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Medicare versus Medicaid

June 9, 2021

Medicare and Medicaid are often confused with each other as they have similar names. But there are some big differences between Medicare versus Medicaid. Both offer assistance in paying for medical expenses. Medicaid is offered based mainly on financial need. Medicare is for seniors and certain people with disabilities. Learn more about Medicare versus Medicaid in Arizona from Jim.

The Basics of Medicare

Who qualifies for Medicare? People who are 65 or older, they or their spouse have worked at least 10 years, younger people with certain disabilities also qualify for Medicare coverage.

How much does Medicare cost? One of the most common misconceptions about Medicare is that it is totally free. Costs vary depending on your income and the specific plan you choose.

Medicare is a health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). It is a federal health insurance program for U.S. citizens who are 65 and older. It is also available to some younger people with certain disabilities. If you have paid towards Medicare for at least 10 years (usually it is automatically taken out of your paycheck) then you will automatically be eligible for Medicare when you reach the age of 65. Medicare covers anyone, regardless of their income. Premiums and other payments can vary or be higher for those with higher incomes though.

Medicare is made up of 4 different parts. Medicare Part A is a standard insurance plan offered by Medicare. It covers expenses related to hospitals such as home health care and inpatient care. There is little to no cost for Part A coverage for the majority of seniors. Medicare Part B is also sometimes known as medical insurance. It covers medical services. Part B covers certain care, supplies, and treatments that are deemed medically necessary. Medicare Part C is offered by private insurance companies. It will include some benefits of both Part A and Part B. Depending on the specific plan, it can also include benefits from Medicare Part D and it is also known as Medicare Advantage. Medicare Part D is insurance for prescription drugs. Since most plans don’t include coverage for drugs, Part D can be great to add on depending on your situation.

mom with her kid in a park

Medicaid is offered to people based on financial need, regardless of age

The Basics of Medicaid

Who qualifies for Medicaid? Medicaid is offered to people based on the financial need for the service and age doesn’t matter. To qualify for Medicaid, you have to meet certain requirements and your income has to be below a certain level.

How much does Medicaid cost? Every state has the option of setting various prices for premiums, deductibles and out-of-pocket costs for Medicaid. Most people do not have to pay anything for Medicaid benefits but may have to pay copays on certain services or treatments.

Medicaid is a medical insurance program operated by states and is offered to lower-income individuals and families, regardless of age. In fact, the largest demographic that is enrolled in Medicaid are children. Medicaid is a federally aided program but it is run at the state level so each state has its own set of rules. It is available depending on your income and how it compares to the determined “poverty level”.

Medicaid will cover most necessary medical treatments but not every doctor or office accepts Medicaid. If you have other private insurance, Medicaid will usually pick up any leftover costs after your other insurance has paid. If you make too much to qualify for Medicaid but have children, there may still be the option for you to enroll your kids in the Children’s Health Insurance Program (CHIP).

Can You Have Both Medicare and Medicaid?

Many people can qualify for both Medicare and Medicaid. About 20% of seniors who have Medicare also qualify for help from Medicaid. In this case, Medicare will usually be your primary insurance and Medicaid will cover any leftover expenses. With both Medicare and Medicaid, most or all of your necessary medical expenses and treatments will be covered. Keep in mind that eligibility for Medicare is determined at the federal level and eligibility for Medicaid is determined at the state level. You can have both Medicare and Medicaid if you qualify for both.

Do you have questions about Medicare and Medicaid? I can help! Contact me for more information about how I can help find the right plan that is tailored to your needs. I offer Medicare services in the northern Phoenix area as well as other areas of Arizona.