Your loved one needs help paying for their medical bills. You know Medicaid and Medicare are government insurance programs, but what is the difference? You aren’t sure if you or your loved one will qualify or what the insurance will cover once qualified.
While both Medicare and Medicaid can help you pay for healthcare, Medicare is an entitlement for seniors 65 and over, along with some younger people with disabilities, while Medicaid is a public-assistance program for needy Americans of all ages.
Medicare is a health insurance policy offered to seniors 65 and over, along with people under 65 with certain disabilities. Medicare costs are deducted from your wages throughout your working years, and after retirement you are entitled to use the benefits which you have already paid for over time.
You may recognize that Medicare has several parts, and you have likely heard of Medicare Parts A through D. Medicare coverage comes in four parts, some of which require payment of a monthly premium. This is similar to private health insurance. Here’s a quick overview of what the four parts cover:
- Part A – Hospital Care
- Part B – Doctors, Medical Tests and Procedures
- Part C – Includes Parts A, B, and D
- Part D – Prescription Drug Coverage
Despite having these four parts, Medicare isn’t a comprehensive health insurance plan. There may be certain gaps in coverage without a Medicare Advantage or Medigap policy. Long Term Care is one type of care that is not covered without this extra policy.
Medicaid is a public assistance program based on financial need. Medicaid is paid by federal, state, and local governments using public money from taxes. Medicaid programs can be shaped by each individual state to fit the specific needs of their residents.
There are several groups which can qualify for Medicaid provided they have financial need.
- Pregnant women
The first of these groups is pregnant women. Whether a pregnant woman is single or married, if there is financial need, they and their child can be covered by Medicaid.
- Parent of a minor or a teenager living alone
The second group is a parent of a minor or a teenager living alone. If you have a child under the age of 18 and you have financial need, you could qualify for Medicaid. Medicaid can also help if your child is sick and needs nursing-home level care, but could stay at home with financial assistance. Medicaid also covers teenagers living on their own, and some states allow for coverage for children up to 21 years old.
- Aged, blind, or disabled
The third group includes those who are over 65 and cannot afford healthcare coverage. This group also includes people with medical need regardless of their age.
- No disabilities, no children under 18
The final group includes low-income individuals under the age of 65 who do not have a disability or children under 18. This group is dependent on the specific state in which you live, and is not always offered.
Under Medicaid, each state is required to cover certain mandatory benefits, with other benefits varying by state. The required benefits include inpatient and outpatient hospital services, nursing-home and home healthcare, laboratory and x-ray diagnostic services, transport to a medical facility, and tobacco-cessation counseling for pregnant women.
Some states also provide prescription drug coverage, physical and occupational therapy, optometry, chiropractic services, dental care, and more under Medicaid.
Depending on your specific situation, you or a loved one may qualify for both Medicaid and Medicare. If this is the case, Medicaid will pay for most of the premiums for your Medicare Parts A and B, along with any deductibles and co-payments you may have.