Both Medicare and Medicaid were created by the federal government and are funded by taxpayer dollars. Their purpose is to help cover healthcare costs. Despite their similarities, these programs perform different functions and have different eligibility requirements.
Receiving Medicare will not automatically qualify you for receipt of Medicaid. However, if you meet the eligibility requirements for both programs, you may qualify for both. Note that in California, Medicaid is simply called a Medi-Cal.
The Medicare program is not need-based. Instead, it helps cover health care costs of the elderly and people with certain disabilities. At 65, any US citizen can get Medicare. The coverage includes the following persons:
Medicare covers four health care circumstances, as outlined below:
Unless one is also qualified for Medicaid, or some other low-income subsidy, Medicare does not come for free. Even though there is an entitlement to receive Medicare paid for by social security taxes, one has to pay part of the costs. For example:
The federal government as well as state government administer Medicaid. The federal government usually pays 50% of the state’s Medicaid costs.
Unlike Medicare, Medicaid is not an entitlement program based on social security taxes paid throughout one’s life. Medicaid has strict eligibility requirements because its purpose is to alleviate the health care costs for the poor. Every state has its own eligibility requirements under which a person may be qualified as poor. Depending on the state, eligibility requirements for the Medicaid may be based on:
Note that in addition to Medicaid, seniors may also meet separate eligibility requirements for the Medicare.
Medicaid covers conditions considered to be "medically necessary." Coverage varies by state, but covered conditions typically include:
Note that Medicaid covers services that Medicare may not cover such as:
Depending on the state, Medicaid consumers may be required to cover small costs for some services out of their own pocket. Otherwise, Medicaid can actually supplant coverage for Medicare costs. For example:
A qualified health insurance lawyer attorney may help you succeed in obtaining the necessary coverage. A lawyer can also represent you in an existing coverage dispute.
Last Modified: 08-24-2016 10:20 PM PDTLaw Library Disclaimer
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