Understanding the Difference Between Medicare and Medicaid?

Do you and your Medicare clients understand the difference between Medicare and Medicaid? A lot of people have a difficult time understanding the difference between the two. Both programs begin with the letter “M.” They’re both health insurance programs run by the government. People often ask questions about what Medicare and Medicaid are, what services they cover, and who administers the programs. Here is a good explanation of each to help you better serve your clients, educate them on the differences, and determine what they qualify for.

Let’s start with Medicare. Medicare is the earned-benefit program for Americans aged 65 or older or disabled. Workers pay into Medicare throughout their working years. The Centers for Medicare & Medicaid Services is the agency in charge of both Medicare and Medicaid, but you sign up for Medicare A (Hospital) and Medicare B (Medical) through Social Security.

Your clients can apply for Medicare online from the convenience of their home at www.socialsecurity.gov/medicare/. If they are already receiving Social Security retirement benefits when they reach age 65 or are in the 25^th month of receiving disability checks, we will enroll them automatically.

Medicare Part C (Medicare Advantage) and Part D (Prescription Drug) plans are available for purchase in the insurance marketplace. Social Security administers a program called Extra Help to help people with low income and low resources pay for premiums, co-pays, and co-insurance costs for Part D plans. Your clients can find out more about Extra Help and file for it at www.socialsecurity.gov/medicare/prescriptionhelp. Each year, The Centers for Medicare & Medicaid Services publishes Medicare and You available online at their website at www.medicare.gov/medicare-and-you/medicare-and-you.html. This publication is a user’s manual for Medicare.

Each state runs its own Medicaid program under guidance from the Centers for Medicare & Medicaid Services. Medicaid offers care for the most vulnerable among us. While it does not require paying taxes while working, it does have guidelines about how much income and resources they can have to qualify. Medicaid provides coverage for older people, people with disabilities, and some families with children. Each state has its own eligibility rules and decides which services to cover. The names of the Medicaid program may vary from state to state. You can read about each state’s Medicaid program at www.medicaid.gov/medicaid/by-state/by-state.html. You can find each state’s Medicaid contact information at www.medicaid.gov/about-us/contact-us/contact-state-page.html.

Medicare and Medicaid are two of the major insurance programs that provide healthcare to the American public. Understanding each program, as well as how the two programs differ, can help you educate your clients and help them find the right healthcare program.