Medicare and Medicaid are two government-run programs meant to help citizens with various healthcare needs. Since the terms are often used interchangeably, it’s easy to get confused about what each represents. However, each program offers different benefits and has different criteria to qualify and be eligible to claim benefits. So it makes sense to go over the differences between Medicare vs. Medicaid. SeniorSmart believes in educating individuals and families about their options upon entering retirement and beyond. We’re glad to walk you through the process. By the end, we hope you’ll have more clarity about the eligibility requirements for each.
What is Medicare?
One big difference between Medicare vs. Medicaid is that Medicare is typically for people aged 65 years or older. However, Americans with certain disabilities may also qualify for coverage even if they do not meet the age requirement. People typically become eligible for Medicare coverage after meeting the criteria listed below:
- They are at least 65 years old.
- Diagnosed with End-Stage Renal Disease (ESRD).
- They are under 65 years old but have a qualifying disability.
- They are under 65 and have maintained eligibility for either Social Security or Railroad Retirement benefits for the past 24 months.
Individuals still employed by the time they reach age 65 and have worked for ten years may end up automatically enrolled in free Medicare Part A coverage. Those with a spouse with Medicare-covered government employment could also qualify for coverage that way.
Medicare Part A covers expenses you may incur tied to an inpatient hospital stay, hospice care, skilled nursing facility, and some services for home health care. Other forms of Medicare coverage include Part B, Part C, and Part D.
Medicare Part B provides insurance benefits to patients who receive the following services:
- Doctor office visits
- Ambulance services
- Preventative services
- Mental health services
- Durable medical equipment (DME)
- Limited prescription drug coverage
- Second opinions on surgery options
Medicare Part C, commonly referred to as Medicare Advantage Plans, bundle coverage for Medicare Part A, B, and D into one package. Part D provides prescription drug coverage under specific policies.
What is Medicaid?
One thing Medicare and Medicaid have in common is that the government funds them. However, when looking at the differences between Medicare vs. Medicaid, Medicaid differs from Medicare in that funds come from a mix of state and federal government funds. It provides insurance coverage to people in lower-income brackets. Another difference in Medicare vs. Medicaid is that there are no age limits on who qualifies for Medicare.
States set individual eligibility requirements for Medicaid, another difference between Medicare vs. Medicaid. Any state offering Medicaid coverage must provide coverage to those falling into specific groups, which includes pregnant women, low-income families, and qualifying children. People currently receiving Social Security Income (SSI) may also receive Medicaid.
Benefits provided under a typical Medicaid policy include the following:
- Routine dental
Note that in a comparison of Medicare vs. Medicaid, Medicare doesn’t offer coverage for the above services.
Can Someone Have Medicare and Medicaid?
Yes, some people do qualify for both Medicare and Medicare coverage. It’s referred to as dual eligibility, and you must meet the following requirements to qualify:
- Be a low-income adult who is 65 years or older.
- Be a low-income person with a qualifying disability like Amyotrophic lateral sclerosis (ALS).
The SeniorSmart Advantage
Keep an eye out for more information on Medicare vs. Medicaid and other news essential to seniors through the materials that the expert team at SeniorSmart produces. On our website, individuals, couples, and families can discover the latest trends in senior living, learn about upcoming benefits and how to apply for them in clear language, and discover tips about how to get the most out of the retirement years. Contact SeniorSmart today at 205.460.1124 for more information.