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Differences between Medicare and Medicaid

The words “Medicare” and “Medicaid” are so much alike that it’s easy to get them confused. Both are government programs and both help people pay for health care. But that’s where the similarities end.   For a brief overview of the differences between the two programs, please see below.

  • Medicare is a a federal  health insurance program for people who are 65 or older, OR who are under 65 but with certain disabilities of any age or have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s Disease).  To learn more about Medicare, please visit https://www.medicare.gov/
  • Medicaid is a joint federal and state program that helps pay health care costs for certain people and families with limited income and resources.  To read more about the Medicaid program please visit https://www.medicaid.gov/medicaid/eligibility/
    • If you are eligible for both Medicare and Medicaid (aka a "dual-eligible" individual), you can have both types of coverage, and they will work together to provide you with health coverage at very low cost to you.

Also know that while Medicare and Medicaid are both health insurance programs administered by the government, there are differences in covered services and cost-sharing. Make sure to call Medicare or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible individual.

If you already have Medicare and  Medicaid, please call or click for a free, no-obligation   

Dual Special Needs (DSNP) plan quote today!

  Toll Free:  (800) 375-1195

Calling this number will direct you to a licensed Agent/Broker.  


Getting Started with Medicaid

Below is a general guide to the Medicaid application process. Be sure to contact your local Medicaid office for state-specific rules.

  • Note: Your Medicaid office may be called the Department of Health, the Department of Social Services, the Department of Insurance, the Cabinet of Health & Family Services, or by another name.

In general, some states may require you apply in person, while others may allow you to apply by mail, online, by telephone, or at locations in the community, such as health centers and community organizations.  When you inquire, find out which documents and forms of identification you may need in order to apply.  


Typically your Medicaid office may ask you to show the following:

  • Proof of date of birth (e.g., birth certificate)
  • Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card)
  • Proof of all types of income, earned and unearned (e.g., paycheck stubs, retirement benefits, Supplemental Security Income)
  • Proof of resources (e.g., bank or stock statements, life insurance policies, property)
  • Proof of residence (e.g., rent receipt, landlord statement, deed)
  • Medicare card and any other insurance cards (you can also provide a copy of the insurance policy)

Note: Medicaid coverage is available, regardless of citizenship status, if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency, and you must meet all other eligibility requirements.


Troubleshooting

If you have any problems applying at a Medicaid office, ask to speak with a supervisor.

If you do not receive a timely decision on your Medicaid application or are turned down for Medicaid, you can appeal by asking for a state fair hearing (not a city or local one). Check with your Medicaid office to learn more about requesting a fair hearing.

Once you have Medicaid, you must recertify (show that you remain eligible for Medicaid) to continue to get Medicaid coverage. When you submit your Medicaid application, be sure to ask when and how you will need to recertify. In many states, recertification is an annual process.

Visit the Healthcare.gov link below to see if you might qualify for Medicaid and ways to apply


Healthcare.gov