Medicaid or Medicare- Which Plan Do You Qualify For?

The complicated world of healthcare can be difficult to navigate, but the United States government offers two comprehensive plans for individuals who are in need of health insurance: Medicare and Medicaid. These foundational elements of the American healthcare system serve as necessary assistance to guarantee that individuals in need have access to imperative medical care and financial support. The differences between Medicaid and Medicare, their eligibility requirements, the number of services they cover, and the dominant effects they have on the lives of countless people and families across the country will all be revealed as this article delves into the complexities of these two programs. Readers will gain clarity on the inner workings of the United States government’s two premier health coverage plans and will be able to accurately determine which program best matches their qualifications. 


What is Medicare?

Medicare is a paid coverage plan, (with options to lower, or alleviate all costs for those who qualify) specifically for individuals over the age of 65, or younger individuals who suffer from certain disabilities or illnesses. The program's goal is to guarantee that senior citizens in America can get necessary healthcare treatments without the burden of exorbitant costs. Medicare is a crucial component of the country’s social safety net, as it provides millions of enrollees with a lifeline of assistance that encourages better health outcomes and improves the overall quality of living for senior and disabled US citizens.

Medicare is structured as a multiplan healthcare option that caters to a number of healthcare demands. Enrollees are given the choice to select the level of coverage that best meets their unique requirements, and they also have the option to sign up for supplemental policies to assist with any coverage gaps, such as copayments and deductibles. The program also offers vital financial protections that prevent prospective enrollees from being denied coverage or charged excessive premiums according to their health status or pre-existing disorders. With the help of this feature, people with disabilities or ongoing health issues can receive the care they need without having to worry about paying outrageous prices or having their insurance coverage rejected.

What is Medicaid?

Medicaid is a federal-state partnership program that provides basic healthcare coverage to low-income individuals and families in the US. Medicaid was established in 1965 to complement Medicare. The program is governed by federal laws but grants states the discretion to manage and alter the program to meet the needs of their constituents. Medicaid offers a safety net for vulnerable groups such as children, pregnant women, individuals with disabilities, and some low-income adults. Medicaid is an income-related program, therefore eligibility is determined by an individual's or household's income as well as other conditions that may vary from state to state. Due to state flexibility in what the program offers, Medicaid's benefits can vary significantly from one state to the next. All states offer certain federally mandated services, such as inpatient and outpatient hospital care, physician services, and laboratory tests, while also having the option to provide additional services at their discretion. 

Given that Medicaid coverage is generally dependent on socioeconomic factors such as income, and other factors, states have a threshold that determines qualifications to receive Medicaid benefit in that given state. In the state of New York, the threshold changes based on the number of individuals in a given household. For example, for an individual who lives on their own, the maximum they can make to qualify for Medicaid is $19,392. Whereas a family of four has a maximum combined income of $39,900 in order to qualify for Medicaid benefits. It is also possible to qualify for both Medicare and Medicaid benefits if an individual meets the criteria for both plans. I.e, a 69-year-old woman who lives alone, and makes less than $19,392, may qualify to receive benefits from both plans, should she be interested. 

What are the Benefits of Medicare and Medicaid?

Now that the qualifications for both plans have been established, let’s compare the benefits that come with each plan. Enrolling in the base plan of Medicare provides coverage for Medicare Part A. Medicare Part A only covers hospital care. If enrollees want more comprehensive benefits, they must purchase (via an additional monthly premium), either Part  B, C, or D. Unlike Medicare, there is only one coverage plan for Medicaid, with a few optional benefits that are offered at the state’s discretion. In the state of New York, those who are eligible for Medicaid receive mandatory benefits such as hospital care, doctor visits, laboratory services, home health services, vision, dental, and prescription drug coverage, with additional optional coverage available at the discretion of the individual and state.

The step up to Part A of Medicare is called “Original Medicare.” Original Medicare is a more comprehensive plan, which combines either part A with part B, or part A with part D. Both parts B and D cover various additional healthcare benefits that enrollees may find useful. Part B is considered the Medical Insurance portion of Medicare. It covers services such as ambulances, doctor visits, therapy, and vaccinations for a predetermined monthly premium. Medicare part D helps enrollees cover the costs of a predetermined set of prescription drugs. Finally, Medicare Advantage, otherwise known as “Medicare part C,” bundles the three original plans together (hospital care, preventive care, and prescription drugs) under one plan, for an additional monthly cost. 

Medicare and Medicaid both serve two distinct groups of individuals, however, the extent of the benefits offered are generally the same. Enrolling in Medicare Advantage will ultimately provide enrollees with the same or similar benefits, as an individual who is enrolled in Medicaid’s healthcare program. 

Which Option Should You Choose?

Individuals who are looking for government-provided health insurance options have two places they can look. If the individual is over the age of 65 or suffers from a disability or illness, the Medicare option is available. If an individual or a family has an income that is at or below the state’s threshold for eligibility, then the Medicaid option is available. If an individual meets the criteria of eligibility for both plans, they may be able to qualify for both. 

Though there are two plans available, remember that all plans are not created equally. Medicare is offered via a paid premium and has multiple coverage plans (each at its own additional cost to the base plan). Enrollees must determine their needs, and financial abilities, before determining what coverage they will choose when selecting Medicare as their health insurance option. Medicaid however, has one comprehensive plan (based on state), with mandatory and optional benefits that are offered at low or no cost to enrollees. So Medicaid, or Medicare? It all comes down to qualifications. 

Why Do You Need An Attorney?

Using the services of an attorney can alleviate much of the stress and confusion that comes with applying for government-provided health care. Many people make crucial mistakes that cause significant consequences down the line. Investing in the services of an experienced attorney like Inna Fershteyn can not only put you in the position to avoid crucial mistakes but will also connect you with the best health plan for you and your family. For more information and any Medicaid/Medicare needs, please contact the Law Office of Inna Fershteyn at (718) 333-1233.