Confusion still exists about the differences between Medicare and Medicaid. So to straighten it all out, keep reading…
Medicare
* Medicare is federally funded.
* Eligibility: Available to individuals 65 and older, or younger if receiving Social Security disability benefits.
* Part A is free but Part B and D can have premiums
* Coverage: Does not cover all costs. But most people purchase supplemental insurance, a prescription drug plan, or a Medicare Advantage plan.
* Medicare covers short-term physical therapy, occupational therapy, and skilled nursing care in the home after an acute medical episode.
Medicare Basics for 2025
(1) Medicare Part A is the hospital insurance, which covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services. The deductible is $1,600 per benefit period.
(2) Medicare Part B is the general medical insurance), covering outpatient services, doctor visits, preventive care, and durable medical equipment.
The monthly premium for most people is $185 (higher income people pay more).
The annual deductible is $257
(3) Medicare Part D is the prescription drug Coverage, which covers prescription medications.
Premiums vary by plan and may include income-based adjustments.
(4) Medicare Advantage, known as Part C, is managed by private insurance plans that combine Parts A, B, and often D.
Extra benefits like dental, vision, and wellness programs may be offered by these plans.
(5) Medicare Supplement, known as Medigap are secondary insurance policies that help cover Medicare co-pays, deductibles, and coinsurance.
Premiums can average around $350 per month, in addition to the monthly Medicare premium.
Medicaid
* Medicaid is state-funded with federal assistance.
* Eligibility: Available under 65 through the NY State of Health website (if otherwise uninsured) cost depends on income, but assets are not looked at.
For those over the age of 65, Medicaid eligibility is asset- and income-based for those who already have Medicare.
* Coverage provides long-term personal care services (currently, there is no lookback for in-home care) and nursing home care (a five-year lookback applies).
* Covers long-term home care and nursing home care needs not covered by Medicare or other insurance.
Medicaid Basics for 2025
If you have Medicare and other coverage, those remain your primary insurance. Medicaid steps in for long-term care services that aren’t covered by Medicare or other plans.
(1) Eligibility Requirements
Medicaid has asset limits of $32,396 for single individuals and $43,312 for couples. It also has monthly income limits: $1,820 for single individuals and $2,453 for couples.
(2) Eligibility Strategies
With proper guidance, most people can quickly establish Medicaid eligibility for long-term care at home.
For nursing home care, even individuals with assets can protect a portion of them using approved planning strategies.
So those are the nuts and bolts of Medicare and Medicaid and how they may work together. It can feel complicated but there are professionals out there who can help!
Colin Sandler, LCSW, CCM, is owner of Medicaid Solutions, 2127 Crompond Road, Cortlandt Manor, NY. She has been providing advice on aging to seniors and their families for over 20 years. Email her at Colin@Medicaidsolutions.com or call 914-924-2566
Latest posts by Colin Sandler
(see all)
24 May 2025
0 Commentsmedicare vs. medicaid
Confusion still exists about the differences between Medicare and Medicaid. So to straighten it all out, keep reading…
Medicare
* Medicare is federally funded.
* Eligibility: Available to individuals 65 and older, or younger if receiving Social Security disability benefits.
* Part A is free but Part B and D can have premiums
* Coverage: Does not cover all costs. But most people purchase supplemental insurance, a prescription drug plan, or a Medicare Advantage plan.
* Medicare covers short-term physical therapy, occupational therapy, and skilled nursing care in the home after an acute medical episode.
Medicare Basics for 2025
(1) Medicare Part A is the hospital insurance, which covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services. The deductible is $1,600 per benefit period.
(2) Medicare Part B is the general medical insurance), covering outpatient services, doctor visits, preventive care, and durable medical equipment.
The monthly premium for most people is $185 (higher income people pay more).
The annual deductible is $257
(3) Medicare Part D is the prescription drug Coverage, which covers prescription medications.
Premiums vary by plan and may include income-based adjustments.
(4) Medicare Advantage, known as Part C, is managed by private insurance plans that combine Parts A, B, and often D.
Extra benefits like dental, vision, and wellness programs may be offered by these plans.
(5) Medicare Supplement, known as Medigap are secondary insurance policies that help cover Medicare co-pays, deductibles, and coinsurance.
Premiums can average around $350 per month, in addition to the monthly Medicare premium.
Medicaid
* Medicaid is state-funded with federal assistance.
* Eligibility: Available under 65 through the NY State of Health website (if otherwise uninsured) cost depends on income, but assets are not looked at.
For those over the age of 65, Medicaid eligibility is asset- and income-based for those who already have Medicare.
* Coverage provides long-term personal care services (currently, there is no lookback for in-home care) and nursing home care (a five-year lookback applies).
* Covers long-term home care and nursing home care needs not covered by Medicare or other insurance.
Medicaid Basics for 2025
If you have Medicare and other coverage, those remain your primary insurance. Medicaid steps in for long-term care services that aren’t covered by Medicare or other plans.
(1) Eligibility Requirements
Medicaid has asset limits of $32,396 for single individuals and $43,312 for couples. It also has monthly income limits: $1,820 for single individuals and $2,453 for couples.
(2) Eligibility Strategies
With proper guidance, most people can quickly establish Medicaid eligibility for long-term care at home.
For nursing home care, even individuals with assets can protect a portion of them using approved planning strategies.
So those are the nuts and bolts of Medicare and Medicaid and how they may work together. It can feel complicated but there are professionals out there who can help!