Difference between Medicare and Medicaid

Understanding the Difference between Medicare and Medicaid

Many people are confused by the difference between Medicare and Medicaid. Here is everything you need to know to figure out which one is best suited for your needs.

Medicare basics

Medicare is a health insurance program that’s sponsored by the federal government and was founded in 1965. It covers people who meet any one of the following criteria:

-are 65 years of age or older

-are disabled (can be any age)

-have end-stage renal disease (ESRD)

If you qualify for Medicare, be sure to check if you also qualify for Part C coverage (also known as Medicare Advantage). If you do, you will be entitled to additional coverage for things – such as prescription medication – that aren’t always covered by the basic program.

After you are enrolled in Medicare, be sure to mark the window for annual enrollment (AE) (October 15 to December 7) on your calendar. Commonly known as the Annual Election period or Open Enrollment period, it allows you to make changes to your coverage if needed. After December 7, you will have to stick with your current plan until the next AE.

Medicaid basics

Medicaid is sponsored by the state and helps pay for out-of-pocket medical expenses of qualifying people with low incomes.

The amount of medical expenses covered depends on income level and is based on need; those with the lowest income get higher levels of coverage than those with higher incomes. Your local Social Security office can help you figure out what level of support you qualify for, if any.

If you qualify for assistance via Medicaid, depending on your situation, the following types of medical expenses can be covered:

-Part B medical premiums

-co-pays for physician visits

-co-insurance for surgeries and Part A hospital stays

What to do if you don’t qualify for Medicaid or Medicare

If you don’t qualify for either of these programs right now, it’s definitely worth keeping up to date on their coverage criteria so you’ll know if you become eligible in the future. Last, but not least, you should know that people with low income may qualify for help from the Arizona State Health Insurance program (AHCCCS) – it’s yet one more avenue to look into if you need assistance with your medical expenses.

Final steps

Whether you’re interested in these programs because you foresee a need for expensive long-term care, or you’re just planning for general medical expenses, it’s worth learning the ins and outs of these programs. Now that you know the basics, be sure to let us know if you need more information because the annual enrollment period is coming up soon. We can refer you to knowledgeable and experienced Medicare advisors that can help you to navigate the nuances of the system.

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