Health Insurance in United States of America

Medicare vs Medicaid

February 7, 2022 Channagangaiah

Medicare Medicaid

Medicare is a health insurance program sponsored by Federal government. Medicaid is a health insurance program sponsored by State and Federal government.

It is funded by Federal Government and administered by Centers for Medicaid and Medicaid Services. Funded by Federal & State government.

It has the same Program Nationwide. Medicaid is statewide program that vary from state to state with federal guidelines.

Who can qualify for Medicare?
Medicare provides coverage for individuals with age 65 and older or with disability, and people with ESRD (End Stage Renal Disease). Who can qualify for Medicaid?
Medicaid provides coverage for very low income individuals and families (especially pregnant women and children).

Coverage and Benefits depends on the plan you selected: (Original Medicare or Medicare Advantage Plans).
Medicare Part A – Hospital Services
Medicare Part B – Provider Services
Medicare Part C (Medicare Advantage)
Medicare Part D – Prescription Drugs. Coverage and Benefits varies from state by state although each state follows federal guidelines (Hospital, provider, Nursing facility, laboratory, x-ray, Home health care services).

Participants pay out of cost such as low cost premiums, annual deductibles and coinsurance amount. Participants pay little copay for vision and dental or No portion of coverage for medical.

Typically Medicare effective date rely on when you enroll in coverage. Available at any time.

Eligiblity and applying for Medicare: Same rules Nationwide. Eligiblity and applying for Medicaid: Each state as different rules and applying for Medicaid.

If individual is eligible need to apply once. Individual need to recertify every year by proving they meet eligibility requirements.

You can apply through SSA (ssa.gov/benefits/Medicare). You can apply through healthcare.gov or your state’s Medicaid website(Medicaid.gov).

Medicare	Medicaid
Medicare is a health insurance program sponsored by Federal government.	Medicaid is a health insurance program sponsored by State and Federal government.
It is funded by Federal Government and administered by Centers for Medicaid and Medicaid Services.	Funded by Federal & State government.
It has the same Program Nationwide.	Medicaid is statewide program that vary from state to state with federal guidelines.
Who can qualify for Medicare? Medicare provides coverage for individuals with age 65 and older or with disability, and people with ESRD (End Stage Renal Disease).	Who can qualify for Medicaid? Medicaid provides coverage for very low income individuals and families (especially pregnant women and children).
Coverage and Benefits depends on the plan you selected: (Original Medicare or Medicare Advantage Plans). Medicare Part A – Hospital Services Medicare Part B – Provider Services Medicare Part C (Medicare Advantage) Medicare Part D – Prescription Drugs.	Coverage and Benefits varies from state by state although each state follows federal guidelines (Hospital, provider, Nursing facility, laboratory, x-ray, Home health care services).
Participants pay out of cost such as low cost premiums, annual deductibles and coinsurance amount.	Participants pay little copay for vision and dental or No portion of coverage for medical.
Typically Medicare effective date rely on when you enroll in coverage.	Available at any time.
Eligiblity and applying for Medicare: Same rules Nationwide.	Eligiblity and applying for Medicaid: Each state as different rules and applying for Medicaid.
If individual is eligible need to apply once.	Individual need to recertify every year by proving they meet eligibility requirements.
You can apply through SSA (ssa.gov/benefits/Medicare).	You can apply through healthcare.gov or your state’s Medicaid website(Medicaid.gov).

Can an individual be Eligible for both Medicare and Medicaid insurance?

Yes, individual are eligible who meets the above criteria can enroll for both original Medicare and Medicaid program.

What is Dual Eligible?

Us Citizen that qualifies for support from both programs (Original Medicare and Medicaid Coverage) is considered dual eligible. Individual who are registered in both Original Medicare and Medicaid programs may receive better healthcare coverage and have lesser out-of-pocket expense.

Which is called original Medicare and what are the other parts of Medicare?

Medicare Part A (Hospital Services) and Medicare Part B (Provider Services) called as original Medicare.

In addition to Original Medicare (Part A and Part B), the other parts of Medicare are as follows:

Medicare Part C (Medicare Advantage Plan) – Offered by Private companies.
Medicare Part D (Prescription Drugs).
And Medicare supplement/Medigap.

If you have Medicare and Medicaid, which insurance will be primary?

Medicare is always primary and then Medicaid will be secondary Insurance. Medicaid insurance cover expenses that Medicare insurance does not.

When patient visit a doctor office with Medicare and Medicaid insurance for his treatment. Medicare will always pay first for the charges billed and Medicaid pays last. Medicaid Insurance will pay patient copays if any, and other charges which are not covered from Medicare (like long term care).

Can I Start Medicare before my 65^th Birthday?

Medicare Coverage starts on the 1^st day of the month in which the person reaches the age 65. The date of Medicare entitlement is, however dependent on the month of enrollment.

Initial Enrollment Period:

Initial Enrollment period starts 3 months before you turn age 65 includes the birthday month and ends 3 months after your birthday.

Suppose if you sign up for 3, 2 or 1 month before you turn age 65, then your coverage starts 1^st day of your birthday month.

Example: Consider Chris age will turn 65 on his birthday that is on July 20^th. If Chris sign’s up for Medicare in April, May or June, then his coverage will start from July 1^st.

For those whose birthdays fall on the 1^st day of the month, Medicare coverage will start from the first day of the previous month.

Example: Alia will turn 65 on August 1^st. If Alia sign’s up for Medicare in May, June or July, then her coverage will start from July 1^st.

Suppose if you sign up on your birthday month, Coverage starts one month after you sign up date.
If you sign up after one month after you turn age 65, then coverage starts two month after you sign up date.
If you sign up after two or three month after you turn age 65, then coverage starts three month after you sign up date.

General Enrollment Period:

In General Enrollment Period, individual can sign up between (From January 1^st to March 31^st) each year. Coverage starts from July 1^st of the same year.

What do I need to apply for Medicaid?

Different states have different requirements to apply for Medicaid. You will likely need to fill out an application form and documents required such as:

Proof of United State Citizenship.
Proof of DOB (example: Birth Certificate).
Family information (Number of people in your family).
Financial Information such as: Proof of all Income (Pay stubs), Proof of resources (Bank Statement), rent or mortgage information.
Medical information: If you are pregnant, Proof of disability or medical documentation showing a lifelong illness.

How can I enroll in Medicaid?

You will need to apply through your state’s agency that manages the Medicaid program, please visit Medicaid website (Medicaid.gov) for more information.