Manor Moments

Medicare and Medicaid- What’s the Difference?

December 2017

Both are health insurance programs with similar names – so it’s not surprising that many people confuse the two.

Medicare is the national health care program for individuals aged 65 or older or who are disabled. Employees pay a Medicare tax during their working years. It is administered by the federal government and includes coverage for:

  • Care received as an inpatient in a hospital or skilled nursing facility (Part A);
  • Doctor visits, outpatient visits and preventive care (Part B);
  • Prescription drugs (Part D)

Note: Medicare Advantage plans (Part C) combine parts of the coverage above into one plan.

You are automatically enrolled in Medicare Parts A and B when you turn 65 (you can do this through the Social Security office.)  Costs for Medicare depend on the coverage you choose, and may include premiums, deductibles and co-pays.

The most common misperception is that Medicare will pay for unlimited care in a skilled nursing facility – which is not correct. Medicare will pay for a limited number of days in a nursing home with approval from a medical provider.

Medicaid (Medical Assistance) is a joint federal and state program that helps to pay medical costs for people with limited income- regardless of age.

Mandatory benefits include:

  • Care and services in a hospital or skilled nursing facility;
  • Care received in a federally-qualified health center or clinic;
  • Physician, nurse and certified health care practitioner services.

Coverage and expenses depend on the state’s guidelines. In Pennsylvania, there is an asset limit for eligibility.

It is important to know the difference between the two programs. There is additional information at the following site and in the “Helpful Information” section of Cornwall Manor’s website.

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