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medicare vs. medicaid

Posted by / Filed in: Health Insurance

Medicare vs. Medicaid

When it comes to health insurance, navigating all of the avenues for coverage can be a confusing and complicated procedure. To add a little more fuel to the fire, the powers that be have coined one type of coverage Medicare and another type of coverage Medicaid. What’s the difference between these two similar-sounding programs? So what’s the difference between Medicare vs. Medicaid?

Medicare Coverage

Medicare is a program that provides health insurance to people age 65 and older and to those with disabilities. Administered by the Centers for Medicare & Medicaid Services, the program is funded by federal payroll taxes, general tax revenues, and premiums from beneficiaries.

You only qualify for Medicare coverage if:

  • You’re 65 or older
  • You have certain disabilities
  • You have end-stage renal disease

Medicare features four different areas of coverage:

Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Care in a skilled nursing facility
  • Hospice care
  • Home health care

Part B (Medical Insurance) helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventative services

Part C (Medicare Advantage):

  • Includes all the benefits and services covered under Parts A and B
  • Most likely includes Medicare prescription drug coverage (Part D)
  • Run by Medicare-approved private insurance companies
  • Can include extra benefits and services for an added cost

Part D (Medicare Prescription Drug Coverage):

  • Helps cover the cost of prescriptions
  • Run by Medicare-approved private insurance companies
  • May help lower prescription costs and help protect against rising costs in the future

Medicaid Coverage

Medicaid is a separate program that is funded jointly by the federal and state governments to offer benefits to people with limited income and resources. Each state administers its own program and has its own rules regarding eligibility for coverage. Learn about West Virginia’s Medicaid eligibility requirements at Medicaid.gov.

You may be eligible for Medicaid if you have limited income and are:

  • 65 or older
  • Younger than 19
  • Pregnant
  • Living with a disability
  • A parent or adult caring for a child
  • An adult without dependent children (in some states)
  • An eligible immigrant

Medicaid covers costs related to:

  • Doctor visits
  • Hospital stays
  • Long-term services and supports
  • Preventative care (e.g., immunizations, mammograms, and colonoscopies)
  • Prenatal and maternity care
  • Mental health care
  • Necessary medications
  • Vision and dental care for children

For more information about Medicaid, visit www.HealthCare.gov/do-i-qualify-for-medicaid.

Can I Be Eligible for Both?

Yes! Some people are eligible for both Medicare and Medicaid depending on their situations. For those with dual eligibility, most health care costs are usually covered.

Now that you’re armed with the knowledge you need to make informed decisions about your health care coverage, you should find it easier to navigate through the process of applying for Medicare or Medicaid.

Already have Medicare coverage and looking to supplement Parts A and B with long-term care insurance or respite care insurance? Call us today at 304-263-3361 to explore your coverage options with one of our agents.


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