Medicare vs. Medicaid

Medicare and Medicaid are similar programs that share similar benefits, which can lead to them being confused with one other. But there are key differences that not only determine who can qualify, but who they are right for.

Where Do They Come From?

Medicare is a federal health insurance program. This also means that the eligibility requirements will be the same regardless of which part of the U.S. you’re in.

Medicaid is a joint federal and state program. This means that you can qualify for Medicaid in one state, but not another.

How Do I Qualify?

To qualify for Medicare, you must be at least 65 years old or receive disability benefits from Social Security for 24 months in a row if you’re under 65.

The first way to qualify for Medicaid is through Modified Adjusted Gross Income (MAGI). Each state has its own MAGI requirement. If you earn above this, you may “spend down” if you are considered medically needy. Spending down entails deducting one’s medical expenses from overall income to meet his or her state’s MAGI requirement.

What Are The Benefits?

Medicare has a wide range of benefits that make it useful for diverse healthcare settings and treatment types. Benefits are according to the Medicare Part:

  • Part A offers inpatient coverage
  • Part B provides outpatient coverage, including x-rays, screenings, ambulance services, and medical equipment
  • Part C (also known as Medicare Advantage) combines Part A and B coverage into one plan, with additional benefits such as dental, vision, and hearing. Prescription coverage and gym memberships may also be included
  • Part D covers prescription drugs

You have control over your coverage. Many opt for Original Medicare (which is Part A and B together), but others may choose to have Part A only, or add Medicare Advantage to go along with Part A and B.

Medicaid is required to have inpatient and outpatient coverage, as well as services for family planning and tobacco cessation counseling for pregnant women. States also have the option to offer other benefits such as hospice care, prosthetics, and physical therapy.

Get a FREE Quote

Can I Have Both?

Yes, you can have both. When you get treatment, Medicare will cover what it can, and then Medicaid will cover as much as it can for the remaining costs.

You may also enroll in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP), which allows you to have all the benefits of Medicare Advantage while also allowing you to get the extra coverage to meet your financial needs. You don’t have to pay to join, and prescription drug coverage will be built into the plan.

We Can Help

No matter if you qualify for Medicare or Medicaid, ReLion Insurance Solutions has got you covered. We put our full effort into providing excellent service so that you can get the coverage you need at the price you deserve. Call us today at 858-999-2858.