Comparing eligibility - which one covers more people?
Not everyone who qualifies for Medicare qualifies for Medicaid. Medicare doesn’t rely on your income to determine your eligibility like Medicaid does.
The age requirement makes Medicare more restrictive, though it can be argued that it’s more exclusive by design since Medicare is targeted toward the 65 and older age demographic. On the other hand, Medicaid doesn’t really target a specific age group. Anyone can be eligible as long as they meet their state’s income requirements.
What are the coverage differences?
Medicare and Medicaid are very similar because of how they cover inpatient and outpatient care by default. But there are a few differences.
What Medicaid covers that Medicare doesn’t is likely irrelevant to those eligible for Medicare. Medicaid provides coverage related to pregnancy and family care, such as birth center services and tobacco cessation counseling for pregnant women. Medicare does not cover these services, but it’s highly unlikely someone age 65 or over would need this coverage.
There are also differences in what’s mandatory and optional for Medicaid and Medicare. Medicaid’s optional coverage options include physical therapy, hospice, occupational therapy, and chiropractic services. Medicare covers all of these as long as they are medically necessary. Medicare’s coverage is more extensive in terms of what it automatically covers.
Can I have both?
A person can qualify for both without having to choose between the two. The one exception to the age requirement for Medicare is receiving income through disability benefits from Social Security. You can be any age and get Medicare as long as you’ve been on disability for 24 months. Medicaid also accepts individuals receiving disability benefits from Social Security.
Medicare Advantage has a policy known as the Dual-Eligible Special Needs plan. It’s made for medically needy and/or low-income seniors who qualify for both Medicaid and Medicare. D-SNPs offer inpatient, outpatient, and prescription drug coverage, while also helping pay Part A and B-related costs. This plan has additional benefits such as dental, vision, and hearing.
A D-SNP doesn’t use benefits from both Medicare and Medicaid at once. When you get treatment, Medicare will pay first. After it covers what it can, Medicaid will cover as much of the remaining bill as possible. You will only need to pay a small amount for your care, if your expenses are not completely covered already.
Get the best coverage
At KBI Solutions, we believe in finding you coverage that best fits your medical and financial needs. If you have any questions or concerns about Medicare and Medicaid, please give us a call today at 254-918-5444.
