Is it Medicare or Medicaid?

A lot of people have a difficult time understanding the difference between Medicare and Medicaid. Both programs begin with the letter “M.” They’re both health insurance programs run by the government. People often ask questions about what Medicare and Medicaid are, what services they cover, and who administers the programs.

Let’s start with Medicare. Medicare is the earned-benefit program for Americans aged 65 or older or disabled. Workers pay into Medicare throughout their working years. The Centers for Medicare & Medicaid Services is the agency in charge of both Medicare and Medicaid, but you sign up for Medicare A (Hospital) and Medicare B (Medical) through Social Security.

You can apply for Medicare online from the convenience of your home at the link on our website: www.socialsecurity.gov/medicare/. If you’re already receiving Social Security retirement benefits when you reach age 65 or are in the 25th month of receiving disability checks, we will enroll you automatically.

Medicare Part C (Medicare Advantage) and Part D (Prescription Drug) plans are available for purchase in the insurance marketplace. Social Security administers a program called Extra Help to help people with low income and low resources pay for premiums, co-pays, and co-insurance costs for Part D plans. You can find out more about Extra Help and file for it at www.socialsecurity.gov/medicare/prescriptionhelp. Each year, The Centers for Medicare & Medicaid Services publishes Medicare and You available online at their website at www.medicare.gov/medicare-and-you/medicare-and-you.html. This publication is a user’s manual for Medicare.

Each state runs its own Medicaid program under guidance from the Centers for Medicare & Medicaid Services. Medicaid offers care for the most vulnerable among us. While it does not require paying taxes while working, it does have guidelines about how much income and resources you can have to qualify. Medicaid provides coverage for older people, people with disabilities, and some families with children. Each state has its own eligibility rules and decides which services to cover. The names of the Medicaid program may vary from state to state. You can read about each state’s Medicaid program at www.medicaid.gov/medicaid/by-state/by-state.html. You can find each state’s Medicaid contact information at www.medicaid.gov/about-us/contact-us/contact-state-page.html.

Medicare and Medicaid are two of the major insurance programs that provide healthcare to the American public. Understanding each program, as well as how the two programs differ, can help you and those you care about find the right healthcare program.

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73 thoughts on “Is it Medicare or Medicaid?

  1. Here’s an easy way to tell the difference: If you have worked most of your life you get Medicare & pay 20% of every expense covered.

    If you didn’t work a day in your life you get Medicaid & that covers 100% of everything.

    Moral of this sad story: Not working pays much more!

    • False. Stupid. Irrelevant now, anyway. Both were fitted in the budget bill, BOTH will be ELIMINATED in the tax bill being voted on any day now. Don’t believe me, read the actual bills in pdf at Congress.gov. You’ll be happy to know that no one will have health insurance, whether they “worked a day in their life” or not…

          • The mess you are in now is not the work of Don Trump nor the Republicans. It’s the fine work of Obama and the hiring to run the show by him of Experian, the Credit Bureau maggots with the morals of snakes, who cheat everyone and think NOTHING of it! Ask them when the last time anyone qualifies for Social Security benefits!! Ask anyone how long Experian was fighting with the Federal Trade Commission for stealing from the public charging them wrongly for credit card checking!! I get so sick of all of it and then I hear idiots like those poor people who have no idea what they are talking about!!

    • Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure. See our Medicare web page for more information.

  2. I decided to keep my husband’s private Medical Program (currently SSS) and pay for it after I qualified for Social Security at age 66 and he had retired from work. I want to know if we decide to get Medicare Part B, can we get it without penalty, this is, without having to pay extra for Medicare B. Could you clarify?

    • Hi Laura. Under certain conditions, you may qualify for a Special Enrollment Period, which would allow you to sign up for Medicare Part B if you are past your Initial Enrollment Period. If you or your husband are actively working and covered under an employer’s group health insurance program, you can delay enrollment into Medicare Part B until the work activity stops or the health coverage is dropped. Also, because you must pay a premium for Part B coverage, you have the option of turning it down.
      If you didn’t sign up for Medicare Part B when you were first eligible, and you aren’t eligible for a Special Enrollment Period, you can sign up during the General Enrollment Period, between January 1 – March 31 each year.
      We suggest that individuals speak to their health benefits advisor, or health plan representative to see what’s best for them, and to prevent any penalties or delayed enrollment in the future. To learn more about the Medicare enrollment periods got to http://www.Medicare.gov or visit our Medicare web page for more information.
      For specific questions about your case, call 1-800-772-1213 and ask one of our agents to assist you. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m. Or you can contact your local Social Security office directly. Hope this helps!

    • You mean the Medicaid that pays for the assisted living or nursung home for your elderly parents and/or grandparents who are RETIRED but not able to care for themselves any more but who don’t have $3000/month for private assisted living? THAT’S one of the groups you’re slamming…also disabled people who worked but lost everything due to becoming disabled & now are too poor to afford medical insurance. People who judge are bad enough; those who judge when they don’t even have the facts right are despicable.

      • I am with you on that.Hope it never happen to them and they cut it off. Sad some people careless about the sick and needy. We all still the same in God eyes. Lord help this world in the name of Jesus I pray.

      • I totally agree with your comments. I lost my job due to health problems and I thank God I had Medicaid to see me through my unemployed, homeless time. So, yea, people should not be judgemental ; they may be in this situation theirself someday.

  3. Many of our doctors have opted out of Medicare. We have secondary (Gap) insurance but it does no good because they won’t honor any claims until Medicare
    issues their Summary notice. Only providers can submit Medicare claims,so that leaves many of our medical expenses to be “out of pocket”. Why can’t patients submit claims to Medicare. Even if they are disapproved because the doctor doesn’t participate, at least we would have a chance that the secondary insurance might cover some of the costs.

  4. Sir; do you have information about which company has better price for prescription medication .
    I have United health . Now I have to take Residronate sodium 150 mg and the cost is very high for me.
    Any suggestions. ???

    • Because people vote away their rights and earned entitlements, that’s why. There are millions of low-information voters who believe government is their enemy instead of the guarantor of these rights and who believe the poor and destitute are making this whole country poor. So they vote for politicians who reduce the taxes of the rich and well-placed who pay these politicians off while promising more “good-paying” jobs that never show up. Then when deficits are created, the programs they paid their whole life for through their own taxes keep getting reduced. If you think watching Fox News makes you informed, guess again. All it does is make you angry. That is not the same thing as smart.

      • They make these company and politician stop violating our rights and stop caring about the rich only. Most people vote for politician for what come out their mouth and don’t investigate what they really doing behind closed doors. Money is being uncounted for and nothing is done to the theifs. If we didn’t they would punish us. The people are being neglect in and living in proverty while the very rich down the power or want them to die by taking their insurance. And have them live in unsafe housing that they are getting government funding to keep up and tenant have to suffer senior disable and all. Look at all the up keep and maintenance provision and air heating system and faucets leeks mold and bunch of mess neglected you see it every where on t.v . Now because people getting by with hiding murder.

  5. In a simple format this is good information that the majority of people should be able to understand. Also please send a copy of this to every member of the House and Senate of the United States highlighting the second paragraph. Thanks.

  6. Why is it so difficult to make a change of address? By phone I was told my wait would be an hour. By online I was unable to find where I should enter the change and after a considerable time (perhaps a 1/2 hour) I gave up! Consequently I still have been unable to post the change.

    • Hi Jeannette, we are sorry to hear that you’re having difficulty trying to change your address. If you are receiving Social Security retirement or disability, or have Medicare, you can create a my Social Security account to change your address online. If you have already created an account but are having difficulty accessing it, please call 1-800-772-1213 for assistance. After you hear “Briefly tell me why you are calling,” say “Help Desk” for help with a my Social Security account.
      If you are receiving Supplemental Security Income, you need to contact your local office to update your records.
      If you do not receive Social Security benefits, SSI or Medicare, you do not need to change your address with us. We hope this helps!

    • Thank you for your question. If you are a lawfully admitted permanent resident or a green card holder, not insured for Social Security benefits, age 65 or older, who has continuously resided in the U.S. for 5 years or longer, you may still be able to purchase Medicare Part A & B. Also, if you’re married and if your spouse is at least 62 and insured for Social Security benefits, you could be eligible for Medicare benefits. You can call our toll free number at 1-800-772-1213 for further assistance. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m.

  7. I have been living overseas since 1963. I worked as a Civil Service employee of the US Government in Germany and retired from government service in 1998. I moved to Italy after I retired and I am still living in Italy.

    I understand Medicare is not available outside the USA. In that regard I enrolled in Medicare Part A because no costs are involved. However I would have to pay for Part B if I enrolled. I see no reason to pay for something that I cannot use. On the other hand if I ever returned to the USA and would want to enroll in Part B I would have to pay retroactively for all the years that I was not enrolled even though I live in Europe and could not receive the benefits of Part B. This seems unfair to me and cannot think of any reason why the retroactive payments are required.
    Can you help me understand the logic of this situation?

    • Hi Stanley. Generally, U.S. citizen receiving Social Security retirement benefits and turning 65 while living in a foreign country are initially notified of their eligibility for Medicare, 3 months before the month of their 65th birthday. Automatic enrollment does not apply to people living in foreign countries.
      Medicare Part B is optional. Beneficiaries may refuse the coverage and if they file a written notification before Part B coverage starts, we always consider this a timely refusal. Timely refusals do not incur premium charges.
      The Supplementary Medical Insurance (SMI) premium (Part B) is increased 10 percent for each full 12 months during which an individual could have been, but was not, enrolled in SMI.
      An exception to the increased premium is a beneficiary delays enrollment in Medicare Part B due to continued employment with Group Health coverage. When enrollment is delayed for any other reason, such as living outside the U.S., the Part B premium surcharge will apply when returning to the U.S. and enrolling in Medicare Part B. In addition, the only enrollment period option is the General Enrollment Period (GEP) in the first three months of each year, which coverage beginning in July of the enrollment year. Please contact your local U.S. embassy or consulate for any assistance related to your Social Security benefits. Medicare is an extensive subject, please visit http://www.ssa.gov/medicare/ for more information.

  8. My husband will be 62 yrs old come Aug 2018 he is receiving disability checks once a month as he will never be able to work again
    What does he qualify for as I find it all confusing

  9. How about some information concerning persons that have been on Social Security/Medicare for several years. For instance, COLA information and the premium cost for Part B for the upcoming new year.After all we are only 41 days(+/-) from the new year of 2018. Some of us are not new to SS/MediCare, but just want to be kept in the updated loop. Thank you & Happy Thanksgiving!!

    • Anybody interested in becoming a beneficiary’s representative payee will need to contact their local office for a face-to-face interview. Our representatives in the field office will be able to provide answers to your specific questions. To make an appointment, please call 1-800-772-1213 (TTY 1-800-325-0778). Representatives are available Monday through Friday, between 7 a.m. to 7 p.m. Thanks.

  10. I just started receiving Medicare benefits this year. Do I have to renew my Medicare in January? Will a notice be mailed out to me if I need to renew?

  11. When I signed up for Social Security the agent said I didn’t need part B because I had coverage with my job.
    When I retire is that when I apply for part B?

    • Thank you for your question, Rebecca. If you are still working and covered under a group health plan based on that employment, you may not need to file for Medicare part B until you stop working or drop your health care coverage. You may qualify for a Special Enrollment Period (SEP), which would allow you to sign up for Medicare Part B, if you are now past your Initial Enrollment Period. Usually, you don’t pay a late enrollment penalty if you sign up during a SEP. To learn more about the Medicare enrollment periods and how to enroll, visit http://www.Medicare.gov. We hope this information helps!

  12. At age 63 I filed for disability from my job and received 66and2/3 of my yearly salary but I was forced to file for social security disability and would have that amount subtracted from my pay whether I received it or not.While I was disabled until age 65 I had Part A as my job carried under full coverage for 2 years and I filed the 2 forms SS Admin told me,now instead of 109$ I will pay 134$ deducted from my social security,why should or must I have to file another appeal?

    • For assistance, call our toll free number at 1-800-772-1213. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m. Thanks.

  13. Received Benefit notification stating that I should pay $134 per month for Medicare. According to information I received, this amount is what I would pay IF I was not receiving Social Security. If I was on Medicare and receiving Social Security my payment would be only $109. This is due to a law that prevents Medicare premiums from cutting into Social Security benefits. Last year my payment was $110 per month.
    Could you please explain?

    • Unfortunately, but for security reasons, we do not have access to personal records in this blog. Please call our toll free number at 1-800-772-1213 for assistance. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m. Generally, you will have a shorter wait time if you call later in the week. Thanks.

    • Happy New Year, David! In 2018 the Substantial Gainful Activity limit for SSDI is $1,180 per month (or $1,970 for blind applicants). We count the gross amount of your monthly wages. In addition to the amount of money you make, Social Security may also look at the number of hours you’re able to work. Social Security has Work Incentives for people on disability who want to work. See our publication “Working While Disabled – How We Can Help” and visit our Frequently Asked Questions web page on disability for more information. Please call our toll free number at 1-800-772-1213 and speak to one of our agents for further assistance. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m. Thanks.

  14. I am on Medicaid and just turned 65, I am also collecting Social Security,Soc Sec took 134.00 dollars out of my benefits and I don/t think its fair! Can any one tell me how to rectify that process and decline the Medicare removal of that kind of monthly money? Thanks

  15. Does Medicare or Medicaid make phone calls to citizens? With all the scams going on now, I am reluctant to provide any information to someone claiming to be with Medicare. Especially if the person claiming to work with Medicare has a foreign accent. I usually just hang up om them.

    • Hi Paul. Government employees occasionally contact citizens by telephone for customer-service purposes. We may call you in limited situations, such as if you recently filed a claim or have other business that are pending.
      Please be suspicious of unsolicited phone calls, or email messages. If an unknown individual claims to be from a legitimate organization, try to verify his or her identity directly with the company. Avoid providing personal information unless you are certain of a person’s authority to have the information. Thanks!

  16. How do I sign up for the special enrollment period for Medicare Part B? I still work full time and don’t need the Part B yet.

    • Hi Denna! You may have the chance to sign up for Medicare during a Special Enrollment Period (SEP), if you’re covered under a group health plan based on current employment. You will have an 8-month SEP to sign up for Medicare Part B. The 8-month period begins the month after the employment ends or the month after group health plan insurance based on current employment ends.
      If you need to terminate your Medicare Part B, our policy requires that a personal interview be conducted with a Social Security representative. We will help you submit the required form, or your signed request for termination.
      To make an appointment or to speak with one of our agents for further assistance, call our toll free number at 1-800-772-1213. Representatives are available Monday through Friday, between 7 a.m. and 7 p.m. We hope this helps!

  17. My spouse is a non- US citizen. I have read that at the event that I pass away my spouse will have to pay a 60 percent income tax on her SS benefits. WHY!

    • See our Frequently Asked Questions web page on “Noncitizens“. For tax questions, you will need to contact the IRS. Their toll-free number is 1-800-829-1040. We hope this helps.

  18. Two weeks ago I talked to a Social Security representative asking for a duplicate letter to one sent to me in November with the explanation of my 2018 Medicare billing due. As of February 5 I have not received the letter which she said was mailed. Would you be able to trace that letter?

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