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MEDICARE VS.MEDICAID

Medicare and Medicaid are both health insurance plans provided to individuals who have met certain requirements for coverage.  Medicare is a federal health insurance program administered by the US Government, while Medicaid is a state health insurance program which may also receive some federal funding.  Medicare and Medicaid share some similar characteristics but have other characteristics that are very different.

Medicare eligibility may be achieved in one of two ways:  By reaching January 1 of the year in which you will become 65 years of age; OR by receiving a Social Security disability award (SSDI) earlier than age 65.  Medicare coverage does not begin, however, until you have been eligible for a Social Security disability payment for 25 months.  Here is an example:  If Social Security finds you were disabled as of 1/1/13, you must wait 5 months from that date to receive your first payment because of a mandatory 5 month waiting period.  So your first payment would be for 5/1/13.  Then, you must wait 24 additional months to become eligible for Medicare.  That means that you would first be eligible for Medicare insurance coverage on 5/1/15.  Medicare Part A is free and covers in-patient services while confined to a hospital.  Medicare Part B currently charges a premium of about $104 per month and covers out-patient services such as doctor's office visits, outpatient diagnostic services, ER visits, etc.  Part B is also optional.  There are no income or financial restrictions on receiving Medicare insurance.

Medicaid insurance eligibility is administered by state run agencies.  You may become eligible for Medicaid by meeting your state's guidelines OR by receiving a disability award under Title XIV, or SSI.  Since SSI is also administered by Social Security, many people get SSDI (regular Social Security) and SSI (Title XIV) confused.  They are, however, two very different programs.  Once you are found disabled under SSI rules (determined by the Social Security Administration) - there is no waiting period for Medicaid.  Coverage can begin almost immediately.  Medicaid usually does not require you pay a premium. However, since Medicare is connected to low income households or to SSI beneficiaries, you generally have to meet strict income and financial resource restrictions to receive Medicaid insurance.  

The amount of medical fees paid to doctors and other healthcare providers may be lower under Medicaid rules than under Medicare rules.  Therefore, some doctors who accept Medicare may not accept Medicaid.

You can find out more about Medicare by visiting www.Medicare.gov.  To find out more about Medicaid, contact your state or regional Medicaid office.
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This is provided as general information.  While we believe it is factually correct, the Forsythe Firm takes no responsibility for errors contained in this post.  The Forsythe Firm is not affiliated with Medicare, Medicaid or the US Social Security Administration.





 

 

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