Differences Between Medicare and Medicaid

Medicare vs Medicaid
Medical Insurance is a major concern for all individuals who are either receiving Social Security retirement benefits based on age, whether they are disabled and receive Social Security Disability Insurance, or if they receive Supplemental Security Income. All three Social Security Administration programs include either Medicare or Medicaid insurance coverage eligibility, and some individuals with a reduced monthly benefit can actually qualify for both programs. They are two completely different programs with respect to what they will cover and how bills are paid, such as co-payments for some recipients, and it is important for everyone who is disabled or nearing retirement to understand how the programs work. In fact, many Medicare beneficiaries must alter their personal estates in some instances to qualify for Medicaid when they will require residency in a nursing home because Medicare does not cover this cost. This potential situation is a prime example of how the programs differ, but there are other contrasts as well.

Medicare Basics

Medicare is the first insurance coverage that retirees identify with because it is the most common program. Original Medicare insurance consists of a primary Part A and Part B with additional coverage being purchased by the recipient in the form of a Medicare Advantage Plan. Medicare alone is a paid program as well for those who are covered, but the premium is set at a standard rate for all who are eligible. Medicare also requires co-payments for visits to treatment facilities and doctor appointments in addition to paying for basic coverage and a Part D plan. Part D Medicare Advantage plans are optional, but often necessary to enjoy full Medicare benefits.

Medicare Advantage plans are purchased through private insurance policies and premiums can be based on personal assets and income level of the purchaser. There are many different plans offered by multiple insurance carriers, and knowing which plan to choose can be confusing for many. It is typically best to take multiple quotes from advantage plan providers to evaluate what they cover and what may suit the individual purchaser best. Every client has differing medical needs, and plans often do not offer consistent standard benefits. The advantage plan that is chosen can have a dramatic impact on additional costs when health insurance is being applied in the payment process.

Medicaid Basics

The Medicaid program functions completely different from Medicare in most cases. States do have the authority to require some amount of payment with respect to co-pay when beneficiaries seek medical treatment, but most states do not use this authority for all patients. Medicaid is essentially free for the disabled or individuals with minimal personal assets or are under 150% of the official federal government poverty guidelines with respect to earned income. The program is not restricted to retirees or the disabled. Additionally, retirees receiving Social Security benefits whose government benefit is discounted due to early retirement for whatever reason may qualify for Medicaid through the poverty guide assessment. These individuals often receive a small amount of Supplemental Security Income payments as well to meet the government income minimum. All recipients of Supplemental Security Income are eligible and automatically assigned to Medicaid coverage when being approved for the needs-based income program.

Individuals who receive both Medicare and Medicaid can also purchase a Medicare Advantage Plan to help cover what original Medicare does not. Actually, many of the plans will be a no cost coverage for the additional insurance protection regarding medication co-pays and potential treatment payment. Additionally, many Medicaid beneficiaries are actually children with a specific disability and medical need who may also remain on Medicaid their entire life. These individuals are not eligible for Medicare until they reach age 62, and most will typically remain on Medicaid if they do not work enough throughout their adult life to qualify for Medicare coverage.

Qualifying for Medicaid for Medicare Recipients

The major issue with Medicare coverage beyond having to pay monthly premiums and co-pays for treatment and medications is that it does not include payment for nursing home residency. Many retirees live longer lives than others and suffer from medical conditions that may require skilled nursing attention on a constant basis. This can create a serious issue regarding family estates. There are steps that retirees can take with their personal estate that can qualify them for Medicaid eligibility. All retirees and their families should be aware of this potential issue as family members experience serious medical issues as they age or if they are injured in an accident.

These are just the basic elements of what Medicare and Medicaid insurance coverage may entail. Each individual will have different circumstances that will impact their eligibility if they become disabled or enter into retirement by virtue of age. These government benefits are also additional to any private insurance program that anyone may receive as a benefit of having worked a significant period with a particular employer or purchased as private health insurance. It is important for all potential recipients to do some personal research into Medicare and Medicaid eligibility whenever possible in making prudent decisions regarding overall health insurance coverage.