What is the Difference Between Medicaid and Medicare

Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 2009/03/14 - Updated: 2016/10/08
Topic: Health Care Information - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Explains the difference between Medicare and Medicaid and what they cover.

Introduction

Just like there's confusion over the difference between SSDI and SSI, there's confusion over the difference between Medicare and Medicaid.

Main Item

So, here in a nutshell, is the definition of each.

Medicare

The very same health plan that retired people over 65 enjoy - can be obtained after receiving SSDI for 24 months. (NOTE: ONCE YOU QUALIFY FOR SSDI, YOU HAVE TO WAIT FOR 29 MONTHS BEFORE RECEIVING YOUR FIRST CHECK.)

Medicare has two parts:

Part A, which you pay for through your payroll taxes, and which covers overnight hospital bills, hospices, home health care and very limited, partial nursing home care.

Part B, three-fourths of which is paid for by federal income tax, and one-fourth ($84.00 a month in 2006, deducted from your SSDI check) by you. It pays for doctor, ambulance, emergency room, clinic and most other outpatient care (except drugs and nutritional products).

As from May 15th, 2006, Medicare now has a Part D which covers partial payment of prescriptions. Most people who qualify for Medicare select a "Supplement" package that covers additional things such as Doctor visits (minus the co-pay) and other things usually covered by a Health Insurance Plan. You have to pay extra for this. If you become eligible for Medicare after May 15th, 2006, you have to select a carrier for Part D. This can be included in your "supplemental" package, as mine is, or it can be a separate coverage.

Medicaid

Is run by the state and local governments. It completely covers hospitalization, clinic visits, emergency room visits, doctors' visits, hospices, home health care, nursing home stays, ambulance and outpatient prescription drugs. Medicaid has very small co-payments for prescriptions, doctor visits and some other care. While all hospitals and almost all drug stores accept Medicaid, most doctors don't, and many home health agencies, nursing homes, and hospices are also reluctant to accept Medicaid. People on SSI are eligible for Medicaid, and in most but not all of the states in the nation, SSI sends lists of recipients to the local government, which then automatically sends Medicaid cards out to them. But in some states, you must always apply separately for Medicaid at the welfare office, even if you're on SSI.

It's possible - indeed, sometimes it's absolutely necessary - to be on both Medicare and Medicaid. In that case, Medicare first pays medical bills up to whatever its rules allow, then Medicaid pays the rest. Always get Medicaid, if you can, to supplement Medicare, because with it, you'll have a way to pay deductibles and co-payments that you would otherwise face without it. Moreover, Medicaid pays for some things Medicare doesn't cover at all. Conversely, always get and keep Medicare (including Part B) even if you are already on Medicaid. Medicare pays doctors and hospitals more than Medicaid does, and therefore will make them more likely to accept you as a patient and devote adequate time to your case. Don't be afraid of the Part B monthly premium, either. Once you're on Medicaid, it will start paying the Medicare premium for you, and your SSDI check will go up by $84.00.

According to the Social Security Administration some assets are considered exempt (not countable) toward SSI eligibility such as:

• The house an individual lives in and the land it is on;
• Personal and household goods (depending on their value);
• Life insurance with a face value of $1,500 or less;
• Burial plots or spaces for the individual and immediate family; burial funds for the individual;
• A car with a current fair market value up to $4,500. The car may be of any value, however, if it has been modified to accommodate a person's disability or if it is needed for necessary activities.

Some of an individuals income is also not counted toward SSI eligibility such as:

The first $20 of most income received in a month (from any source); the first $65 a month earned from working and half the amount over $65; food stamps; most food clothing and shelter from non-profit organizations; most home energy assistance. If the individual with a disability works, any wages used to pay for items needed for work related to the disability are not counted as income. (Source: Social Security Administration.) Since eligibility for government benefits is dependent on these financial restrictions, a person with a disability would be in jeopardy of loosing those benefits if he or she amasses any resources above the limit.

Author Credentials: Ian was born and grew up in Australia. Since then, he has traveled and lived in numerous locations and currently resides in Montreal, Canada. Ian is the founder, a writer, and editor in chief for Disabled World. Ian believes in the Social Model of Disability, a belief developed by disabled people in the 1970s. The social model changes the focus away from people's impairments and towards removing barriers that disabled people face daily. To learn more about Ian's background, expertise, and achievements, check out his bio.