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What are the Differences Between Medicaid and Medicare?

While they sound alike, Medicare and Medicaid are two different programs. Both of them can help you with health care and medical costs. But while Medicaid is a public assistance program that can provide health care to low-income Americans, Medicare is a federal health insurance program that offers coverage to seniors and some younger people with disabilities. If you’re eligible for both Medicare and Medicaid, you can have both, and they will work together to cover your health care. Both programs are offered by the government, but there are some key differences with regard to covered services and cost sharing.

What is Medicare?

Medicare is a federal health insurance program that becomes available for people once they turn 65, but it can be available for younger people who have certain illnesses. As you get closer to your 65th birthday, you will get some information in the mail about Medicare enrollment, and you can choose from any of the following:

  • Medicare Part A — This will cover you if you’re hospitalized.
  • Medicare Part B — Also called “Original Medicare,” this will cover your outpatient care (such as doctor visits).
  • Medicare Part C — Also called “Medicare Advantage,” these plans are offered by private insurance companies, and they combine the coverage of Parts A and B with prescription drug coverage. They can also offer other supplemental benefits (such as vision and dental services).
  • Medicare Part D — This type of Medicare coverage is offered by private insurance companies, and it can help you pay for prescription drugs.

Medicare Part D is only available to people who have Parts A and B but not to people with Medicare Advantage, because these plans will often have their own prescription drug coverage.

You have the option to get a Medicare supplement policy (also called “Medigap”) that can pay for any out-of-pocket Medicare procedures, and you have many options that will vary by premium, deductible, and out-of-pocket expenses. You will need Medicare Part D if you have a Medicare supplement policy.

What is Medicaid?

Medicaid is a combined federal and state health insurance program that’s offered to low-income Americans, and it offers the same level of protection that’s found in most employer-based health insurance plans. Medicaid can be offered by the state or through a private insurance company (called “Medicaid managed care”), which has become more common in recent years. But even if you decide to enroll in Medicaid managed care, you will still need to sign up through your state’s Medicaid program.

No matter what type of plan you sign up for, the federal government requires Medicaid to cover the following:

  • Hospitalizations
  • Home health care
  • Doctor visits
  • Labs and x-rays
  • Maternity care
  • Pediatric care
  • Preventative care
  • Child dental care

Medicaid is typically available to anyone with an income that’s below 100% of the federal poverty level, but many states have also expanded their eligibility requirements. This was made possible by the Affordable Care Act, which allows states to expand their eligibility for up to 138% of the federal poverty level. You may also be eligible if your income is below 200% of the federal poverty level and you’re pregnant, disabled, elderly, a parent, or a caregiver.

Be sure to reach out to JWB Insurance for more information about the differences between Medicaid and Medicare and how we can help you get the health insurance coverage you need.