A Guide to Understanding Medicare vs Medicare Advantage vs. Medicaid (MediCal)

Did you know that, annually, around 120 million Americans are enrolled in both the Medicare and Medicaid (MediCal) programs? That’s higher than the number of people who receive health insurance through full-time employment. 

If you’re looking to enroll in one of these programs, however, it can be difficult to understand the difference between Medicare vs Medicaid vs Medicare Advantage. What are the differences between these programs, and how can you know which is right for you?

Let’s take a closer look.

Medicare vs Medicaid vs Medicare Advantage: The Background

Ultimately, Medicare, Medicaid, and Medicare Advantage are all forms of health insurance. The benefits, eligibility criteria, and parameters for each program differ.

Medicare and Medicaid are both government-sponsored plans designed for certain high-need populations. By contrast, Medicare Advantage plans are offered by private insurance companies to deliver Medicare coverage in a different way. 

Let’s take a look at the specifics of each plan.

Medicare: Health Care for Older Americans

Medicare is the more well-known of the two government-sponsored programs because it is the one that every American will one day be eligible for.

Who is Eligible for Medicare?

There are no income requirements for Medicare. Instead, any American citizen over the age of 65 is eligible to apply for Medicare benefits.

Workers who paid Medicare taxes for ten years, or who had a spouse who did so, are eligible to receive Medicare Part A coverage premium-free. Seniors who did not pay into Medicare may be eligible to purchase Part A coverage.

What’s the Difference Between Medicare Part A and Part B?

Medicare Part A covers any hospital and inpatient care. By contrast, Medicare Part B covers any doctors’ visits or outpatient care. 

Most Medicare recipients do not pay a premium for Part A, almost all recipients must pay a monthly premium for Part B. Additionally, most services received through Medicare Parts A and B require the patient to pay coinsurance. 

Together, Medicare Part A and B fall under the category of what’s often called “Original Medicare.”

What Does “Original Medicare” Cover?

In addition to using Medicare Part A to cover hospital care, recipients may use the benefits to cover care in a skilled nursing facility, home health care, or hospice. In most cases, patients are limited to 100 days of coverage for any kind of long-term care.

Medicare Part B covers more of a patient’s preventative care services. This includes things like doctors’ visits, lab tests, some vaccines, and therapy. Patients who need equipment like walkers and ventilators may be able to receive these through Part B.

When Medicare is Not Enough

While Medicare offers basic care, many patients find that they need additional services not offered by “Original Medicare.” These are often provided through Medicare Part C (also known as Medicare Advantage), Medicare Part D, and even Medicaid. Additional services include signing up with either a Medicare Supplement plan or Medicare Advantage Plan.

How Does Medicare Advantage Work?

A Medicare Advantage Plan (also sometimes called “Medicare Part C”) offers patients a different way of receiving their Medicare Part A and B benefits.

Essentially, these plans bundle the care you receive through parts A and B to deliver them through a single plan. They also often offer additional benefits not available through Original Medicare. This includes coverage for things like vision checkups, hearing aids, dental care, transportation,  etc.

An example of a Medicare Advantage plan like the one described above is, United Healthcare’s Medicare Advantage plan: AARP® Medicare Advantage SecureHorizons® (HMO). To find out more, click here.

What About Medicare Part D?

Medicare Part D adds prescription drug coverage to Original Medicare. These plans can be purchased as separate, stand-alone plans, or as part of a Medicare Advantage Plan.

What Do You Pay for a Medicare Advantage Plan?

When you enroll in a Medicare Advantage Plan, you must still be enrolled in Original Medicare. This includes paying the monthly premium for Medicare Part B.

The federal government then pays a portion of your Medicare Advantage Plan premium. In some cases, the remaining premium for the patient may be as low as $0. In other cases, however, you will have an additional premium to pay.

Even so, enrolling in a Medicare Advantage Plan can save money in the long run, especially for patients who use their insurance often. This is because, in addition to covering more services, Medicare Advantage Plans often have lower coinsurance costs.

Additionally, Medicare Advantage Plans have maximum out-of-pocket costs. Once a patient reaches that maximum, they no longer have to pay coinsurance for the remainder of the year.

Also, since many Medicare Advantage Plans include Medicare Part D, this also offers cost savings. Most patients will choose to purchase Part D coverage regardless. Purchasing it through an Advantage plan saves money. In addition, at Meritage Medical Network, we have an outstanding team of Care Managers who help to coordinate all of your care.

What About Medicaid (MediCal)?

The final type of coverage to consider is Medicaid, called MediCal in California. Generally, Medicaid was designed to cover the healthcare costs of low-income Americans. These are premium-free plans that often cover children, pregnant women, and Americans with disabilities. 

In some cases, however, Seniors covered by Medicare may also receive services through Medicaid.

When Do Seniors Get Medicaid?

The most common instance where Seniors apply for Medicaid is when they need long-term care. This is because, as stated earlier, Medicare typically only covers the first 100 days of long-term care. Medicaid can cover stays for patients who need to be in a nursing home or long-term care facility.

Additionally, for Seniors who cannot afford the costs of Medicare premiums or coinsurance, Medicaid may be an option. Low-income seniors may qualify for a subsidy for their Part B coverage.

Getting the Care You Need

Now that you understand the differences between Medicare vs Medicaid vs Medicare Advantage, it’s time to focus on getting the care you need. 

Contact us today to learn how Meritage Medical Network can get you access to care from over 700 trusted providers. We’re committed to helping you get excellent care.

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