Medicare and Medicaid are two health-insurance programs that help to pay the costs of healthcare for US citizens. These two separate programs are frequently misunderstood in terms of the coverage they provide and how they operate.

First and foremost, Medicare and Medicaid effectively serve two distinct groups.

They are TWO separate government initiatives that are controlled and funded by separate departments of the government. They differ in services & cost-sharing.

Medicaid is a state-federal program that offers health insurance to low-income health-care program that is often a final choice for those people who have exhausted all other options.

Those who are eligible typically are children, pregnant women, the elderly, people with disability, and low-income adults. This program has strict eligibility requirements including income restrictions, that vary state-state. Those covered by Medicaid do not get billed for covered services.

Services provided by Medicaid vary by state, however, the federal government requires coverage for a number of services, including Services for hospitalization and laboratory testing, X-rays

Services of a doctor or nurse, Services provided by nursing homes, nursing facility services care at home. Treatment at a clinic, nurse practitioner services for children and families, and Services of a midwife.

Long-term care is not covered by Medicare or most commercial health insurance policies, so Medicaid is frequently utilized to support it. In fact, Medicaid is the country’s largest single source of long-term care funding, covering the costs of nursing homes for those who have spent all of their money on healthcare and have no other way of paying for nursing care.

Prescription drug coverage, optometrist services, eyeglasses, medical transportation, physical therapy, prosthetic devices, and dental treatments are all optional benefits that any state may provide.

Medicare on the other hand is a federal program that covers you regardless of your income If you are 65 and older OR under 65 and are eligible (disability-based). This essentially becomes a PRIMARY healthcare provider for seniors. Medicare is a phenomenal program that helps millions to cover their healthcare costs.

This program is separated and broken down into four parts. Those parts being A-D by coverage -prescription drugs, supplemental, hospitalization, and medically required services. A and B are the “original Medicare”. The four parts are:

Part A- hospitalization coverage
All Individuals 65 and older, regardless of income, are covered for hospitalization. To be eligible, you or your spouse must have worked and paid Medicare taxes for at least ten years.

Part B- Medical Coverage
Part B, which covers medically required services and equipment, is available to those who are eligible for Medicare Part A.

Part C-Medicare Advantage plans
Part C, often known as Medicare Advantage, is available to people who are eligible for Medicare Parts A and B. Part C provides vision, hearing, dental coverage, and also prescription drug coverage, in addition to the coverage provided by Parts A and B.

Part D- Prescription drug coverage
Prescription drug coverage is provided under Medicare Part D. Participants must pay out-of-pocket for Part D plans, which include monthly premiums, a yearly deductible, and copayments for specific medicines. Those with Medicare Part C should only seek Part D if their plan does not cover prescription drugs.

However, you can have both if you are qualified for both Medicare and Medicaid. The two merging becomes a “dual health plan” meaning you are eligible for both by meeting requirements to qualify for Medicaid and also qualify for Medicare due to age. Dual programs are designed for people who have both Medicare and Medicaid. When Medicaid recipients turn 65, they retain their Medicaid eligibility while simultaneously becoming eligible for Medicare. Medicaid coverage may change based on the recipient’s income at that time. Medicaid may cover the cost of Medicare Part B premiums for higher-income people. Individuals with lower incomes may continue to receive full benefits. If this occurs, then they will collaborate to provide you with health insurance while also reducing your rates. In working together Dual plans combine your coverage including- medical, prescription, and hospital benefits. With this, you can gain more benefits than with Medicare solo. Some can get it all at a $0 plan.

Are you interested in learning more about Medicare or don’t know where to begin?

As a Licensed Insurance Broker and a National Social Security Advisor Certificate holder,

Jessalyn Pito is available to assist in YOUR Medicare journey. As your Medicare Maven, Jessalyn is happy to provide you with easy-to-understand education and information. In addition to helping, you find the service that best fits your needs, she will be by your side and check in periodically to ensure you are utilizing all available benefits. Are you in need of Medicare? Get in touch with Jessalyn Pito today!