Are Medicaid and Medicare the Same Thing?
In a word: No. Medicaid and Medicare are not the same.
If Medicare and Medicaid are the same thing is a common question we get asked at CoverageCoach, so we’ll explore it here. The names of these programs are very similar, and they’re both government-funded programs. So it’s easy to see why folks get confused about them.
What is Medicaid?
Medicaid.gov says “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.”
It’s a program to help low-income individuals and families get the healthcare services they need at greatly reduced prices, or even free.
- Individual states administer the program. It must always meet specific federal requirements.
- Some states have their own version of the plan. California — the most populous state in the union by far — has Medi-Cal.
- Medicaid programs are all funded both by individual states, and the federal government together.
Medicare is an entirely different plan.
What is Medicare?
Medicare is senior health insurance.
- It’s available for seniors 65+ who have paid into the program via payroll taxes throughout their lifetime.
- It’s based on two parts.
- Medicare Part A is hospital insurance and will pay for most hospital visits
- Medicare Part B is senior health insurance. It pays for most doctor visits and needed treatments.
- Medicare enrollees may still need to pay coinsurance and copays for health services.
Medicare is an outstanding senior health care program. You can be proud that you’ve earned this coverage! Still, it’s not perfect. For instance, Original Medicare (Parts A and B) doesn’t cover prescription drugs. That can quickly become a significant concern for retirees.
- That’s why many folks turn to additional senior insurance in the form of Medicare Supplement plans, or Medicare Advantage plans.
We’ve written more about the differences between these optional plans before. For now, know that Medicare Supplement plans focus on your copay and coinsurance payments. And, Medicare Advantage plans are health programs that include dental and vision insurance, for instance.
But what if you’re enrolled in Medicaid now, and nearing age 65. Will you qualify for Medicare?
If I’m on Medicaid (or Medi-Cal), Will I Qualify for Medicare?
This is another common and important question. Eligibility for Medicare begins when you turn 65, or retire from the workforce and stop using a private health insurance plan through an employer.
- Your eligibility for Medicare has almost nothing to do with Medicaid / Medi-Cal.
- In other words, your enrollment in Medicaid doesn’t automatically qualify you for Medicare.
- To receive Original Medicare benefits, you must have worked and paid taxes for forty quarters (about ten years) in the years leading up to your retirement.
- If you’ve been unemployed for many years, you might not qualify for Medicare at no cost.
- However, there are still senior health insurance plans available for folks in this situation.
Medicare.gov offers a helpful enrollment calculator for people in various circumstances. If you’re on Social Security Disability (SSDI or “Disability) for instance, or if you’ve been a single homemaker for most of your life, it might have the answers you need.
Or, reach out to the team at CoverageCoach. We promise to give you a completely confidential, no-pressure, FREE consultation about your Medicare eligibility and related senior health insurance programs. Let’s talk!