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Medicare and Medicaid: What’s the Difference?

Medicaid and Medicare are two healthcare assistance programs that the federal government manages. While they share some similarities, there are also many differences between the two programs, and the qualifying requirements of each differ greatly. Some individuals will qualify for both programs at the same time, but many others only qualify for one or the other. Still others do not qualify for either.

What is Medicaid? 

Medicaid is a federally funded healthcare program that each state administers separately. This healthcare program is made available to low-income individuals of any age and is granted to those with demonstrated financial need.

There is no premium payment associated with Medicaid, but occasionally, there may be small fees associated with services received through the Medicaid program. Services covered by Medicaid typically include healthcare needs such as doctor visits, hospital stays and ancillary medical services such as eyeglasses.

If you believe you may be eligible for Medicaid, you can apply through your state’s health services office.

What is Medicare? 

Medicare is also a federally funded healthcare assistance program, and it is administered at the federal level, with nationally standardized requirements and guidelines.

Generally, individuals become qualified to receive Medicare benefits at the age of 62 — sometimes earlier if there is a disability claim that warrants Social Security benefits. Medicare is not a need-based program and is provided to anyone who has paid into the program through payroll taxes or self-employment taxes once they reach the required age.

Medicare comprises three main parts. Medicare Part A provides coverage for hospital stays and expenses and is the premium-free portion of Medicare. Medicare Part B covers medical expenses such as doctor visits and carries a monthly premium that must be paid by the individual to maintain coverage. Medicare Part D is the prescription coverage portion of the program and also requires a premium be paid each month for continued benefits.

The Medicare healthcare program includes copays, coinsurance and deductibles that cause individuals with this coverage to incur out-of-pocket expenses and medical bills that are not included in their coverage. Medigap insurance plans can be purchased to help offset these costs, and in some need-based cases, Medicaid may offer coverage for these additional expenses.

Is it possible to be eligible for both programs? 

State guidelines will dictate whether an individual qualifies for Medicaid while already on Medicare. Because Medicaid is a need-based program, income levels and available resources are considered when determining eligibility for Medicaid. However, some states allow for “spend-down” considerations in which medical bills are deducted from income to determine financial medical need on an individual level.

In cases where someone can enroll in both Medicare and Medicaid at the same time, Medicaid can assist with the out-of-pocket expenses often incurred as a result of Medicare deductibles, copays and coinsurance. Medicaid may also cover some expenses not covered by Medicare.

Rob Levine & Associates Can Help 

If you feel you might be eligible for Medicaid and/or Medicare and aren’t sure where to begin, Rob Levine & Associates can help. Call us today at 1-866-LAW-SSDI to set up a consultation to discuss your case with an attorney.

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