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What is the Difference between Medicare & Medicaid?

Find out the difference between Medicare and Medicaid, who qualifies for Medicare and Medicaid, how much each costs, and which one pays for Assisted Living Communities and Nursing Homes
What is the Difference between Medicare & Medicaid?

The government programs Medicare and Medicaid have played an important role in millions of people’s lives for more than 50 years. However, there is often a good amount of confusion regarding the difference between the two programs and who qualifies for each one.

In this blog, we will examine both Medicare and Medicaid more closely and review how each program works.

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What is Medicare?   

Medicare is a federal program that provides health insurance-like coverage for people 65 or older, or those who have a qualifying medical condition or disability. There are more than 63 million people today on Medicare.

The main components of Medicare are Part A and Part B.

  • Part A – Designed to cover expenses for stays in a hospital.
  • Part B – Pays for claims incurred at a doctor’s office.
  • Parts C (Medicare Advantage) and D (pharmacy benefits) – These coverages are managed and offered by insurance companies.

What is Medicaid?

Medicaid is run by state governments and is designed to help adults and children with limited financial resources access health care. Programs can vary by state, but they all follow federal government coverage guidelines.

Who Qualifies for Medicare and Medicaid?

People who have reached the age of 65, or younger individuals with certain disabilities or permanent kidney failure are eligible for Medicare. To be eligible for Medicaid, each state determines their own regulations. Usually, eligibility is based on an applicant’s family size and the total income of the household.

How Much Does Medicare & Medicaid Cost?

Both programs usually include out of pocket premiums, copays, and coinsurance. However, costs can vary greatly. The price of Medicare depends on when a person enrolls and what level of coverage they choose. The premiums for Medicare are usually deducted from the enrolled person’s social security payments.

The cost of Medicaid for people who qualify will vary by state and depends upon the annual income of the recipient. Some Medicaid programs have no out of pocket premium costs.

Does Medicare or Medicaid Pay for Assisted Living Communities or Nursing Homes?

Medicare will pay for medical services in Assisted Living communities, but not the actual long term costs of living there. Under certain circumstances, Medicare will cover the rehabilitative expenses for short term stays.  Medicaid will pay 100% of nursing home costs if a resident meets specific eligibility requirements.

Frontier Management is Here to Help

Navigating the coverage, costs and eligibility of both Medicare and Medicaid can be challenging. The highly experienced and knowledgeable staff at Frontier has helped many families understand their options under both programs. If you would like to speak to us further about these topics, we are here to help. We cordially invite you to visit one of our beautiful properties, take a tour and speak with our friendly staff.

Find a community near you that perfectly fits your needs.