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Medicare vs. Medicaid

Medicare and Medicaid are both public health insurance provided by the government for citizens who cannot afford them. Private insurance can be pretty pricey, and if an individual does not make enough or has other issues that prevent them from securing private health insurance, then public health insurance can be the way to go.

There are a number of reasons why one would need to apply for public health insurance. It could range from insufficient income to a disability or the age of the applicant.

There are definite differences between Medicare and Medicaid, both of which are provided by the government. One of the fundamental differences is that Medicare is provided by the federal government, while Medicaid is both a state and federal program for health coverage. Both programs are funded by taxpayers and differ in qualifications and coverage.

Qualifying For Medicare

Medicare is the public health insurance provided by the U.S. government for its aged (senior) and disabled citizens. It covers individuals with limited income, which is usually a result of their age and disability, making them unable to earn better income. 

To qualify for Medicare, a citizen must be 65 years and above or have a verified disability. Senior citizens can begin applying for Medicare three months before they turn 65 to provide ample time for the coverage to kick in by the time they are of qualifying age. However, citizens can sign up earlier for this health insurance plan if they are disabled, have end-stage renal failure, or have ALS (Lou Gehrig’s disease).

Qualifying For Medicaid

Medicaid is more of an assistance program than it is an insurance plan. Unlike Medicare, Medicaid is available to American citizens of all ages. Medicaid is tailored to individuals who can work to earn an income but do not earn enough to afford private insurance. 

Citizens who apply for the Medicaid assistance program will need to prove that while they earn an income, they do not earn enough to afford monthly insurance premiums payments. Medicaid will usually cover the cost of care and medical expenses for individuals that qualify for it. Although it is not unheard of that individuals can be required to make a small copay with the plan.

Low-income citizens, disabled and senior citizens, pregnant women, families with children are provided with Medicaid coverage in all 50 states. It is essential to note that states can expand Medicaid plans, so keeping up-to-date with what your state is doing is crucial.

Coverage Options For Medicare and Medicaid

Both Medicare and Medicaid provide coverage options to a certain extent for their beneficiaries. Coverage can be all-encompassing like in Medicaid or can feature many coverage gaps, as experienced with Medicare. To get a more comprehensive Medicare coverage, beneficiaries may have to purchase additional plans to plug these gaps.

Medicare Coverage

  • Disabled and senior citizens
  • Covers hospital, doctor visits, and medication expenses
  • It does not cover nursing home and custodial care
  • Coverage is dependent on purchased plans
  • Covers designated illnesses such as ALS and ESRD (End-Stage Renal Disease)

Medicaid Coverage

  • It covers low-income citizens
  • Hospital, doctor visits, and medications are covered
  • Covers nursing home and custodial care
  • Coverage is dependent on the state of residence
  • No designated illnesses due to comprehensive coverage

Getting Dual Coverage

Both Medicare and Medicaid can sometimes cover citizens based on their qualifications. It is not well-known, but it is a fact that some people are eligible for dual coverage. This usually occurs because Medicare does not provide comprehensive health coverage for the beneficiaries, and some citizens cannot afford the cost of purchasing additional plans to cover these gaps.

Thus, they will need to be enrolled under Medicaid, although subsidized. With Medicaid, the cost of having comprehensive coverage is highly subsidized to the point where an individual will only have a small copay or no cost at all. 

It should be noted that dual coverage is not the only way to deal with gaps in Medicare coverage. A supplemental policy known as Medigap was introduced to plug this gap in the plan. Beneficiaries can apply for Medigap policies like Medicare Part F, but these are offered by private health insurance providers and would mean additional costs for the insured.

How To Check Eligibility For Medicare and Medicaid

American citizens can check their eligibility for any of the government-funded health insurance plans via their websites. The Medicare website features an Eligibility and Premium Calculator, which collects applicants’ information and tells them if they qualify for Medicare. If they do, it shows what their estimated premiums would be for the plans they choose.

Checking eligibility for Medicaid is a less straightforward process. Eligibility is assessed using MAGI (Modified Adjusted Gross Income). This considers the applicant’s income and determines if an individual is financially eligible for Medicaid. However, some citizens are exempt from this assessment generally due to disability and age. In cases like this, the government uses SSI methodologies to determine eligibility. 

For dual coverage, eligibility is assessed using the same methodologies used to determine SSI eligibility. This is not all-inclusive as there are cases where these assessment methods are not applied. 

SSI recipients and individuals under the breast and cervical cancer treatment and prevention program are not assessed using income. Young adults who were in the foster care system qualify for Medicaid at any income level. Children with an ongoing adoption assistance agreement under Title IV-E of the Social Security Act are automatically eligible for Medicaid.

Why Apply For Medicare or Medicaid

Public health insurance plans like Medicare or Medicaid are much cheaper than policies provided by private companies. Coverage could also come ultimately cost-free depending on the situation of the individual. This helps individuals get the medical care that they would otherwise not be able to afford if they were paying out-of-pocket.

Coverage can go into effect immediately after approval, and individuals can appeal if they are determined not to be eligible for any of the health coverage plans. The plans take the burden off low-income individuals and families who would otherwise go into debt if they had to pay their medical costs themselves. 

The process, which can seem daunting at first, can turn out to be smooth as Medicare and Medicaid agents will work with individuals to figure out the best plan for them.

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