Medicare vs. Medicaid

Defining Medicare vs. Medicaid

POSTED BY Tracy . July 2, 2020

Understanding the difference between Medicare vs. Medicaid

A lot of people have a difficult time understanding the difference between Medicare and Medicaid. They are both health insurance programs run by the government. Understanding each program, as well as how the two differ, can help you find the right healthcare program for you or a loved one.

Let’s start with Medicare.

Medicare is the earned-benefit program for Americans aged 65 or older or disabled. Workers pay into Medicare throughout their working years. The Centers for Medicare & Medicaid Services is the agency in charge of both Medicare and Medicaid, but you sign up for Medicare A (Hospital) and Medicare B (Medical) through Social Security.

You can apply for Medicare online from the convenience of your home on the Social Security Administration (SSA) website. If you’re already receiving Social Security retirement benefits when you reach age 65 or are in the 25th month of receiving disability checks, you will be enrolled automatically.

Medicare Part C (Medicare Advantage) and Part D (Prescription Drug) plans are available for purchase in the insurance marketplace. Social Security administers a program called Extra Help to assist people with low income and low resources pay for premiums, co-pays and coinsurance costs for Part D plans. If you think you may qualify, visit Extra Help. Each year, The Centers for Medicare & Medicaid Services publishes Medicare and You, available online at their website. This publication is a user’s manual for Medicare.

Each state runs its own Medicaid program under guidance from the Centers for Medicare & Medicaid Services. Medicaid offers care for the most vulnerable among us. While it does not require paying taxes while working, it does have guidelines about how much income and resources you can have to qualify. Medicaid provides coverage for older people, people with disabilities, and some families with children. Each state has its own eligibility rules and decides which services to cover. The names of the Medicaid program may vary from state to state. To learn more about each state’s Medicaid program, click here.

Sadly, disability denials are common. Statistically, initial claims have a denial rate of approximately 67%. Reconsiderations (the first step of appeals in most states) are denied at an even higher rate (up to 87%). A denial means that you’ll need to file an appeal and hope Social Security changes its mind.

At Jan Dils, Attorneys at Law, we know what to expect and can help you present your very best case. So, whether you have read this article and think you may qualify for Social Security disability or have been denied coverage, don’t hesitate to give us a call. Consultations are always free. For more information, visit jandils.com or call us at 877.526.3457. You can also fill out this form and we will respond to you shortly.

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