Do you know the difference between Medicare and Medicaid?
Medicare is the federal government’s health insurance program for people 65 and over. It’s also for those who have end stage renal disease or have been on disability for a certain amount of time.
Medicaid, on the other hand, is an assistance program for individuals who meet certain income requirements. It helps people of all ages receive medical care. A person can be enrolled in both Medicare and Medicaid at the same time.
“I think one of the most important things that people need to know about both insurances is that medical necessity of the service must be met before it is covered,” says Greg Krazmarzick, senior director of post-acute compliance for the Good Samaritan Society/Sanford Health.
Medicare
Many seniors are enrolled in Medicare. The basic coverage — Medicare Part A and Medicare Part B — can help you pay for hospital stays, equipment and doctor visits that are medically necessary.
While Medicare policies may help pay for short-term care services you need for recovery, Medicare does not cover long-term nursing home stays, assisted living services or in-home personal care and help with daily activities (also called custodial care).
Greg says one of the common misconceptions about Medicare in long-term care settings is that it will automatically cover 100 days of care. Rather, Medicare will cover up to 100 days of medically appropriate care.
Read frequently asked questions about Medicare.
Medicaid
Medicaid is a federal- and state-funded program that helps people with very limited income and resources pay for health and medical expenses. It is a separate program from Medicare, with coverage and eligibility that varies from state to state. Read more about medicaid coverage.
Greg says one of the common misconceptions about Medicaid is that it’s applied the same in all states. In reality, each state has its own Medicaid program and is managed differently from enrollment requirements to coverage.
Most Medicaid programs will help pay for doctor visits, health equipment, prescriptions, lab and X-ray services, and inpatient and outpatient services from a hospital or care center. Learn more about medicaid.
Unlike Medicare, Medicaid may also cover long-term care services like nursing home stays, assisted living services and in-home personal care if a person qualifies for their state’s Medicaid program. Read more state overviews.
