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What is the Difference Between Medicare and Medicaid?

For those of us that are new to this stuff, the terms Medicare and Medicaid can be confusing. Some folks have one and some folks have the other. Still other people are eligible for both programs. The differences are described below and will help you know which one you need to apply for and where to go to apply for it.

Medicare
This is a federal program that is primarily for the following groups of people:

• Individuals over the age of 65.


• Anybody of any age that suffers from renal (kidney) failure or disease.


• Anybody who is medically or physically unable to work.

Because this is a federally controlled program, the application is available at your local Social Security office. The different coverages are called:

• Part A (Hospital Insurance) - Covers care in hospitals, hospice, nursing home facility care and home health care.


• Part B (Medical insurance) - Covers outpatient services, home health care services and products as well as doctor's services and preventative services.


• Part C (Private insurance) - This is for insurance like HMOs or PPOs that are provided by private insurance companies approved by Medicare. These are also called Medicare Advanatage or MA plans and include all Part A and Part B coverage.


• Part D (Prescription insurance) - Helps cover the cost of prescription drugs and may assist in lowering costs later.

Medicaid
Medicaid is a state controlled program that is primarily for low income individuals and families. The following groups of people are eligible for Medicaid coverage:

• Women who are pregnant


• Persons beneath the age of 19


• Persons above the age of 65


• Anybody who is blind, physically disabled or requires nursing home care.

You can apply for Medicaid at your state's Medicaid agency.

Dual eligibility
Some people are eligible for both programs. Medicare can be utilized as gap insurance for uncovered Medicaid expenses. You will need to apply for each program separately at the appropriate places. Each will need to know about the other, so be honest and give all information that is asked for.

In the area of nursing facility care, both programs have coverage listed. Medicare Part A covers nursing home care and Medicaid has provisions as well. This can help a great deal with the costs incurred by caregivers. If you have your own insurance, the costs may all be deferred and negated through the process. No guarantee on that, but it could happen.

Call your state's Medicaid agency and your local Social Security office for more details and see if you are dually eligible. Whether you need assisted living services or home health care services, you may be able to get it paid for by these programs; at least in part, anyway.