Medicare Vs. Medicaid, what’s the difference?

As Qualified Medicare Advisors, serving communities, we are often asked, “what is Medicaid?”, or “Is Medicare the same as Medicaid?  Simply put, Medicare is a federal entitlement program, and Medicaid is a state run, needs-based program.

But let’s explore these two programs further…

MEDICARE 

You are eligible for Medicare through age (65 years and older) or disability (24 months of disability allows you to become Medicare eligible).  For age-attained Medicare benefits, Part A (Hospital insurance) is granted if you (or your spouse) have worked 40 quarters (aka 10 years) in the USA and paid the Medicare tax during this time. Part A for hospital services is premium free if you meet these requirements, which most do, but is also purchasable if the requirements were not met. Part B insurance (covers outpatient, doctor visits, DME, Lab, etc.) comes at a monthly premium ($144.60 for 2020).

Other qualifications for Original Medicare are as follows:

  • Have end-stage renal disease (ESRD) (permanent kidney failure that requires dialysis treatment or a kidney transplant)
  • Have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis, or ALS)

Having Parts A & B of Medicare allow you the option of further enhancing your coverage to include a Supplement (Medigap Plan) or Medicare Advantage (MAPD) Plan, so, unless you receive coverage through another source, it is important that you have both to optimize your choices.

  • For more information on Parts C and D of Medicare, check out “What is a Medicare Advantage Plan?”

MEDICAID

Medicaid uses financial qualifications (assets and income) as the benchmark for determining eligibility. For the State of Hawaii, the income limits are a little higher than the National Average ($1,198 per month or less in 2019) but the asset levels remain the same at no more than $2,000 in cash and cash equivalent resources. Medicaid can also be used to pay for long term, custodial care, but additional requirements around medical needs, such as assistance with certain “activities of daily living” must also be met to qualify. Medicaid remains the primary payor of custodial care in the USA.

Medicaid has multiple levels of assistance, once qualified, that determine the level of coverage and assistance provided.  Examples include QMB, SLMB, and QI.

What if you have access to both Medicare and Medicaid?  

If you, or someone you know, has both Medicare and Medicaid, there are programs called Dual SNP or Special Needs Plans that those with Medicaid benefits may qualify for, depending on their level of Medicaid coverage. Reasons for using a DSNP plan vs traditional Medicaid is similar to the selection of Medigap or Medicare Advantage vs traditional Medicare.

Benefits include:

  • Increased access to a larger network of doctors and hospitals.
  • Additional benefits and value added services such as transportation, meals, over-the- counter allowances, gym memberships, rewards programs, and so on.
  • Quicker access to needed health care services.

With so many scenarios, it is most beneficial to consult with a qualified local advisor to determine eligibility for the plans in your community. Your Qualified Medicare Advisor can help you navigate options that best serve your needs.

 

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