Paul Sanchez
Medicaid and Medicare are two different health insurance programs in the US. While Medicaid is an insurance program for people with low incomes, Medicare is a health insurance program for people aged 65 or older or those with certain disabilities or permanent kidney failure. To apply for Medicaid, you must be a resident of the state where you are applying for benefits and meet the income and asset limits. You can apply online or by mailing a paper application to your local Department of Social Services. To apply for Medicare, you can sign up online or call the Railroad Retirement Board if you or your spouse worked for a railroad. You will automatically get Part A (Hospital Insurance) and can choose to sign up for Part B (Medical Insurance) if you live outside the US or in Puerto Rico.
| Characteristics | Values |
|---|---|
| Medicare | Sign up for Part A (Hospital Insurance) and Part B (Medical Insurance) |
| Sign up for Part B if you live in Puerto Rico or outside the U.S. | |
| Sign up for Part B within 3 months of turning 65 | |
| Apply online at Social Security | |
| If you have Lou Gehrig's Disease (ALS), you will receive Medicare Parts A and B immediately when you enroll in Social Security disability benefits | |
| If you have End-Stage Renal Disease (ESRD), you can call 800-772-1213 to apply | |
| Medicaid | A joint federal and state program that helps cover medical costs for people with limited income and resources |
| Each state has its own eligibility requirements | |
| May cover some drugs that Medicare doesn't cover | |
| You can apply through your state's Medicaid agency or the Health Insurance Marketplace |
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What You'll Learn
Eligibility requirements for Medicaid
Medicaid is a federal-state program that helps cover medical costs for people with limited income and resources. The eligibility requirements for Medicaid vary by state, and each state has its own Medicaid agency that determines eligibility. Here are the general eligibility requirements for Medicaid:
Income and Resources
The primary factor in determining eligibility for Medicaid is an individual's income and resources. Each state sets its own income and resource limits, and individuals must meet their state's specific rules. Some states have a medically needy program, which allows individuals with high medical expenses to spend down their income to qualify for Medicaid. This means that individuals can lower their countable income by incurring medical expenses, such as Medicare premiums and deductibles, to qualify for Medicaid.
Residency
To be eligible for Medicaid, individuals must typically be residents of the state where they are applying for benefits. This requirement ensures that individuals receive coverage from the state in which they live and ensures consistency in coverage.
Non-Financial Criteria
In addition to financial criteria, there are also non-financial eligibility criteria for Medicaid. For example, certain groups, such as children in foster care or former foster care recipients, may be automatically eligible for Medicaid regardless of their income level. Similarly, children with disabilities who have high medical needs may qualify for Medicaid even if their family's income is above the limit, as long as the family pays a monthly premium based on their income.
Coverage Groups
Eligibility for Medicaid is often determined by placing individuals into coverage groups, each with its own rules and income levels. These coverage groups can include factors such as age, health status, and family composition. For example, pregnant women, children under a certain age, and individuals who are 65 or older, blind, or have a disability may fall into specific coverage groups with different eligibility requirements.
Documentation
When applying for Medicaid, individuals may need to provide various forms of documentation. This can include proof of identity, residency, income, and medical expenses. It is important to check with the specific state's Medicaid agency to determine the exact documentation required, as this may vary from state to state.
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How to apply for Medicaid
Medicaid provides free or low-cost medical benefits to eligible individuals with low incomes. Each state has its own requirements, but in general, eligibility depends on income or a combination of income and other factors.
To apply for Medicaid, you must first check with your state's Medicaid agency to see if you or your family members are eligible. You can do this by locating and contacting your state's Medicaid agency. You must be a resident of the state where you are applying for benefits.
Next, create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for Medicaid, your information will be sent to your state agency, and they will contact you about enrollment.
When applying for Medicaid, you may need to provide certain information or documentation, such as proof of citizenship, Social Security numbers, birth certificates, and proof of income. The specific requirements vary by state, so be sure to check with your local Medicaid agency to understand the exact application process and requirements for your state.
In Virginia, for example, you can apply for Medicaid online, by phone, or by mailing or dropping off a paper application to your local Department of Social Services. Similarly, in Arizona, you can apply for Medicaid online through Health-e-Arizona Plus or by phone.
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Medicare Part A and Part B
Part A provides inpatient/hospital coverage, helping to cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part A is free if you worked and paid Medicare taxes for at least 10 years, or if you are eligible because of your current or former spouse's work. You get Part A automatically if you're receiving benefits from Social Security or the Railroad Retirement Board, or if you live in Puerto Rico or outside the US.
Part B provides outpatient/medical coverage. Most people pay a monthly premium for Part B, the amount of which depends on your income level. You have to sign up for Part B, and if you don't do so within 3 months of turning 65, you might have to pay a monthly late enrollment penalty. You can sign up for Part B online, at Social Security, or over the phone.
To get full Medicare benefits, you need both Part A and Part B. You can also join a separate Medicare drug plan to get Medicare drug coverage (Part D).
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Medicare enrolment process
The Medicare enrolment process depends on your unique situation. Here is a step-by-step guide to help you understand how to enrol in Medicare:
If you are 65 or older:
- Enrolling in Parts A and B: If you are 65 or older, you can enrol in Medicare Parts A (Hospital Insurance) and Part B (Medical Insurance). You can do this online, by phone, or by visiting your local Social Security office. The Initial Enrollment Period begins 3 months before you turn 65 and ends 3 months after the month you turn 65. During this period, you can sign up for both Parts A and B. If you miss this Initial Enrollment Period, you may have to pay a late enrollment penalty for Part B.
- Enrolling in Part A only: If you are still working and have health coverage through your employer when you turn 65, you can choose to delay Part B and enrol in Part A only. You can do this online or by contacting Social Security.
- Enrolling in Part B after delaying: If you delayed Part B when you first became eligible, you can sign up for it later during the General Enrollment Period (from January 1 to March 31 each year). However, you might have to pay a late enrollment penalty.
If you are under 65:
- If you are under 65, you may be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or Lou Gehrig's Disease (ALS).
- With a disability: If you receive Social Security disability benefits, you will automatically begin receiving Medicare Parts A and B after 24 months. If you have ALS, you will receive Medicare Parts A and B immediately when you enrol in Social Security disability benefits.
- With ESRD: If you have ESRD, you can call Social Security at 800-772-1213 to apply for Medicare.
- With permanent kidney failure: If you are under 65 and have permanent kidney failure, you may be eligible for Medicare.
Additional considerations:
- Medicare Advantage and Part D: You can review and sign up for Medicare Advantage (Part C) and prescription drug plans (Part D) on Medicare.gov or by calling the provided phone numbers.
- Online enrolment: Enrolling online through your secure my Social Security account is the easiest and fastest way to sign up and get any financial help you may need.
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Medicare and Medicaid differences
Medicare is a federal health insurance program for people aged 65 and over, as well as younger people with disabilities or permanent kidney failure. It is made up of several parts:
- Part A: Hospital Insurance, which covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. Most people get this automatically and do not have to pay a premium.
- Part B: Medical Insurance, which covers outpatient care, doctor visits, medical equipment, and some preventive services. There is usually a monthly premium for this part, and you need to sign up for it.
- Part C: Medicare Advantage, an alternative to Original Medicare (Parts A and B) that offers more coverage options, often including prescription drug coverage (Part D).
- Part D: Prescription Drug Coverage, which helps cover the cost of prescription drugs and some recommended shots or vaccines.
Medicaid, on the other hand, is a joint federal and state program that helps cover medical costs for people with limited income and resources. Eligibility and benefits vary by state, and each state runs its own program. Medicaid offers benefits not typically covered by Medicare, such as nursing home care and personal care services. People with Medicaid usually don't have to pay anything for covered medical expenses but may owe a small co-payment for some items or services. If you have both Medicare and full Medicaid coverage ("dually eligible"), Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other insurance.
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Frequently asked questions
Medicare is a federal health insurance program for people aged 65 and over, or those with a qualifying disability. Medicaid is a joint federal and state program that helps cover medical costs for people with a low income.
If you are already receiving Social Security retirement benefits, you will be automatically enrolled in Medicare Parts A and B when you turn 65. If not, you can apply online or by phone.
You can apply for Medicaid through your state's Medicaid agency. You will need to check your state's specific eligibility requirements and may need to provide certain information or documentation.
Yes, it is possible to have both Medicare and Medicaid coverage at the same time. In this case, Medicare pays first for any Medicare-covered services, and Medicaid pays last, after any other insurance you may have.
Medicare Part A covers hospitalization, home or skilled nursing, and hospice care.
