Medicare? Medicaid?

The past few weeks have been filled almost completely with work on JABA’s new Resource Guide, “Generations”. Along with information on just about ever service for those of us over 65 available here in Central Virginia we wanted to include some articles explaining some of the more confusing aspects of aging. One of the biggies is the difference between Medicare and Medicaid.  A lot of people confuse the two. 

While working on this piece I discovered some misconceptions of my own on the subject, which is why I asked the head of our Virginia Insurance Counseling and Assistance Program (VICAP,) Phyllis Payne, to help explain the two. Here’s her guest post:


Medicare and Medicaid are two government programs that sound very much alike but serve very different purposes.  Medicare is primarily a health insurance program while Medicaid is primarily a financial assistance program.

 Medicare covers beneficiaries who are age 65 or older, or who are younger than 65 and have been receiving social security disability for at least 2 years.  Coverage is provided to eligible individuals regardless of income or resources.

There are four major parts to Medicare.  These are parts A,B,C and D.  Part A is hospitalization insurance.  It covers beneficiaries when they are hospitalized.

Part A is generally provided at no cost.  Part B is medical insurance.  It covers doctors visits, diagnostic tests, x-ray and laboratory tests, outpatient services and durable medical equipment (such as oxygen and wheelchairs). For most covered individuals in 2012, Part B will cost $99.90 a month and will automatically be deducted from social security.  Parts A and B together are known as Original Medicare.  Eligible individuals can sign up for Parts A and B through Social Security.  Part D is Medicare’s prescription drug program.  Part C is also known as Medicare Advantage Plans.  These plans replace Original Medicare by combining Parts A, B and usually D into a single privately insured plan.   Costs for Part C and D vary by plan. All Medicare benefits are also subject to deductibles, co-insurance and/or copays.

Medicaid is a program that provides financial assistance to eligible participants. Eligibility is based on income and resources.  Benefits are available to individuals of all ages.  Medicaid may provide medical assistance to eligible individuals who are not eligible for Medicare. It may also assist Medicare eligible beneficiaries with their premiums, deductibles and copays under Medicare. Medicaid may also provide other benefits such as transportation and Long Term Care.

Whether it is Medicare or Medicaid that you need, the VICAP office at JABA can help. Call (434) 817-5222 and ask to speak with an Insurance Counselor.

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2 Responses to Medicare? Medicaid?

  1. Paula says:

    I’ve read somewhere that Medicare and MediGap goes together, what medicare doesn’t cover, MediGap can cover. Is it also like this with this Medicaid?

    • jabacares says:

      Thanks for the question. I passed this to our VICAP (Virginia Insurance Counseling & Assistance Program)people and here’s there explanation. Hope it helps!

      Medicare and Medigap do go together and depending on which Medigap, they cover most or all medical costs—but not prescription drug costs. Medicare beneficiaries pay a $99.90/month premium and Medigap policies have monthly premiums between $100 and $200 depending on the consumer’s age. Medicare is available for individuals over 65 and the long term disabled. Medicaid is coverage for extremely low income elderly, disabled and children. There is no monthly premium and Medicaid covers prescription and over the counter medications as well as medical costs. Both Medicare and Medicaid have lists of services they consider allowable and not allowable and not all physicians participate in either Medicare or Medicaid.

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