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People confuse c Medicare and Medicaid due to the similarity in the names.  Both are federal health insurance programs, set up in 1965 through an amendment to the Social Security Act.  While both provide coverage for medical expenses and Healthcare, they do have some differences, and we will discuss this a little more below.

Coverage

 Medicaid is an assistance program that covers all ages, as long as the state determines that you are needy or require financial assistance.  Depending on the state, you get coverage for certain services like in and outpatient hospital care,  Homecare,  nursing,  x-ray diagnostic services,  transportation to medical facilities,  among others. You may also get coverage for prescriptions, occupational and physical therapy, chiropractic services, optometry, dental care, among others.

Medicare is an insurance program that primarily caters to individuals who are above the age of 65.  Younger people who have disabilities may also qualify for coverage.

Funding

Medicaid gets its money from public funding collected through taxation.  It gets its funding from both federal and state governments. Patience may pay part of the cost through deductibles, and they may also pay monthly premiums for non-hospital coverage.

Medicare is deducted from your paycheck as a mandatory contribution, much like Social Security.  The patient usually doesn’t pay for any medical expenses that are covered but may, in some instances, have to make a small co-payment.

Qualification Criteria

 Medicaid

You are eligible to qualify for Medicaid if you have a financial need, and qualify as per the federal guidelines.  These include:-

  • Pregnancy coverage whether you’re single or married
  •  Anyone who has a minor and needs financial help, or special care like skilled nursing
  •  If you’re a teenager who is living on your own
  •  If your old, blind, disabled,  and above the age of 65
  • Services such as lab and X-ray, surgical, dental services for adults,  family planning and health screening
  • Custodial care for those who may have had an accident or stroke requiring specialized nursing both at home or at a nursing facility.
  •  Nursing Home Care for rehabilitation or on a short-term basis. You may pay part of the cost depending on your tax deductions and income.
  • If as per the federal poverty guidelines, you qualify as a medically needy individual.

Other than income, the state will also take into consideration what assets you have.  Such include checking’s and savings accounts, bonds, stocks, vehicles, and other property.  They will, however, not consider things such as your primary residence, personal effects, and household goods, among others.

If you have more assets than the government allows, you will need to spend down until you get to an amount that places you in the financially needy bracket.  To qualify, you cannot have more than $2,000 as an individual or $3,000 as a couple in liquid assets.

Spending down could involve things like paying off your mortgage,   renovating a home among others.  Be careful that you do not attract the transfer penalty, which applies to individuals who deplete their assets quickly to qualify for Medicaid.

Medicare

  • It comes in four parts namely:-
  1. A – Hospital care that will cover the cost if you are in a medical facility.
  2. B– Cover for medical tests, procedures, and doctors. It  has a monthly premium  attached to it
  3. C – Medicare advantage which covers Hospital care, doctors, procedures, and prescription drug coverage.  you get this cover through insurance companies
  4. D – Prescription drug coverage which you get through private insurance companies requiring you to pay a monthly premium. The insurance companies are federally approved.
  • It provides  cover for anyone who has contributed to the Medicare system
  • It will also cover anyone who has received social security disability benefits  40 years and those suffering from certain conditions such as ALS

Can One Qualify For Both Medicare And Medicaid

It is possible to have both Medicare and Medicaid. Up to 17% of those with Medicaid also receive Medicare; the numbers are especially high among the seniors were receiving long-term care.  There are certain benefits you will receive with Medicaid, for instance, cover for nursing care, which Medicare will not cover.  However, as stated above, to be eligible for Medicaid, you still have to meet the income requirements.

You can also benefit from the Medicare savings programs such as: –

  •  Qualified Medicare beneficiary (QMB)
  •  Specified low-income Medicare beneficiary (SLMB)
  •  Qualified disabled working individual (QDWI)  program

Most people will also have additional insurance cover to take care of the aspects that Medicare and Medicaid do not.  Such include dental services or even those prescriptions that are not on the covered list.

 Final Thoughts

We have shared with you the essential aspects of both Medicare and Medicaid.  It is, however, vital that you also take the time to understand what the two can offer you properly. Contact us here at Stress Free Health Options to get more help on choosing the right plan for you.

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