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Medicare vs. Medicaid: Do You Qualify for BOTH?

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Understanding what the two programs are

Published: September 23, 2021

Category: Educational, Medicare Healthcare

Just when you think that Medicare itself cannot get any more confusing, it does. But, for some Americans, it becomes more confusing in a positive way. For many Americans who are close to retirement and qualify for Medicaid health assistance, the question about whether they will also qualify for Medicare health insurance is one they’re likely to consider, especially if they don’t have the answer. And if it’s still a question you have, you can rest easy knowing that it will be answered by the end of this article.

This article is intended to answer your question about whether you qualify for both Medicare and Medicaid, what each is, how you can qualify for the two services and what their overall differences are.

Let’s get into it by first understanding what the two programs are.

What is Medicare?

If you’re familiar with The Best Senior Services’ website and blogs, then you’re probably familiar with the available Medicare plans out there. But for those who are new here and wanting to learn more about the program, Medicare is a health insurance program that covers Americans who are at least 65 years old.

There are four parts to Medicare: Parts A, B, C and D:

  • Medicare Part A covers hospital insurance. This means that your in-patient hospital stays will receive some coverage from Medicare. For many enrollees, Part A is provided at no additional cost.
  • Medicare Part B covers medical insurance. This means that your out-patient medical visits to doctor’s offices will receive some coverage from Medicare. Part B is paid for through monthly premiums that enrollees will receive. The premium costs will vary based on your income.
  • Medicare Part C is a Medicare Advantage plan. A Medicare Advantage plan is an alternative plan to the Original Government Medicare (OGM) plan. It is sold through private insurance companies that have been verified through Medicare, and is known for providing more coverage than the OGM plan.
  • Medicare Part D covers drug prescriptions. This is optional coverage, designed to help Medicare recipients pay for prescription drug costs. Part D is offered for both the OGM plan and the Medicare Advantage plan.

What is Medicaid?

Medicaid has been around since 1965, the same year Medicare was implemented. It is a federal program that helps with healthcare costs for millions of Americans, like children, pregnant women, seniors, Americans with disabilities and more. There are a few ways in which Medicaid is similar to Medicare, including how its spending is focused on helping those who are disabled and aging, as well as its coverage. Coverage that is similar to Medicare can include hospital visits, in-home care, doctor’s visits, wellness screenings, medical transportation and more. Additional benefits can include hospice, speech therapy, physical and occupational therapy, prescription drug coverage, personal care and more.

Medicaid is a joint program, meaning it’s funded both by the federal government and by your state’s government. Medicaid’s joint program status means that there isn’t a limit to the amount of people who can be enrolled in Medicaid, which is a major benefit to many. And like many other programs across the nation, Medicaid is constantly evolving. As time has progressed, the eligibility margins have grown and coverage milestones have been met. Perhaps the biggest milestone it has passed is being known as one of the nation’s largest health insurers available.

Those who are enrolled with Medicaid have the option to receive their coverage through private care plans that are verified through their states. And even if you’re already enrolled in a separate, private insurance plan, that doesn’t hinder your eligibility for Medicaid. In most cases, you should still be able to qualify for the Medicaid program.

Speaking of qualifications, let’s get a better understanding of how you can qualify for both of these programs.

How do I qualify for Medicare and Medicaid programs?

Luckily for many, the qualifications outlined by Medicare and Medicaid are cut-and-dry, meaning you’ll have a great understanding of whether you’re eligible before you begin the application process. Those who are eligible for Medicare’s services typically tend to be at least 65 years old. However, you may also qualify for Medicare before the age of 65 if you have been receiving Social Security disability for 24 months, have Lou Gehrig’s disease (formally known as amyotrophic lateral sclerosis) or end-stage renal disease.

Those who have already been receiving Social Security benefits are automatically enrolled in Medicare Parts A and B upon the month they turn 65. Additional coverage options will then be made available for those who are interested. Those who need to manually enroll themselves into a Medicare program can do so through the Social Security Administration (SSA). They can enroll through the SSA website, calling 1-800-772-1213 (or 1-800-325-0778 for TTY users) or by visiting their local Social Security office.

After becoming a part of the Medicare program, enrollees can expect to receive welcome packages with their new Medicare card, also known as the Red, White & Blue Card, included. It’s important to keep this card close so that you can protect yourself from Medicare fraud, as well as those who could scam you, as many seniors fall victim to scams as it relates to Medicare.

The qualifications for Medicaid are slightly different from Medicare’s qualifications. According to Medicaid.gov, those who will be able to qualify for “mandatory eligibility groups” are low-income families as well as “qualified pregnant women and children, and individuals receiving Suppliemental Security Income (SSI).”  However, unlike Medicare, there isn’t really a way to be automatically enrolled into a Medicaid program, unless you meet certain criteria by the SSI, as outlined by the SSA. Otherwise, those who are interested in applying for Medicaid coverage can do so by visiting their state’s Medicaid agency.

Now that we understand how you can qualify and apply for both of these programs, let’s get to the really important question — are you eligible to be enrolled into both of these programs concurrently?

Can I qualify for both Medicare and Medicaid?

The short answer is: yes! If you’re qualified for Medicaid, you can qualify for Medicare, too, and vice versa. When you qualify for both programs, it’s known as having ”Dual Eligibility.” And for those with Dual Eligibility, there is a possibility that all of your healthcare costs will be covered. This means that Medicare copays and coinsurance could be handled, as well as any charges that would not be taken care of by your primary insurance carrier.

However, it’s still important to note that there are some differences between the two that you’ll need to know. The most important difference is that Medicare is an insurance program, while Medicaid is an assistance program. As a result, the qualification requirements for the two services are different, which is why we highlighted them earlier in the article. Other differences include the fact that, though Medicaid is a joint federal-state program, Medicare is solely run by the federal government. Finally, Medicare enrollees determine the amount of coverage they receive, while those covered under Medicaid’s services are covered by what their respective states provide.

Regardless of differences, though, both programs are great and intended to make sure that its members are as protected as possible.

Medicare and Medicaid are two great programs that protect everyone who is enrolled within them. And when these two programs come together, they make sure that those who are dually eligible receive great coverage. If you’re interested in learning more about Medicare, Medicaid or other financial services during your retirement, then look no further than The Best Senior Services (TBSS). We inform seniors about important topics related to their retirement and connect them with local licensed agents, so that they can spend more time enjoying their retirement instead of worrying about it.

Visit our website or call us at 855-979-8277 to get started with us today.