Medicaid vs. Medicare

By Nicole Lipinski, RN, MS, ADC-MC, CDP

Medicaid, Medicare – they sound alike? But they are different! What is the difference? Or are they the same? Let’s explore and see if we can figure this out! 

Medicaid is both state and federally funded. The program provides benefits based on financial need. Health insurance is provided to low-income Americans of all ages. The application process can take a few weeks to a month. The applicant must expect to provide extensive financial information and may be asked to participate in medical screening. 

To qualify for this program, the participant would need to be pregnant, parent of a minor teenager and living alone, aged, blind, or disabled. You can also qualify if you are not disabled and do not have children under the age of 18 if you are under the age of 65 and meet the income guidelines. 

Medicaid enrollment does not have an open enrollment period. You apply based on need. Income guidelines are generally based on Federal poverty levels. Although some of your assets will be counted, others will not be considered. It is best to review this when you are going through the application process. 

Medicare, on the other hand, is health care coverage for people who are 65 or older, certain people under 65 with disabilities, or people of any age with End-Stage Renal Disease. These are patients with permanent kidney failure requiring dialysis or a kidney transplant. 

Medicare Part A is hospital coverage. Med A coverage covers inpatient care in a hospital, skilled nursing facility care, hospice care, and home health care. There are no monthly premiums for most participants. However, there are few participants who buy into this plan. 

Medicare Part B supplements Medicare part A. Med B covers services and supplies that are needed to cover your medical condition. These services are from doctors and other healthcare providers. Services also include outpatient care and durable medical equipment and many preventable services. Most people who enroll pay standard part B premium. 

For more information about Medicaid or Medicare coverage, you can visit https://www.cms.gov/. For information about long term care, short term rehab, dementia care, or Parkinson’s disease management, contact Nicole Lipinski, RN, MS, ADC-MC, CDP at nlipinski@jhep.org or 570-344-6177 ext. 1113. 

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