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What is the difference between the Medicare and Medicaid programs?

What is the difference between the Medicare and Medicaid programs? They are both types of low cost, government-funded,health insurance. The qualifications and benefits for each type of coerage, however, differs.  Learn more here.

What is Medicare?

Medicare is a federally-funded health insurance program for people over the age of 65, and younger people with some diabilities including those with end-stage renal disease and ALS or Lou Gehrig Disease.

Medicare includes coverage for:

  • in-patient hospital stays (Medicare part A)
  • outpatient services and supplies (Medicare part B)
  • prescriptions (Medicare part D).

Because Medicare is federal program a person is eligible to use this type of health insurance in all 50 states.

People with Medicare may have to pay a monthly premium, copayment, coinsurance and deductible. Even though Medicare is an entitlement, one must sign up to receive it.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is an alternative way for Medicare beneficiaries to receive their Medicare benefits. Instead of receiving benefits through Original Medicare (Part A and Part B) directly from the federal government, Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Medicare Advantage plans typically offer more choice. This option can expand the network of doctors, hospitals, and oter healthcare providers available in-network. It may also offer other benefits such as dental, vision, hearing and fitness benefits depending on the plan.

Medicare beneficiaries who are eligible for Medicare Part A and enrolled in Part B can choose to enroll in a Medicare Advantage plan instead of Original Medicare. Enrollment typically occurs during specific enrollment periods, such as the Annual Enrollment Period (October 15 to December 7 each year) or during special enrollment periods. Costs can vary widely depending on the plan.

What is a Medicare Supplement Insurance Plan?

Medicare Supplement Insurance covers out-of-pocket expenses such as co-pays, coinsurance and deductibles.  It is guarenteed renewable regardless of health status. Medicare Supplement insurance is not the same as Medicare Advantage.

What is Medicaid?

Medicaid is a health insurance benefit for people with limited income and resources. It is funded by both the state and federal governments. It may have different names in different states, for example it’s called Medi-Cal in California.

There are federal guidelines for Medicaid, and well as state guidelines.  Therefore, qualifications for Medicaid may vary from state to state.

Medicaid coverage may cover nursing home and personal care services not covered by medicare.

Just as with Medicare, in order to receive Medicaid coverage one must sign up for benefits.

What is Medicaid Managed Care?

Medicaid managed care is a system where states contract with managed care organizations (MCOs), often private insurance plans, to provide Medicaid benefits to enrollees. Unlike traditional fee-for-service Medicaid, where healthcare providers are reimbursed for each service rendered, Medicaid managed care plans receive a fixed monthly payment per enrollee from the state. This payment covers all or most of the enrollee’s healthcare needs.

The benefits may have the name of the health insurance company which manages the service other than straight Medicaid. Like with Medicare Advantge, Medicaid Managed Care plans may provide enrollement choice and access to doctors and hospitals who don’t participate in direct Medicaid.

Can I have both Medicare and Medicaid?

A person is said to be “dual eligible” when they qualify for both Medicare and Medicaid.  In this case Medicare would be the primary insurance, which means it would pay first for Medicare-covered expenses. Medicaid, or any other health insurance, would be the secondary insurances that would then cover any eligible balances.

Conclusion: What is the difference between the Medicare and Medicaid programs?

Having health insurance is important to protecting your health and finances. Medicare and Medicaid are government-funded health insurance plans that provide a safety-net benefit for people later in life, with disabilities, serious chronic conditions and low incomes. Many doctors, hospitals and other healthcare providers participate so you can get the care you need.

Look for a black doctor who participates in Medicare or Medicaid here!