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Medicare vs. Medicaid

At Peritia Advisors, our mission is to provide you with insurance that keeps you healthy and happy, no matter what your situation. Get in touch with us with any Medicare questions you may have.

Medicare and Medicaid are often referenced in the same conversation, and the similarities in their names can lead to confusing one with the other. Many also qualify for both, which can lead to the misconception that qualifying for one means automatic eligibility for the other. They’re distinctly different programs with strong similarities, which can work in your favor if you qualify for both.

Where Do They Come From?

Medicare and Medicaid are both government-sponsored programs and taxpayer-funded. The difference, however, comes from the level of government providing it.

Medicare is a federal program. Since it’s federal, it has uniform eligibility criteria. If you qualify for Medicare in one state, you can get it in any other.

Medicaid is a joint federal and state program. Every state has slight requirement differences. It is possible to be eligible for Medicaid in one state, but not another.

What Are The Eligibility Standards?

Medicare is available to those who are 65 or older. If you are not yet 65, you can still get Medicare if you have been receiving disability benefits from Social Security for 24 months or more.

Medicaid eligibility is income-focused. You must earn at or below a certain amount based on your state’s requirements for Modified Adjusted Gross Income (MAGI). Some states allow you to navigate this if your earnings are too high, yet you are considered medically needy. If you’re medically needy, you can deduct your medical costs from your income in order to meet your state’s MAGI requirement.

What Are The Benefits?

Medicare’s benefits are divided by plan type. Medicare comes in Parts A, B, C, and D. Part A is responsible for inpatient coverage. Part B covers outpatient treatments and services, such as exams, screenings, and immunizations. Part C (also known as Medicare Advantage) combines inpatient, outpatient, and in some cases drug coverage, and bundles them into one plan. Part D is Medicare’s drug plan.

Like Medicare, Medicaid offers coverage for inpatient and outpatient services. But Medicaid does offer coverage for certain items missing from Medicare, such as home health care, family planning services, and services for helping pregnant women discontinue tobacco use.

What Are The Benefits Of Having Both?

When you have both, the two plans coordinate the coverage. They pay in order – when you get a treatment or service, Medicare will pay first, and then Medicaid will cover what it can of the rest. You will only have to pay for what is left over after that.

Another choice is the Dual Eligible Special Needs Plan (D-SNP). This is a type of Medicare Advantage plan exclusive to those who qualify for both Medicare and Medicaid. It’s a comprehensive plan because it bundles the benefits of Medicaid and the other Medicare plans into one policy. There’s also guaranteed prescription drug coverage, which is another reason why this is an appealing option.

Make The Most Of Your Eligibility

At Peritia Advisors, we help you seize all available opportunities. You deserve to have a plan that makes expenses an afterthought. We place emphasis on quality, and that goes for both our service and the policy you will be enrolled in. You’re the first priority, and you deserve the best policy at the lowest price.