Should you choose Original Medicare, which includes Medicare Part A and Part B? Or would it be better to apply for a Medicare Advantage plan, also known as Medicare Part C? Your budget and what you need from coverage are factors to take into account when deciding. It is important to know the difference between Original Medicare and Medicare Advantage when comparing plans to choose the one that is best for you.
The words “Medicare” and “Medicaid” are so similar it’s easy to get confused. To add to the confusion, the two are government programs to help people pay for health care. But that’s where the similarities end.
Below is more information about each program and the points of comparison.
What is Medicare? What is Medicaid?
Medicare is a federal program generally for people 65 years of age or older or who have a qualifying disability or medical condition. Medicare Part A and Part B are provided by the federal government, and Medicare Part C and Part D, although dependent on the federal government, are provided by private insurance companies.
Medicaid is a state government program that helps pay health care costs for people with limited incomes and resources, and there are different programs for specific populations. Medicaid plans vary from state to state but follow federal guidelines for benefits.
What do Medicare and Medicaid Cover?
Part A is hospital insurance and Part B is medical insurance. Medicare Part D is prescription drug coverage and Part C (Medicare Advantage) is an all-in-one coverage option that combines Parts A, B, and D, as well as other benefits that could include dental services, from the vision, hearing, and physical conditioning. Medicare Part A and Part B coverage are standard, but Part C and Part D vary based on the terms of coverage provided by the plan, insurance provider, and location.
Medicaid programs include federally mandated benefits and optional benefits. Each state decides which optional benefits to include.
How Much Does Medicaid Cost? How Much Does Medicare Cost?
Both Medicare and Medicaid can include premiums, deductibles, copays, and coinsurance. For Medicare, what you pay will vary depending on when you enroll, what coverage options you choose, and what health services and supplies you use during the year. For Medicaid, the amount you pay will depend on your income and the rules in your specific state. Also, some specific groups that have Medicaid are exempt from many out-of-pocket costs.
There are also four different Medicare Savings Programs, which are designed to help with the cost of Medicare. If you qualify for one of these programs, you may be able to get help paying your Medicare premiums and, in some cases, also get help paying your Medicare Part A and Part B deductibles, coinsurance, and copayments.
Can You Have Both Medicare and Medicaid?
Yes, some people can have both Medicare and Medicaid. People who qualify for both Medicare and Medicaid are “dual eligible.” If you qualify and choose to enroll in the two programs, the two can work together to help you cover most of your health care costs. You may also qualify for a special kind of Medicare Advantage plan, called a Dual Eligible Special Needs Plan.
How to get Medicare
To get Medicare Part A and Part B, you will need to enroll directly in Social Security. The exception to this rule is if you are receiving Social Security or Railroad Retirement Board benefits when you begin to meet Medicare requirements, usually at age 65. In this case, you will be automatically enrolled in Medicare Parts A and B. To get Medicare Part C and Part D, you will need to enroll directly with the private insurance company that offers the plan you want.
How to get Medicaid
The requirements to enroll in Medicaid depend on the rules in your state. To find out if you qualify and to begin enrollment, contact your State Medical Assistance (Medicaid) office. You can visit medicare.gov to find a local office and learn more about Medicaid enrollment and requirements.
Medicare and Medicaid are two very different health care programs, so it is important to understand the differences between them and, if you are dual-eligible, how they can work together to your benefit.