When I meet with patients in the hospital setting, I do a brief assessment. During this assessment I ask basic questions about their home situation, social supports and financial situation. This helps me to determine what kind of resources or help they may need from me.
I also review with them their health insurance, this is to make sure we have correct information in our system. It also helps me provide patients with the necessary and appropriate resources and information they need when they discharge.
It’s very common for patients to become confused when I ask them if they have Medicare and/or Medicaid. I mean, they sound very similar.
Medicare? Medicaid? Um, what’s the difference? Do I need both?
These are the questions that are quickly asked of me when I inquire about their health insurance.
If these are questions you have too, I’m here to help clear up the confusion.
What is Medicare?
I recently posted a whole Medicare series that explains all of the coverage Medicare provides. You really should check out these posts from the series:
Services Covered by Medicare Part A
Why You Should Care About Medicare Part B
Prescription Coverage through Medicare Part D
How to Fill in the Gaps of Health Coverage with Medicare Supplement Insurance (Medigap)
The Pros & Cons: Medicare Advantage Plans vs Original Medicare
Let’s briefly review what Medicare is and who qualifies.
Medicare is a health insurance program through the Federal Government. Everyone pays into this program. If you look at your paycheck stub, you will find that a certain percent of your check gets paid towards the Medicare tax.
Once you turn 65 and are eligible to receive social security benefits, you are also eligible to receive the Medicare Health Insurance benefits you have been paying into.
You can also qualify for Medicare benefits if you are under age 65, disabled and receiving social security disability. Though you won’t be able to receive Medicare until after 2 years of being medically disabled.
For more details on qualifying for Medicare, check out the Medicare Series posts.
The easiest way to remember Medicare is that it is Federal health insurance for the elderly and disabled as long as they are eligible to receive social security benefits.
What is Medicaid?
Medicaid, on the other hand is a State run program using money from the federal government. Essentially Medicaid provides health insurance for low income families, children, Elderly and those with a disability.
To qualify for Medicaid insurance, you have to meet a certain income guideline determined by your State.
Medicaid is often used as a secondary insurance for those who already have Medicare. It can help pay for co-pays and out of pocket medical expenses not covered by Medicare. Additionally, it can also offer assistance with long term care.
Medicaid offers a Long Term Care program that can help pay for caregivers in the home or nursing home care.
I go into more details about Medicaid in this post:
The Difference Between Medicare and Medicaid
Do You Need Both Medicare & Medicaid?
After explaining the differences between Medicare & Medicaid, hopefully the answer to this question is more clear.
Just because you qualify for Medicare doesn’t mean you qualify for Medicaid. Just because you have Medicaid, doesn’t mean you have Medicare.
Medi-Care= Healthcare for 65+ and disability
Medi-Caid= Healthcare AID for low income families, 65+ and disabled
[Insert Medicare vs Medicaid infographic here]
However, if you DO qualify for both programs, the question may be….
Do you need both?
If I was you or one of your family members were a patient at the hospital I work at, and I was your Social Worker, here is what I would tell you….
If you Qualify for both…It is definitely beneficial.
Why Having Both Medicare & Medicaid are Beneficial
If you qualify for Medicare parts A and B, both cover quite a bit.
Medicare Part A covers most of a hospital inpatient stay and the first 20 days of a skilled nursing facility for rehab.
Medicare Part B helps cover outpatient services, doctor visits, imaging, labs, emergency room visits and outpatient therapy rehab.
However, there are still out of pocket deductibles that must be met, and there are still co-pays.
Medicare Part B already has a monthly premium you have to pay. For 2021 it is about $148.50 per month for the average person. But you still have an out of pocket deductible to meet and you still have to pay 20% of the costs.
If you have Medicare Part D, you have to worry about the Medicare Part D Prescription Donut Hole…read more on it HERE.
So you will also have deductibles and out of pocket expenses with your prescription medications.
If you aren’t low-income to qualify for Medicaid, there is the Medigap plan that can essentially help cover those out of pocket expenses.
However, if you are eligible for Medicaid…(your income is on average less than $2,000 monthly for an individual depending on your State)….
Those out of pocket deductibles and co-pays can be covered by your State Medicaid program.
Not only does Medicaid help fill in those gaps of coverage from Medicare, but it also offers several other services.
Some of these additional services include: Medication Assistance programs, Transportation to medical care, Long Term supportive services either in-home care or nursing home care and other needs.
Check out this post: 7 Services Through Medicaid to Help Seniors Stay Independent
I especially tell my patients the importance of having Medicaid if they only have Medicare Part A only or if they have Medicare Part B only.
If you only have one of these, Medicaid will be your saving grace. It can act as whatever Medicare part you don’t have.
The Bottom Line
If you don’t have the financial capability to buy a Medigap plan, make sure you check out your state’s Medicaid eligibility.
If you are eligible for medicaid, enroll!
Not just to pick up co-pays, not just for medication assistance but for the alternative services available to you. Especially if you are needing in-home supportive care or long-term nursing care.
If you have any questions about how Medicare and Medicaid work, I would love to hear from you. I am your online medical social worker! Reach out!
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