What is Medicare and Medicaid?
Among government-funded health insurance programs, two to consider for Medicare beneficiaries are Medicare and Medicaid. But what exactly are they, and how do they differ?
According to the Department of Health and Human Services, Medicare is health insurance for people 65 years of age or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD).1 This federal government program has several parts, with the most frequently referenced parts being that of Original Medicare, Part A (inpatient/hospital coverage) and Part B (outpatient/medical coverage).2
Like Medicare, Medicaid is a government program designed to help people pay for their medical costs. The primary difference in qualification being that Medicaid is designed to help pay medical costs for income restricted patients rather than provide coverage for a certain age group, disability, or ESRD.3 Each state has different rules about Medicaid eligibility, unlike Medicare – which is standardized. As such, income qualifications for Medicaid will vary by state.3
What is Medicare Supplement Insurance?
Medicare Supplement Insurance (also known as Medigap), is designed to help work only with Original Medicare.4 Medicare Supplement Insurance, unlike Medicare and Medicaid, is sold by private insurance companies, and helps pay for some of the remaining health care costs Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.4
The main reason people consider a Medicare Supplement Insurance policy comes down to the fact that one’s Original Medicare policy may not cover all health care costs.4 When facing deductibles and coinsurance in Original Medicare, Medicare Supplement Insurance plans can help Medicare beneficiaries cover costs where it’s needed most. Because there are a number of Medicare Supplement Insurance policies available to consumers on Original Medicare, it may be easier to find your metaphorical ‘glass slipper’ when it comes to getting additional coverage – turning your health care experience from a possible nightmare into a Cinderella story.
Do You Need Medicare Supplement Insurance if You Qualify for Medicare and Medicaid?
The short answer is no. If you have dual eligibility for Medicare and full Medicaid coverage, most of your health costs are likely covered.3 As a result, having a Medicare Supplement Insurance plan wouldn’t necessarily be beneficial to you, in fact, an insurance company is not allowed to issue a Medicare Supplement insurance policy to a Medicare beneficiary who receives full Medicaid health coverage! The purpose of Medicare Supplement Insurance is to cover the cost left by deductibles and coinsurance in Original Medicare, but as full Medicaid coverage should cover the majority of those costs, a Medicare Supplement Insurance policy isn’t necessary.3
Find What’s Right for You
A number of factors influence your coverage eligibility and decisions. As such, it’s important to review your existing coverage before making a decision to enroll in any additional coverage options. Having a comprehensive understanding of what your coverage is and what you may need more of will help you make the best decision possible for your unique situation.
Your style is your choice. Shouldn't your doctor and your coverage be, too?
Learn more about Medicare Supplement insurance options.
1 Medicare.gov, What’s Medicare, 2020
2 Medicareinteractive.org, Introduction to Medicare, 2020
3 Medicare.gov, Medicaid, 2020
4 Medicare.gov, What’s Medicare Supplement Insurance (Medigap)?, 2020