific populations. Although the Medicaid programs vary from one state to the other all of them follow guidelines issued by the federal government.


Coverage for Medicare and Medicaid


In a nutshell, the Medicare Part A is a hospital insurance plan and the Medicare Part B is a medical insurance plan. Medicare Part D is a prescription drug coverage, and Part C, also known as a Medicare Advantage Plan, is a coverage option that combines Part A, Part B, and Part D along with other benefits that can include dental, vision, fitness, and hearing care.


Medicaid programs include federally mandated benefits and optional benefits. The optional benefits made available in Medicaid vary between states. States are allowed to establish and operate their own Medicaid program and determine the amount, type, duration, and scope of services within the guidelines issued by the federal government.


The federally mandated benefits include:-

  • Inpatient and outpatient hospital services

  • Physician services

  • Laboratory and x-ray services

  • Home health services

Optional benefits provided by Medicaid include:-

  • Prescription drugs

  • Case management

  • Physical therapy

  • Occupational therapy

Cost of Medicare and Medicaid


Both Medicare and Medicaid may include premium, deductibles, co-payments and co-insurance. For Medicare, the amount you pay will vary based on when you’ve enrolled in Medicare, what coverage options you choose, and the healthcare services/item you use throughout the year.


For Medicaid, the amount you pay will be dependent upon your income and the rules of the state you are living in. Along with this, some of the specific groups under Medicaid are exempted from many out-of-pocket costs.


Medicare also offers 4 different types of savings plans that are designed to help people pay for the cost of Medicare. If you meet the qualification requirements for these programs you can get help in paying for your Medicare premium, deductibles, co-payments and co-insurance.


It’s possible for individuals to have both Medicare and Medicaid. Those individuals that qualify for both Medicare and Medicaid are known as “dual eligible.” If you’ve qualified for both the programs, the two can work together to help you cover the costs of healthcare.


Need Some More Information?


We are Independent Insurance Brokers, and have been appointed by many of the major insurance carriers. We can help you find the best policy for your individual situation. We work with clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.


Contact us today at (540) 662-4432 to schedule a FREE CONSULTATION with one of our Insurance agents or simply visit our website medicaretrustedagents.com to obtain more information.

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