What is the difference between Medicare and Medicaid?

Many people confuse the center’s Medicare and Medicaid. While both are state-run health insurance programs, they generally help two different groups of people:

  • Medicare offers health coverage to people age 65 and older and certain younger people with certain disabilities, at any income level
  • Medicaid offers health coverage for low-income people

Let’s take a closer look at the key differences between these two programs.

Can you have Medicare and Medicaid?

If you are 65 or older and meet the state income requirements for Medicaid, you can enroll in both Medicare and Medicaid. Together, they offer more comprehensive health coverage at a lower cost.

What is dual eligibility?

Dual eligibles are those who qualify for both Medicare and Medicaid coverage. If you enroll in Medicare at age 65 and qualify for financial assistance, you can enroll in Original Medicare or Medicare Advantage as a dual eligible. You get the health coverage you need, plus help with additional medical costs.

If you have Medicare and Medicaid, what is the primary insurance?

Although Medicare is the primary payer for medical needs, Medicaid may cover costs that Medicare coverage doesn’t cover. When you see a provider who accepts both Medicare and Medicaid, Medicare pays first for the cost of your medical care. Medicaid pays second; and covers copays and other non-covered costs.

If you are eligible for both Medicare and Medicaid, you may be eligible for the Qualified Medicare Beneficiary Program (QMB), one of Medicare’s savings programs. With the QMB program, you’ll get help with Part A and Part B premiums, coinsurance, and deductibles.

What are the 4 parts of Medicare?

  • Medicare Part A and Part B, also known as Original Medicare, work together to cover most beneficiaries’ inpatient and outpatient medical needs.
  • Part C (also known as Medicare Advantage) and Part D (prescription drug coverage) are available through private insurance companies and offer coverage beyond what Part A and Part B include.

What does Medicare Part B cover?

Medicare Part B offers outpatient medical services. Medicare Part B includes the following:

  • Routine medical visits
  • Exams, tests and x-rays
  • Flu shots and other vaccines
  • Necessary medical supplies
  • Outpatient Mental Health Care
  • Preventive medical care that is medically necessary

What do Medicare Part C and Part D cover?

You can add more coverage to your Original Medicare with Part C and Part D plans, which are offered through private insurance companies like Anthem. You can add one or the other, or you can combine Parts C and D like a Medicare Advantage Prescription Drug (MAPD) ​​plan. Part C, or Medicare Advantage, offers the coverage of Part A and Part B, and may include additional benefits, such as these:

  • Prescription drug coverage when combined with Part D
  • Routine dental care, including cleanings, x-rays, and dentures
  • Routine vision care, including contact lenses and glasses
  • Routine hearing care, including hearing aids
  • Fitness benefits, including fitness classes

Part D plans only offer prescription drug coverage . These plans are a good option when you just need to add drug coverage to your Original Medicare.

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