While they sound alike, Medicare and Medicaid are two different programs. Both can help you pay for health care and medical costs, but Medicare is an age-based federal health insurance coverage program that ensures coverage for individuals ages 65 and over and some younger individuals with disabilities.


Medicaid is a public assistance program based largely on monetary need; it’s paid for with public funds collected through taxes. Unlike Medicare, a federal program, both state federal governments and the federal government fund Medicaid. The program, which provides health insurance to low-income Americans of all ages, works differently in each state, although federal standards apply.

Providing there is a financial need, you likely receive Medicaid if you fall into among the following groups:

  • You’re pregnant: Whether you’re single or married, make an application for Medicaid if you are pregnant. You and your child will be covered.
  • If your child is ill and requires experienced nursing, but might remain home with quality medical care, Medicaid might be able to help. Medicaid covers teenagers living on their own.
  • Aged, blind, or disabled: Medicare comes with sometimes-sizable premium payments. If you are over 65 and can’t afford healthcare coverage, look for Medicaid, also. People with medical need might apply despite age.
  • No impairments, no kids under 18: The Affordable Care Act provides states the opportunity to supply Medicaid to low-income people under the age of 65 without a disability or small kids. Consult your state firm for more information. You can see whether your state is expanding its Medicaid protection here.

Special Considerations

Advantages vary by state, each state is needed to cover specific types of care. These consist of inpatient and outpatient medical facility services, nursing home and house x-ray, laboratory and health care diagnostic services, transportation to a medical facility, and tobacco-cessation therapy for pregnant females.

In addition to paying Medicare-related expenditures such as hospitalization, physicians, and medicines, Medicaid provides two extra kinds of care that Medicare does not:

  • Custodial Care: Custodial care, or individual care, helps you with everyday activities. These activities consist of consuming, bathing, dressing, and utilizing the bathroom. Custodial care can be offered in a knowledgeable nursing center if you’re there for a recuperative stay following a stroke or accident. It can likewise be provided at home, as a method to prevent being admitted to a nursing home, or for some period prior to a retirement home becomes the best option.
  • Assisted Living Home Care: Medicaid is the primary supplier of long-lasting nursing home care. (Medicare will spend for proficient nursing short-term, or rehab in a competent nursing facility; however, it does not cover prolonged care.) Nursing home care under Medicaid is an intricate subject. Even if you get approved for it in general, you may need to pay part of the cost, depending on your income and tax reductions. The results of the application process will determine how much you have to pay.
    In addition, states might offer advantages beyond the obligatory requirements, consisting of prescription drug protection, occupational and physical therapy, optometry, chiropractic services, oral care, and more.

Application rules differ by state, however understand that the process may take weeks or perhaps months and could require a medical screening, in addition to substantial documents of previous and present financial transactions.

Earnings requirements for Medicaid are generally based on the Federal Poverty Level. Guidelines for your state Medicaid program will define the information for your situation. In many cases involving particularly high medical costs, your earnings could go beyond standards and you might still qualify for help as somebody who is “clinically needy.”

Qualifying as “clinically needy” includes a process through which you are enabled to deduct, or “invest down,” your medical expenditures in order to get listed below a particular earnings level. Guidelines differ by state. The Medcaid.gov website will assist link you to a regional workplace that can clarify whether this alternative is available to you.

In addition to earnings, certain of your properties will count toward identifying if you are eligible for Medicaid. In most states, the amount of countable assets you can keep and still certify for Medicaid is $2,000 for a specific and $3,000 for a couple.

Given that Medicare has extremely limited protection for assisted living home, senior citizens who require it sometimes try to receive Medicaid, specifically when they are attempting to guarantee they have sufficient money left over for a partner who isn’t entering into care.

People who have more than the permitted quantity of properties have to spend down until they reach an income level that certifies them for Medicaid. Spending down works in a different way depending upon your state, but you might have the ability to pay off debts, prepay a home loan and other loans, repair work or remodel a home, prepay funeral expenditures, and purchase particular investment products, depending upon what the state enables.

If you suit any of the above groups, you may be able to receive Medicaid benefits even if you’re above the earnings limitations, provided your state has a Medicaid Excess Income Program. Similar to a deductible, you may be needed to pay a certain amount of your costs every month before Medicaid benefits take over. And if you are investing down, you have to invest down a specific variety of years prior to using.

Due to the fact that the authorities are aware of individuals who deplete properties just to qualify for Medicaid. Typically, the penalty is a “timeout” duration throughout which you can not get Medicaid advantages, even though you now technically qualify.

If you would have kept those assets, the procedure to identify the charge includes rejecting advantages in percentage to the time you might have paid for a nursing house. When you apply for Medicaid, the look-back duration starts. So even if the transfer was up to 5 years earlier, it might set off the charge.


Think about Medicare as a health insurance policy offered to the senior-citizen set, in addition to people under 65 who are handicapped in particular methods. It is considered a privilege: If you paid Medicare taxes on your incomes while working (they’re generally gotten of your income immediately, similar to Social Security contributions), you are automatically qualified for Medicare at age 65. It is not income-based.

Medicare can be found in four parts. Some parts need payment of a month-to-month premium comparable to private medical insurance, but the program is not based upon financial need:

  • Part A covers health center care: Covers the expense of remaining in a medical facility.
  • Part B covers physicians, medical tests, and treatments: Basically, anything done to you. There is a regular monthly premium for Part B coverage.
  • Part C Medicare Advantage This is an alternative to conventional Medicare coverage. Coverage often consists of Parts A, B, and D. Private insurance companies administer Medicare Advantage strategies.
  • Part D Prescription drug coverage: Part D is administered by personal insurer, and you are required to have it unless you have protection from another source. Part D needs you to pay a month-to-month premium in most cases.

Medicare isn’t an extensive health insurance strategy. If you just have conventional Medicare, there are spaces in coverage. Medicare does not cover long-lasting care, unless you buy a Medicare Advantage or Medigap policy.

Special Considerations

Even if you aren’t eligible for Medicaid, you might get approved for among three Medicare Savings Programs (MSPs), administered by your state’s Medicaid program.

If somebody receives both Medicare and Medicaid, they are “double eligible.” Under this status, most or all of your health care expenses will be covered. Medicaid will spend for most of your Medicare Parts A and B premiums (if you have premiums), in addition to co-payments and deductibles you might have. It doesn’t matter if you get your Medicare coverage through standard Medicare or a Medicare Advantage (MA) Part C strategy.

If you are “double eligible” and get complete Medicaid, your prescription drug protection (Part D) will go through Medicare, but you will immediately receive Extra Help paying for your medications. In addition, Medicaid might cover some drugs that Medicare does not.

As a taxpayer, you add to Medicare during your working years and will receive Part A coverage most likely at no charge to you. Additional coverage, such as Part B and Part D, might be needed and could feature a regular monthly premium. Because Medicare has spaces in coverage, you’ll likely require extra protection that might come with an additional regular monthly premium on top of what you currently pay.

Medicaid is a needs-based program. Although states have the choice of charging out-of-pocket charges, certain groups, such as individuals and children living in institutions, are typically exempt from these costs.

With life expectancies getting longer, and retirement savings failing, more and more seniors might find themselves getting approved for Medicaid advantages, either completely or in part. In addition to assisting with medical expenses, Medicaid uses coverage not generally readily available through Medicare, such as extended nursing home care and personal or custodial care services. Considering that the income requirements are strict and the program punishes individuals who try to shed possessions right prior to they apply, long-term planning is required to qualify.

Medical Help Me is privately owned and operated by Andrew Byrd, licensed insurance broker. The website is a non-government resource for those who depend on Medicare, providing Medicare information in a simple and straightforward way.

If you’re looking for the government’s Medicare site, please navigate to www.medicare.gov.


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