Medicare vs. Medicaid

While most people have heard of Medicare and Medicaid, many don’t know the distinct differences between the two programs. Generally speaking, Medicare and Medicaid serve different groups, cover different services, and have different costs. Lacayo Group Insurance will explain these differences further.

Medicare vs. Medicaid: Who Participates?

Medicare is the federal health insurance program for people 65 and over, and under 65 with specific disabilities. Your income doesn’t impact your eligibility, but your age does.

Medicaid provides healthcare benefits for low-income folks. With your state Medicaid program, your age doesn’t impact your eligibility.

Some people are known as dual-eligibles because they qualify for Medicare and Medicaid. In this scenario, Medicare will be the primary insurance and Medicaid will be secondary. Medicare and Medicaid will collaborate to give you more healthcare benefits while also lowering your costs.

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Medicare vs. Medicaid: Who Meets the Criteria?

Medicare Eligibility

Nearly everybody 65 or older qualifies for Medicare. If you’re a U.S. citizen or have been a legal resident for a minimum of five years, and your spouse has worked here for at least a decade, you’re eligible to receive benefits.

Those under 65 have to meet certain conditions: you must have a disability or be diagnosed with End-Stage Renal Disease (kidney failure) to get Medicare.

Medicaid Eligibility

Medicaid eligibility is different. When you need some financial help, you may be eligible if you’re pregnant, the parent of a minor, or blind, aged, or disabled. However, you may also qualify for Medicaid if you have no minor children or disabilities.

Typically, you must meet certain income requirements based on the federal poverty level. Florida’s program has more guidelines for your particular situation. Stocks, bonds, and other assets also affect your Medicaid eligibility.

In most states, qualified individuals can own $2,000 in measurable assets. Married couples can own $3,000. Sometimes people have to spend down or reduce their assets to qualify for Medicaid.

Medicare vs. Medicaid: What Is Covered?

Medicaid varies by states, but every state must cover certain types of healthcare, including

  • Lab work
  • X-ray diagnostic services
  • Transportation to a healthcare facility
  • Nursing home and home health care
  • Inpatient and outpatient hospital care
  • Tobacco recess counseling for pregnant women

Medicaid covers Medicare-related expenses, such as benefits if you’re hospitalized and medications that are necessary.

Medicaid also offers coverage for custodial and nursing home care, while Medicare does not.

Medicare vs. Medicaid

Because Medicare offers limited coverage for seniors in nursing homes, those who need long-term care should find out if they’re eligible for Medicaid. 

Medicare vs. Medicaid: What Are the Costs?

Original Medicare Costs

Medicare recipients generally pay a deductible for Part A and Part B each year, as well as copayments for extended stays in the hospital.
Under Medicare Part B, you pay the 20% of doctors’ bills and a standard monthly premium (in 2021, this is $148.50). Sometimes doctors charge excess charges.

Under Medicare Part D, you pay a monthly premium, a deductible, copayments, and all your prescription drug costs over a certain yearly amount — and up to a maximum — unless you qualify for a low-income subsidy, aka “Extra Help”.

You must pay out of pocket for routine vision, dental, and long-term care.

Medicaid Costs

Medicaid charges you small amounts for certain services in some states. Children and pregnant women are exempt from most out-of-pocket expenses, so Medicaid cost-sharing differs from Medicare cost-sharing.

Get Help from Your Local Agency

At Lacayo Group Insurance, we provide the support you need to make the best Medicare decisions for yourself now and for the future. Contact us online or call the number above to speak with a licensed expert.