Medicare or Medicaid? What’s the difference? If you’re confused or overwhelmed by all the information out there, you’re not alone. And if you have a parent entering a senior living environment, you may be especially concerned with making sense of the different benefits available. The following information will help you understand the best options for your family.
Medicare and Medicaid are both government-run health programs with similar-sounding names. But that’s where the similarities end. Funded by different parts of the government, they are intended to serve two different groups.
The Difference Between Medicare and Medicaid
The Medicare Rights Center defines Medicare as “a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income” and Medicaid as “a state and federal program that provides health coverage if you have a very low income.” Although they are two different programs, sometimes they overlap. People who qualify for both are called dually eligible; in these cases, the programs can work together to provide coverage and lower costs.
The Parts of Medicare
Okay, so now you understand the difference between Medicare and Medicaid.
What about Medicare’s different parts? These distinctions often add to the confusion, but put simply, they refer to different categories of health coverage.
- Part A provides hospitalization coverage to individuals 65 years or older, regardless of income. To qualify, your parent or their spouse must have worked and paid Medicare taxes for at least 10 years. Your parent doesn’t have to pay a premium for Part A, but deductibles and coinsurance may apply.
- Part B covers medically necessary services and equipment, such as wheelchairs, walkers, doctor’s office visits, lab work, x-rays, and outpatient surgeries, as well as preventive services such as flu shots. If your parent qualifies for Part A, they automatically qualify for Part B.
- Part C (also known as Medicare Advantage) plans are offered by private companies, functioning much like HMOs or PPOs. In addition to providing coverage offered by Parts A and B, Medicare Advantage offers vision, hearing, and dental coverage. Think of Part C as covering those bases left out by A and B.
- Part D provides prescription drug coverage, requiring out-of-pocket payments. Members must pay monthly premiums, a yearly deductible, and copayments for certain prescriptions. Those enrolled in Medicare Part C are typically eligible for Part D.
Using Medicare and Medicaid to Fund Long-Term Care
While Medicare can partially cover shorter-term care, such as rehabilitation after surgery or skilled nursing care in facilities or at home, it does not pay for the costs of daily, long-term assistance in a residential facility. However, your parent may still qualify for some Medicaid coverage, depending on the state, the facility, and you or your parent’s income. Check Medicaid.gov for more information about your state’s assisted living waivers. You may be surprised by the options and benefits available.
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