Medicare is a program for people over 65, people with End-Stage Renal Disease or ALS, and younger people who are disabled under Social Security rules.
Medicaid is a health care program for people who meet income and asset rules.
You can enroll In Medicare at the Social Security office. You apply for Medicaid at your state department of social services.
Medicare and Medicaid are two separate health insurance programs that were created in 1965 and designed to provide coverage for vulnerable populations.
This article reviews four key questions on the differences, services, enrollment and cost of Medicare versus Medicaid.
1. The difference between Medicare and Medicaid
Medicare is a federal health insurance program based on age. There are some specific circumstances where people qualify based on disability. Most people qualify for Medicare at age 65. People between ages 18-64 are also eligible for Medicare 24-months after they are determined disabled by Social Security (and get SSDI payments). People with End-Stage Renal Disease (ESRD) and ALS (also known as Lou Gehrig’s disease) are also eligible for Medicare. Find out if you are Medicare eligible.
Medicaid is funded jointly by the federal government and states and covers a wide range of individuals with low income and resources, including: families, pregnant women, children, persons with disabilities and individuals receiving Supplemental Security Income (SSI).
Some people qualify for both Medicare and Medicaid. These people are known as dual eligible.
2. Services Medicare and Medicaid cover
Both Medicare and Medicaid cover inpatient and outpatient care, which includes hospitals, doctors, emergency services, and preventive care. Medicaid also covers long-term care services, such as in-home and nursing home care. Medicare only covers short-term home health or skilled nursing facility services, such as rehabilitation following a hospital stay.
Medicare may also offer a range of other services by purchasing additional coverage (such as Part C/Medicare Advantage, Part D drug plans, and Medigap supplemental insurance). Some states may offer some of these additional benefits under their Medicaid program.
3. Medicare/Medicaid enrollment
There are opportunities to enroll in Medicare:
- The most common time to enroll is during the Initial Enrollment Period (IEP), which is the three months before, the month of, and the three months after your 65th birthday.
- If the IEP is missed, enrollment is also available during the General Enrollment Period (Jan-March each year).
- There is also an annual Open Enrollment Period (Oct. 15- Dec. 7 each year) which allows for joining/switching/dropping a Medicare Advantage or Part D prescription drug plan.
Those with SSDI because of a disability do not have to apply due to automatic enrollment in Medicare after two years on SSDI.
To enroll in Medicare, contact Social Security or visit www.ssa.gov.
People can apply for Medicaid at any time through their state social services department. Each state has specific income rules, and the state Medicaid agency can help determine qualification.
4. Cost of Medicare and Medicaid
Everyone with Medicare pays for a portion of the expenses, but how much is paid depends on the type of coverage – Parts A & B, Part C/Medicare Advantage, Part D, and/or Medigap. The costs of Medicare include premiums, deductibles, and copayments/coinsurance. For people concerned about the cost of Medicare, there are programs to help pay those costs.
Medicaid costs depend on income and an individual state’s payment coverage for services. Costs can include premiums, deductibles and copayments/coinsurance. Out-of-pocket costs typically apply to all Medicaid enrollees, but most are limited to very small amounts except those exempted by law.
It is your right to access any health program for which you meet the requirements; never assume that you don’t qualify for Medicare or Medicaid. The following three resources offer free professional advice on enrollment, costs and more:
- Your local State Health Insurance Assistance Program (SHIP) is federally funded to provide free, unbiased counseling on Medicare.
- Our Medicare Questionnaire will give you an in-depth assessment of your situation and personalized recommendations for next steps.
- For more information about benefits programs including those beyond Medicare, visit NCOA’s BenefitsCheckUp.