Why People Confuse Medicare and Medicaid

The names of these two programs, Medicare and Medicaid, are similar. As a result, many people mix them up when trying to enroll. The confusion is not just about the names. Both are government programs that help people pay for health care, but that’s where the similarities end.

Overview of Medicare

Medicare is a federal program for people age 65 and older. Some younger people with disabilities or specific medical conditions also qualify.

Medicare Part A and Medicare Part B come directly from the federal government. In contrast, private insurance companies—licensed and approved—offer Medicare Part C and Medicare Part D under federal rules.

Overview of Medicaid

While the federal government runs Medicare,  Medicaid is a state-run program. It helps people with limited income or resources pay for health care costs.

Each state designs its own Medicaid program, but all must follow federal guidelines. States may also create special programs for certain populations. Because of this flexibility, Medicaid benefits vary from one state to another.

Coverage for Medicare and Medicaid

In short, Medicare includes four parts:

• Part A: Hospital insurance

• Part B: Medical insurance

• Part C: Medicare Advantage, which combines Parts A and B, often includes Part D, and may add dental, vision, fitness, and hearing benefits

• Part D: Prescription drug coverage

Medicaid also covers a wide range of services. Some benefits are federally required, while others are optional. States decide how to structure the optional services.

Federally mandated benefits include:

• Inpatient and outpatient hospital services

• Physician services

• Laboratory and x-ray services

• Home health services

Optional benefits may include:

• Prescription drugs

• Case management

• Physical therapy

• Occupational therapy

Costs of Medicare and Medicaid

Both Medicare and Medicaid may include premiums, deductibles, co-payments, and coinsurance.

For Medicare, what you pay depends on when you enrolled, the coverage you chose, and the services you use during the year.

For Medicaid, costs depend on your income and your state’s rules. Some groups under Medicaid do not have to pay many out-of-pocket costs.

Medicare also offers four savings programs. If you qualify, these programs can help pay your Medicare premiums, deductibles, co-payments, and coinsurance.

Dual Eligibility

It is possible to qualify for both Medicare and Medicaid. People who meet the requirements for both are called “dual eligible.” If you qualify, the two programs can work together to lower your health care costs.

Need More Information?

We are Independent Insurance Brokers appointed by many major insurance carriers. Our team can help you find the policy that best fits your needs. We serve clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.

Contact us today at (540) 662-4432 to schedule a FREE consultation with one of our insurance agents. Or visit medicaretrustedagents.com to learn more.