Whether you're born in America or new to the country, looking for health insurance can be a challenge, especially when terms like Medicare and Medicaid can be so confusing. If you're wondering what's the difference between Medicare and Medicaid, we'll break it down for you point by point.
If you already have Medicare and need travel insurance with medical coverage for a trip abroad, you can read more about which travel insurance plans can help you on your travels.
Medicare or Medicaid: Which Do You Need?
Medicare is a U.S. Federal health insurance program administered by the United Federal government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. Medicare has Part A (Hospital Insurance), Part B (Medical Services), Part C (Managed Health Care) and part D (Prescription Drugs).
Medicaid is a health program for eligible individuals and families with low incomes and resources. It's a means-tested program that is jointly funded by the states and federal government, and is managed by the states. Each state may have its own name for the program. Examples include "Medi-Cal" in California, "MassHealth" in Massachusetts, and "TennCare" in Tennessee.
Either U.S. citizens & permanent residents 65 or older, who have worked (or their spouse has worked) and paid Medicare taxes in the U.S. for 40 quarters.Permanent Residents above age 65, who have lived in the U.S. can purchase Medicare from the government. Medicare for green card holders is an option as long as you meet the permanent residency requirements.
Disabled residents under 65 years of age and who have been receiving either Social Security benefits or the Railroad Retirement Board disability benefits for at least 24 months from the date of entitlement.People with end stage renal disease or need kidney transplant.
Eligible for Social Security Disability Insurance and have amyotrophic lateral sclerosis (ALS-Lou Gehrig's disease).
- Limited income is one of the primary requirements for Medicaid eligibility.
- Other requirements include, but are not limited to, age, pregnancy, disability, blindness, income and resources, and one's status as a U.S. citizen or a lawfully admitted immigrant.
- Special rules exist for those living in a nursing home and disabled children living at home. A child may be covered under Medicaid if she or he is a U.S. citizen or a legal resident of the U.S
- A child may be eligible for Medicaid regardless of the eligibility status of his or her parents or guardians.
- Patients with AIDS with T cell count of 200 or under
- Must be a resident of the plan-offering state.
Benefits & Services
- Part A Hospital Insurance helps cover inpatient care in hospitals, including overnight hospitalization in hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits
- Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
- Medicare Part C is managed care
- Medicare Part D is prescription drug coverage to help lower the price of prescription drugs
- Inpatient hospital services
- Outpatient hospital services
- Prenatal care
- Vaccines for children
- Physician services
- Nursing facility services for persons aged 21 or older.
- Family planning services and supplies
- Rural health clinic services
- Home health care for persons eligible for skilled-nursing services
- Laboratory and x-ray services
- Pediatric and family nurse practitioner services
- Nurse/midwife services
Coverage Start Date
If you already receive Social Security Benefits, you'll automatically be enrolled into Medicare on the month you turn 65 years old. If you're close to 65 years of age and don't receive social security benefits yet, there are two periods of the year that you can enroll:
- Initial Enrollment Period (IEP) for Parts A and B is 7 months, starting 3 months before the month of you turn 65 years old and ending 3 months after the month of eligibility.
- General Enrollment Period extends from January 1 through March 31 each year. Enrollment becomes effective on July 1 of the same year.
No specific dates. Coverage may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change.
If you're a new immigrant aged 65 and above, have been a permanent resident for 5 years or more, and are looking for new immigrant insurance, you may purchase Medicare from the government.
To obtain medical insurance for new immigrants to the U.S., the only available immediate health insurance solution is to get a short term health insurance. Learn more information about insurance for green card holders
For more information on Medicaid services, please visit http://cms.hhs.gov/home/medicaid.asp
Will Medicare or Medicaid Cover You Abroad?
Unfortunately, both Medicare and Medicaid are a form of domestic healthcare, so they won't cover you once we step beyond U.S. borders. However, travel insurance can help protect you financially whether you're faced with an unexpected medical expenses or you need to cancel your trip.
Please contact our Customer Success Team for more information or call toll free 866-384-9104. Our qualified licensed Travel Health Insurance Consultants can assess your situation and help you with a solution.