Medicaid vs Medicare: Which Program is Right for You?

knowledge • Aug 06, 2020

In the midst of the global health crisis, health insurance is even more important than ever. Laid-off and retiring Americans are often unable to access health insurance, even with programs like COBRA. Medicaid and Medicare help to fill the gap and can provide you with coverage that you need. But which program is right for you, or could you be eligible for both? We know government programs can be confusing, but that’s why we’re here. In this post, we will break down the difference between Medicare and Medicaid, so you can learn which program is right for you and how to access them.

Medicare: Insurance for Older Americans

Medicare is a health program for Americans 65 and over. It is a federally funded program that most Americans consider an entitlement, since they have paid into it for years through their taxes. Medicare is available to all Americans who meet the age requirement, regardless of income. You can sign up for medicare three months before you turn 65, and the enrollment period remains open until 3 months after you turn 65. You can enroll later, but there’s sometimes a penalty.

Even if you’re still employed and have health insurance through your work, signing up for medicare as a secondary insurance is worthwhile. We are unveiling a new Medicare service soon, so stay tuned to get help with signing up for Medicare with Skip.

Most people do not have a monthly premium for basic Medicare which covers hospital visits (called Medicare Part A) but likely will have a premium for Medicare insurance that covers doctors’ visits and other medical services (which you can choose to opt out of). For a full breakdown of Medicare costs, check the Medicare website here. A complete medicare plan that covers drugs, doctors’ appointments, and inpatient care will not be free, but it will likely be lower cost than private insurance.

Medicaid: Insurance for Low Income Individuals and Families

Although it sounds similar, Medicaid is very different from Medicare. Medicaid is a program designed to provide health insurance to low income Americans of any age, especially those with young children. Unlike Medicare, Medicaid is jointly funded by both federal and state governments, so states have some control over the eligibility requirements. In total, there are 72 million Americans enrolled in Medicaid and CHIP (Children’s Health Insurance Program), a subsidiary program for kids.

In general, Medicaid is available to those who make less than 200% of the Federal Poverty Level and are either:

Parents or guardians of children under 18
Over 65
Blind and/or disabled

Depending where you live, if you live at or near the federal poverty level but don’t meet other requirements, you might still be able to get Medicaid. For example, in California, Medi-cal, which is the state’s Medicaid program, is available to anyone living on less than 138% of the federal poverty level, and there are additional programs for those who meet other eligibility requirements. You can learn about the specific eligibility in your state with Policygenius’ guide here, or go to the national health insurance website, which should calculate your eligibility automatically. We know signing up for health insurance can be confusing, so we are unveiling new services at Skip to help you get signed up--whether it’s through a government program or a private one. You can learn more about that here.

Dual Eligibility: People who Are Eligible for Both Programs

Did you know you could be eligible for both Medicaid and Medicare coverage? In fact, over 20 million people are “Dual eligibles”, people who meet the requirements for both programs. Dual eligibles are usually older adults living at or below the federal poverty level. You can find out if you are dual eligible through the national healthcare marketplace, your state’s medicaid website, or through Skip.

Final Thoughts

Medicare and Medicaid are both programs that help people who need it access healthcare, but they have different eligibility requirements. Medicare is geared towards older adults, although some disabled individuals also qualify. Medicaid is for those living on very low incomes, usually families, disabled people or older adults. If you think you might be eligible for one or both programs, take the time to enroll. It’s even possible you could be eligible for both! We can help you navigate the health insurance landscape and figure out what programs are right for you with Skip.