Navigating the U.S. health care system and government run health programs is no doubt a complicated feat. Our goal at Voyage Long Term Care is to help and guide you through the process and to assist you in understanding all of the options available to you and your loved ones. A common question that many of our residents and their families ask is for us to help them understand the differences between Medicare and Medicaid.
What are Medicare and Medicaid? Medicare and Medicaid are government programs that provide health care coverage to certain populations. Here’s an overview of who can benefit from the programs and the main differences between the two:
Medicaid is a federal and a state funded program that provides health care coverage for low-income individuals and families, families with children, pregnant women, and people with disabilities. Medicaid recipients must qualify through a redetermination process that occurs every 12 months. Individuals and families must report any adjustments to annual income while on a Medicaid plan.
If you meet income requirements, Medicaid eligibility can cover the entire household.
If a family’s household income exceeds the limits for Medicaid eligibility, yet the family cannot afford to purchase private health insurance, children up to the age of 19 can be covered by the Children’s Health Insurance Program (CHIP). For CHIP eligibility information, visit medicaid.gov/chip.
Medicaid benefits can vary state to state and most plans include behavioral health benefits. For more information about Medicaid, visit medicaid.gov.
To find specific information to Medicaid for the State of Oklahoma, visit https://www.benefits.gov/benefit/1638.
Medicare Medicare is a federally funded program that covers adults age 65 or older, younger people with disabilities, and those with End Stage Renal Disease (permanent kidney failure requiring dialysis).
At age 65, you are eligible for premium-free Part A Medicare coverage if you or your spouse worked and paid Medicare taxes for at least ten years. There is a premium required for Part B coverage.
You can enroll for Medicare when you turn 65 (either three months before your birth date, the month of your birth date, or three months after your birth month). If you don’t enroll during this time period, you can enroll each year from January to March, but waiting to enroll could incur a late enrollment penalty fee.
Medicare coverage is only for individuals—it does not cover an entire family or household. The Medicare program has different types of coverage:
Part A – inpatient coverage
Part B – medical coverage, outpatient procedures, and office visits
Part C – Medicare advantage plans
Private health plans approved by Medicare, administered by a third party
Benefits can vary but must offer all services that Original Medicare covers
May require a monthly premium
May include Part D (prescription) benefits
Part D – prescription drug plan that is supplemental to Parts A and B
In some instances, individuals may qualify for coverage on Medicare and Medicaid—this is called dual coverage. People age 65 and older who also meet income requirements may be eligible for dual coverage. In dual coverage situations, Medicaid is always secondary to Medicare or any other commercial coverage.
For more information about Medicare benefits, visit medicare.gov or call 800-MEDICARE.