Medicare vs. Medicaid

Medicare and Medicaid are often conflated, but the two public health programs are not the same. While similar, they offer different benefits to different people. If you want to know the difference between Medicare and Medicaid, keep reading. 

What is Medicare?

Medicare is a federal health insurance program that is administered by the Social Security Administration. The program provides coverage to millions of Americans, with the majority of them being senior citizens. That is mainly because the primary requirement for qualifying for Medicare is that you must be age 65 or older. 

People who are diagnosed with qualifying disabilities can also become eligible, but they usually must collect Social Security disability benefits for at least 24 months first. Through Medicare, you can get most of your major health insurance needs taken care of, with few gaps left in your coverage. 

What Is Medicaid?

Medicaid is a federal and state health insurance program that provides health care insurance to low-income individuals. Medicaid eligibility is based on income and family size, so if you have a low income or large family, you may be able to get help paying for health care coverage. After qualifying for Medicaid, you can get low-cost coverage that covers mandatory benefits like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, and more.

Medicaid vs Medicare

When a beneficiary has both Medicare and Medicaid, Medicare will always be the primary insurance and Medicaid will be secondary. The most noticeable difference is Medicare is a federal program with no state influences on basic benefit structure. However, Medicaid is a state-run program under the guidance of CMS and partial funding of the federal government. More flexibility is given to the states to their benefit offering and how they administer those benefits. That means Medicaid’s rules in each state are different, unlike Medicare which has universal rules across the country managed by CMS, a federal agency. 

Qualifications for Medicare are different from Medicaid. In addition to age and Social Security disability requirements for Medicare eligibility, there is no income threshold for Medicare. However, there are strict requirements on income for Medicaid. There are many levels of Medicaid that are state specific where Medicare has standard benefits and once eligible it does not change no matter where you move to or live in the United States.

Available assets or resources to qualify for Medicaid are state specific to what level and waiver program you are applying. You can find a state-by-state breakdown at State Overviews | Medicaid.

If you have SSI and straight Medicaid prior to turning 65 you will most likely have your Medicaid benefits reevaluated as Medicare will become your primary health insurance.

We Can Help You Enroll In Public Benefits

Public benefits exist to help you. Take advantage of them now by calling Larry Klein, Medicare Agent and owner of Iowa Medicare Group. You can reach him at 515-664-7078.