Medicare... Medicaid... Medi-WHAT? Here at Cariloop, we deal with Medicaid and Medicare on a daily basis.  It’s easy for people to get the two programs confused and it can have serious consequences when they do.  So, here is just a bit of background that might help ease confusion. Medicaid and Medicare both came into existence in 1965.  They were designed to provide medical insurance to older Americans and low-income Americans. But, although they came into being at the same time, and their names are frustratingly similar, there are key differences in how the two programs function. 

Eligibility

Medicaid is intended to provide health care for low-income people.  Therefore, eligibility for Medicaid is based on one’s income. Medicare is intended to provide health care for senior citizens.  Therefore, eligibility is based on one’s age.  There is no financial requirement. Some people are eligible for both.  

Administration

One of the key differences in the two programs is that they are administered in totally different ways. Medicaid is administered by the state and therefore benefits vary from state to state.  The federal government establishes certain parameters that have to be met by every state but beyond that, different states can and do offer expanded benefits – either by covering more people or providing more coverage per person.  Benefits can vary dramatically. Medicare is administered by the federal government and therefore benefits are the same no matter where you are in the country. Both programs have changed and expanded over the years, adding to the confusion.  

Medicare Expansions

Medicare originally consisted of two parts: 

• Part A – covers you when you need hospitalization
• Part B – covers you when you see a doctor outside of the hospital (at an office). Starting in 1996 – Medicare added:
• Part D – covers your prescription drugs
   

So what about Part C?

What is sometimes called Medicare Part C is when you choose to buy a version of Medicare that is provided by a private company rather than the federal government.  It is also referred to as a Medicare Advantage Plan.  When you buy one of these policies, your “medicare” is provided by a separate entity – for example Humana or Blue Cross Blue Shield.  The federal government pays money to those companies to administer the plan for you. Although there are rules that the companies have to follow, some companies offer extra coverage and they do not all charge the same amount for premiums. Choosing a Medicare Advantage Plan can save money but it can also limit what services are covered or limit you to a specific geographic area.   When navigating the health care system with your loved one, it is easy to get mixed up and which program covers what.  To be sure, message your Cariloop Care Coach. That’s what we’re here for! If you're interested in connecting with a Care Coach, learn more about our individual memberships. By Julie Coats, LBSW, JD, CCM 

If you are caring for a loved one and need some assistance and guidance, a Cariloop Healthcare Coach would love to walk you and your family through whatever you may be dealing with. Become a member or call 1-844-790-5667 to get started.