It can be hard to keep things straight when we’re not feeling our best, so let’s break down Medicare and Medicaid—two vital programs that often cause confusion. Understanding the difference could save you time and money and help you make informed healthcare decisions.
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Medicare: What Is It?
Medicare is a federally funded health insurance program serving:
- Adults 65+
- Certain younger individuals with disabilities
- Patients with end-stage renal disease (dialysis)
- Those with ALS
Key Medicare Facts:
- When to Enroll: Sign up 3 months before or after turning 65 to avoid penalties.
- Costs: Includes deductibles, premiums, and out-of-pocket expenses.
- Supplemental Insurance: Helps cover costs Medicare doesn’t.
- How to Sign Up: Call 1-800-MEDICARE or visit Medicare.gov.
What Medicare Covers:
- Durable medical equipment (wheelchairs, walkers, canes)
- Temporary nursing home stays
- Hospice care (if provided by a Medicare-contracted provider)
- Home health services
What Medicare Does NOT Cover:
- Long-term care (assisted living, memory care, or home care services)
- Hearing aids & tests (some Medicare Advantage plans may cover them)
- Medical expenses outside the U.S. (except some Advantage plans)
Medicaid: What Is It?
Medicaid is a state-funded program under federal guidelines to assist low-income individuals of all ages. Eligibility and coverage vary by state.
Key Medicaid Facts:
- Who Qualifies? Based on income and disability status.
- How to Apply? Contact your local county agency.
Medicaid Covers More Than Medicare, Including:
- Long-term care services (assisted living, memory care, nursing homes if contracted)
- Personal care and in-home services
- Hospice care
- Medical transportation & ambulance services (when using a Medicaid-contracted provider)
FAQs: Can You Have Both Medicare and Medicaid?
Yes! Those eligible for both are known as “dual eligible”, which may help reduce out-of-pocket costs.
What Do the Different Parts of Medicare Cover?
A = Hospital, home health, hospice care
B = Medical coverage, outpatient therapy
C = Medicare Advantage (may cover vision & dental)
D = Prescription drug coverage
Is Medicare or Medicaid Accepted at Edgewood?
Medicaid is accepted at some Edgewood locations—contact us to confirm eligibility.
Medicare does not cover residential long-term care. However, outpatient therapy and home healthcare (offered in some Edgewood communities through CaringEdge) may be covered.
How Do You Get Coverage for Vision, Dental, or International Medical Care?
Medicare Advantage Plans may cover these services, but coverage varies—always check details before enrolling.
Does Medicaid Work Outside the U.S.?
No. Medicaid benefits do not transfer between states either, so if you move, you must reapply in your new state.
Do You Have to Reapply for Medicare and Medicaid Annually?
Medicare: No, but Advantage Plans (Part C) & Part D prescription coverage may change yearly.
Medicaid: YES. You must reapply annually and continue to meet eligibility requirements.
What If You Work Past Age 65?
Medicare becomes your primary insurance if your employer has fewer than 20 employees. Call Medicare for personalized advice.
Helpful Resources
Medicare.gov – Official Medicare site
Edgewood Cost Calculator – Estimate senior living costs
Still Have Questions?
Contact us at info@Edgewoodhealthcare.com to discuss how your insurance may help cover senior living or therapy services.
Final Thoughts:
Understanding Medicare vs. Medicaid can help you make smarter healthcare decisions and potentially save money. Knowing your coverage options is the first step if you or a loved one need senior living or home healthcare services.
Have a specific question? Drop us a message atinfo@Edgewoodhealthcare.com.
