Medicare and Medicaid are two major government health insurance programs that provide healthcare coverage to different segments of the population. However, the similarities between their names often lead to confusion about the key differences between Medicare and Medicaid. This article will clearly explain the contrast between Medicare and Medicaid to help you better understand these two vital programs.
Medicare: Federally-Administered Health Insurance for Senior Citizens and Certain Disabilities
Medicare is a federal health insurance program primarily for individuals ages 65 and older. Some younger people with certain long-term disabilities can also qualify. The Medicare program has different parts with varying costs and benefits. Medicare Parts A and B, also known as Original Medicare, is managed directly by the federal government. Private insurance companies that have contracts with Medicare offer Medicare Advantage plans, also known as Medicare Part C. Prescription drug coverage falls under Medicare Part D plans.
Who Qualifies for Medicare?
The most common criteria for Medicare eligibility are:
- Being at least 65 years old
- Receiving Social Security retirement benefits
- Having paid Medicare taxes and worked for a minimum of ten years
People under age 65 may qualify for Medicare if they have received Social Security disability benefits for at least 2 years. Those with end-stage renal disease or ALS may also meet eligibility guidelines.
What Does Medicare Cover and What are the Costs?
Hospital, medical, and hospice care that is deemed medically necessary is covered by Original Medicare (Parts A and B). Part D prescription plans have a monthly premium and cost-sharing that varies by plan. Medicare Advantage plans (Part C) offer all Part A and B benefits but can have different rules, costs, and restrictions depending on the plan. Services like vision, dental, hearing aids, and long-term care are generally not covered by Medicare without separate supplemental plans.
Medicare has cost-sharing requirements, including premiums, deductibles, copays, and/or coinsurance. Costs differ for each part of Medicare:
- Part A: Most don’t pay a premium if they paid Medicare taxes while working. Has inpatient hospital deductibles and daily copays.
- Part B: Standard monthly premium amount based on income. Annual deductible and 20% coinsurance.
- Part D: Varies by plan – monthly premiums, copays, or coinsurance.
Medigap and Medicare Advantage plans may reduce Medicare costs. Those with low income and assets may qualify for programs to get help with Medicare premiums, deductibles, and/or coinsurance.
Medicaid: Joint State and Federally-Funded Health Coverage
In contrast to Medicare, Medicaid is jointly funded by federal and state governments. Each state administers its own Medicaid program within loose federal guidelines. Medicaid provides free or low-cost health coverage to eligible low-income residents.
Am I Eligible for Medicaid in Florida?
To qualify for Florida Medicaid, individuals must meet certain financial and other non-financial eligibility criteria. Income thresholds are quite low. Medicaid also covers certain groups like pregnant women, children, and people with disabilities. Florida did not expand Medicaid eligibility to more low-income adults under the Affordable Care Act.
What Medical Services Does Florida Medicaid Cover?
Florida Medicaid covers doctor visits, hospital care, mental health services, pregnancy-related care, children’s healthcare services, prescription drugs and more. Benefits for those who qualify under sheltered workshops may be limited. Some Medicaid recipients also get free non-emergency transportation services in Florida.
There are no monthly premiums or deductibles for Florida Medicaid. Minimal copays apply to prescription drugs and some medical services depending on the recipient’s situation.
Key Differences Between Medicare and Medicaid
To summarize, Medicare and Medicaid have significant differences when it comes to:
Administration: Medicare is solely administered federally, while Medicaid is jointly run by federal and state agencies.
Eligibility: The main criteria for Medicare eligibility are age and employment history. Medicaid eligibility considers financial need and other criteria that can vary by state.
Costs: Medicare has premiums, deductibles and copays. Medicaid is free or very low cost for those who qualify.
Covered services: Medicare covers medically necessary care with gaps. Medicaid aims to provide free or affordable essential healthcare for low-income residents.
Prescription drugs: Limited Medicare drug coverage – enrollees need a separate Part D plan. Medicaid covers most prescriptions.
Long-term care: Medicare does not cover extended nursing home and at-home long-term care. For qualifying individuals, Medicaid covers long-term care costs.
How Can I Apply for Medicare or Medicaid in Florida?
Applying for Medicare and Medicaid involves contacting the proper government agencies to submit eligibility documentation and enroll in appropriate health plans.
To apply for Medicare online, you must set up your MySocialSecurity account with the Social Security Administration. You can also apply by phone or in person. When eligible to enroll, you can browse and select Medicare plans on Medicare.gov. Those under 65 applying due to disability need to contact Social Security.
To apply for Medicaid in Florida, create an account on www.myflfamilies.com to apply online or print an application form. You can also apply in person at your local Medicaid office. Have income statements, IDs, and other records on hand. If eligible, you will be enrolled in the Medicaid program and can begin using benefits.
Get Affordable Health Insurance with Stivers Law
Understanding the difference between Medicare and Medicaid is the first step to accessing affordable healthcare. The next step is enrolling in the appropriate program. Contact the estate planning attorneys at Stivers Law in Coral Gables if you need help navigating Medicare or Medicaid programs in Florida.
