The differences between Medicare and Medicaid

The inability to distinguish between Medicaid and Medicare is a mistake we see quite a bit. And with the similarity in name you can understand why. Could the federal government truly not find more distinct names in order to facilitate better understanding? Knowing what we know about government bureaucracy, maybe we shouldn't be surprised. 

Medicare is the federal health insurance program for people who are 65 and older. Consequently, if enrolled, most individuals over the age of 65 are on Medicare Part A and Part B, thus receiving hospital and medical insurance coverage. This covers inpatient care at a hospital, hospice care, services from physicians, outpatient care, and some preventative services. Consumers can also purchase additional coverage by enrolling in a Medicare Part C (Advantage Plan), Medicare Part D (Prescription), or Medicare Supplement Plans. 

A Medicare Advantage Plan is provided by a private health insurance company and has all of the benefits of Part A and Part B with additional benefits such as vision, dental, or prescription coverage. One can purchase an Advantage Plan with prescription coverage or purchase a stand-alone Medicare Part D Prescription plan. 

A Medicare Supplement is also provided by a private health insurance company but is designed to cover certain co-insurance and co-pays one would be required to pay if only on original Medicare. In Utah, there are 10 standardized Medicare Supplement plans that provide differing benefits. 

Original Medicare does not cover the cost of long-term care in an assisted living or skilled nursing facility. The only coverage that Medicare provides in this area is an inpatient rehab stay of no more than 100 days, with only the first 20 days covered at 100% cost. Once the 20 days expire, the patient is responsible for a co-insurance of $161.00 per day for the remaining 80 days. After the 100 days expire, Medicare provides no coverage. 

Medicaid is health insurance coverage, primarily for low-income, medically-needy, or otherwise vulnerable individuals. The program is jointly funded by federal and state monies, with management done at the state level. There are many different types of Medicaid programs in the State of Utah, ranging from programs designed to help children or pregnant women to those geared to assist individuals who are aged, blind, disabled, or in need of long-term care. 

Nursing Home Medicaid is the program that pays for long-term care in a skilled nursing facility or assisted living. The program has medical and financial eligibility requirements and Utah Senior Planning assists the community in qualifying for these much-needed benefits. With the average cost of a semi-private room at a skilled nursing facility an eye-opening $5,322 per month, you can understand how even a nice retirement nest-egg can be extinguished in a matter of months. 

Medicaid is a cost-sharing program, meaning that an individual will pay his or her share of cost to the facility or the State in exchange for the State of Utah picking up the remaining balance left owed on the bill. There are no out-of-pocket maximums if an individual continues to meet Medicaid eligibility requirements. While Medicaid rules and procedures are complex, individuals should not hesitate in reaching out to those who can help explain how they work and whether your situation fits within their framework.

Understanding the differences between Medicare and Medicaid can be challenging. These programs are similar but distinct in important ways. Knowing the basics outlined above can assist you in making the best decisions about your future. 

** The blog is for informational purposes only and we make no warranty as to its content **