When reviewing options for healthcare coverage, you may encounter both Original Medicare and Medicaid, but how do they differ? While both programs are government-funded and aim to assist with medical costs, they serve distinct populations and have different eligibility criteria, coverage options, and funding sources.
By gaining an understanding of these two vital healthcare programs, you can make informed decisions about their coverage to access the support you need. In this article, we’ll walk you through details about Medicaid and Original Medicare and the differences between the two, as well as share an overview of Medicare Advantage plans.
What is Medicaid?
Medicaid is a government-funded healthcare program in the United States that primarily serves low-income individuals and families, regardless of an individual’s age. It’s a joint program funded by both federal and state governments and is administered at the state level. Unlike Original Medicare, which primarily caters to the elderly and certain disabled individuals, Medicaid focuses on providing essential medical assistance to those with limited financial resources, ensuring they have access to services and care, including:
Hospital stays
Doctor visits
Preventative care
Long-term care, like a stay in a skilled nursing facility
The Medicaid program plays a critical role in ensuring that individuals have the opportunity to receive necessary healthcare services, regardless of their financial circumstances.
What is Original Medicare?
Original Medicare refers to the traditional fee-for-service program offered directly by the federal government. It consists of two main parts:
Part A (hospital insurance): Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare.
Part B (medical insurance): Part B covers certain doctor's services, outpatient care, medical supplies, and preventive services.
Beneficiaries of Original Medicare can choose any doctor or hospital that accepts Original Medicare, and they do not need a referral to see a specialist. While Original Medicare provides essential coverage for a wide range of healthcare services, it doesn’t cover all medical expenses. To help cover these gaps in coverage, beneficiaries have the option to enroll in additional private insurance plans.
What is Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is an alternative way for beneficiaries to receive their Original Medicare benefits. Offered by private insurance companies approved by Original Medicare, Medicare Advantage plans must legally provide all the benefits covered under Original Medicare and often include additional coverage for routine services. These plans may also incorporate prescription drug coverage. Unlike Original Medicare, which operates on a fee-for-service model, Medicare Advantage plans typically have a network of healthcare providers and may require beneficiaries to use those providers to receive coverage, although some plans offer out-of-network coverage as well.
Can you have both Medicaid and Original Medicare?
Yes, depending on your age and income, you can have both Medicaid and Original Medicare coverage. Qualifying for both Medicaid and Original Medicare is known as dual eligibility. If you have both of these coverage options, Original Medicare will act as your primary coverage, but Medicaid can help account for expenses that Original Medicare doesn’t include. This means if you visit a healthcare provider who accepts them both, Original Medicare will cover the cost of your care first, and Medicaid can help account for the cost of any remaining services.
SelectQuote Can Guide You to the Medicare Advantage Plan Coverage You Need
When it comes to taking care of your health and well-being, it’s essential to find the right coverage. SelectQuote can help you navigate the intricacies of Medicare Advantage plans, helping you gain a better understanding of Original Medicare and explore your Medicare Advantage options. In just minutes, our licensed insurance agents and proprietary technology can help you review and compare Medicare Advantage plans to help you find available options that could be the right fit for you and your needs.
