Medicare is a government-subsidized health program for:
People 65 and olderYounger people who have received SSDI for a minimum of 24 monthsYounger people with end-stage renal disease (ESRD) who receive dialysis or have had a transplantYounger people with Lou Gehrig’s disease
Medicaid is a federal assistance health program for:
Low-income Americans of any age
What Is Medicare?
Medicare is a federally subsidized health insurance program for individuals ages 65 and older. Younger people who are under 65 may qualify through disability or disease. Those who paid Medicare taxes for a minimum of 10 years usually receive part of Medicare free of cost.
What Does Medicare Cover?
Medicare health plans come in four parts – Part A, Part B, Part C, and Part D. Part A Medicare benefits include:
Hospital care$0 starting monthly premiumsA deductible of $1,408+ for hospital stays
Part B Medicare benefits include:
Doctor care, lab tests, and medical proceduresStandard monthly premiums of $144.60An annual deductible of $198Higher premiums for those in higher income brackets
Part C Medicare Advantage plans include:
Part A, B, and often D coverageExtras such as hearing, vision, and dentalVaried premiums, deductibles, copays, and coinsurance paymentsServices offered through private insurance companies
Part D Medicare benefits include:
Prescription drugsMonthly premiums averaging $32.74
It’s important to note that Medicare does not cover every health care need you might face. Because of this, there are optional Medigap plans to cover the gaps in coverage.
Who Qualifies for Medicare?
To qualify for Medicare, you must fit into one of the following categories:
Age 65 years oldNot covered under employer-provided healthcare programYounger people
Diagnosed with end-stage renal disease (ESRD) And receiving dialysis for two months, OR Have undergone a kidney transplant Diagnosed with Lou Gehrig’s disease (ALS)
It’s important to note that the program is not based on financial need. You will be required to pay for Medicare benefits. Those with higher income levels will be required to pay higher premiums on various parts of Medicare. Base monthly premiums apply to Part B, C, and D.
What Is Medicaid?
Medicaid is a health insurance program subsidized by the government, specifically for low-income Americans. The people who qualify for Medicaid would be unable to afford healthcare without the program.
What Does Medicaid Cover?
Medicaid health plans will vary by state. The federal government requires each state to provide the following as a minimum:
Inpatient hospital servicesOutpatient hospital servicesNursing homestayHome health servicesLaboratory servicesX-Rays and diagnostic servicesTransportation to medical facilitiesCounseling to quit smoking for pregnant women
While the above are services also provided through Medicare, Medicaid also provides the following care which is not offered by Medicare:
Personal care for daily activities
Help eating, bathing, dressing, using the bathroom For rehabilitation only, not extended care Care may occur in a skilled nursing facility or provided at home
Nursing Home Care
Short and long-term nursing care For rehabilitation only, not extended care
Some state Medicaid programs may also offer:
Prescription drugsPhysical therapyOccupational therapyOptometryChiropractic serviceDental careHearing benefits
Who Qualifies for Medicaid?
Eligibility for Medicaid is determined through income taxes and is funded by both the state and the federal government. While there are federal guidelines that steer the entire program, each state’s Medicaid program works differently. Every state has its own rules for qualification, guidelines, and processes. Qualification may include:
Submission of tax documentsGoing through a medical screeningProvision of financial documents
There are costs associated with Medicaid, though children and people living in institutional care are typically exempt. Specific groups are encouraged to apply, including:
Pregnant women
Single or married Mother and child are both covered
Parent of a minorTeenager living aloneBlind or disabledOver 65 years old
And cannot afford Medicare
Under 65 years old with no disabilities or minor children
Medicaid Income Requirements
To qualify for Medicaid, you must meet minimum income requirements based on the federal poverty level. Each state has a set of guidelines that will help you determine your qualification and need level. If you have an income higher than minimum requirements but face exceptionally high medical expenses, you may still qualify. What counts as income?
Savings accountsChecking accounts401(k)BondsStocksCDsProperty (besides your residence)
Most states allow a maximum of $2,000 in assets for a single person and $3,000 for a married couple. Assets that do not count include:
Your primary residenceVehiclesHome furnishingsHousehold itemsPersonal items
It’s important to note that you still might qualify if you have more medical expenses than your income allows you to pay for. For example, if you have $5,000 in assets, but you have medical expenses of $7,000, you might qualify. Note: It is possible to obtain a “dual eligible” status for both Medicare and Medicaid. If this occurs, nearly all of your medical expenses will be covered in full. For those who are dual-eligible, your medical insurance will look like this:
Medicaid coverage for the majority of Part A and B costs, including premiums, deductibles, and copayments.Nearly full coverage for Part D through combined Medicare and Medicaid.
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