Medicare and Medicaid: What You Need to Know

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1. The Differences Between Medicare and Medicaid, and Which One You Qualify for While on SSD or SSI Benefits

REVIEWED BY

C. William Kenny

November 11, 2024

Board certified by National Board of Trial Advocacy

The Differences Between Medicare and Medicaid, and Which One You Qualify for While on SSD or SSI Benefits

When you receive Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits, healthcare becomes a crucial concern. Fortunately, there are two major government programs designed to help individuals with disabilities manage their medical expenses: Medicare and Medicaid. However, understanding the differences between these two programs and determining which one you qualify for can be confusing. In this blog post, we will break down the key differences between Medicare and Medicaid and explain which program you may qualify for while receiving SSD or SSI benefits.

What is Medicare?

Medicare is a federal health insurance program primarily for individuals aged sixty-five and older. However, it also extends coverage to certain younger individuals with disabilities. If you have received SSD benefits for at least 24 months, you automatically become eligible for Medicare, regardless of your age. Medicare is divided into four parts:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health care.
• Part B (Medical Insurance): Covers outpatient care, doctor’s services and some preventive services.
• Part C (Medicare Advantage): A private insurance plan that combines the coverage of Part A and Part B, often including additional benefits like prescription drug coverage and dental services.
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.

While Medicare offers substantial medical coverage, it is important to note that it does not cover all healthcare expenses, such as long-term care or most dental and vision services. You may need supplemental insurance or a Medicare Advantage plan to help cover the gaps.

What is Medicaid?

Medicaid, on the other hand, is a joint federal and state program that provides health coverage to low-income individuals, including those with disabilities. Medicaid is designed to assist individuals who cannot afford the costs of healthcare, offering a broader range of services compared to Medicare, including long-term care, personal care services and some other health-related services that Medicare does not cover.

Eligibility for Medicaid is based on income and other factors, such as household size and state-specific requirements. Because Medicaid is administered by states, the exact qualifications, benefits and services vary from state to state.

Key Differences Between Medicare and Medicaid

• Eligibility Criteria:

• Medicare is available to individuals with disabilities who have been receiving SSD benefits for 24 months or more, or those sixty-five and older.
• Medicaid is available to low-income individuals, including those with disabilities, regardless of whether they qualify for SSD or SSI, though income and asset limits play a significant role in eligibility.

• Coverage:
  • Medicare provides coverage for hospital stays, outpatient care and prescription drugs, but does not cover long-term care or other certain services.
  • Medicaid offers a wider range of services, including long-term care, home healthcare and other services not covered by Medicare.
• Costs:
  • Medicare involves monthly premiums (for Part B and D), as well as deductibles and co-pays for some services.
  • Medicaid often has little to no cost for eligible individuals, with some states offering low-cost or no-cost premiums, co-pays and deductibles.

Which Program Do You Qualify for While on SSD or SSI?

If you are receiving SSD benefits, you will automatically qualify for Medicare after 24 months of eligibility. However, if your income is low enough, you may also qualify for Medicaid, depending on your state’s income limits.

If you are receiving SSI benefits, you are more likely to qualify for Medicaid because SSI is a needs-based program. Medicaid eligibility for SSI recipients is generally easier to obtain due to their low income and assets. However, in some cases, individuals on SSI might also qualify for Medicare if they meet specific requirements related to disability and their medical needs.

Both Medicare and Medicaid provide critical health coverage for individuals with disabilities, but the programs serve different purposes and have distinct eligibility requirements. If you are receiving SSD or SSI benefits, you will likely qualify for one or both of these programs, depending on your situation. To ensure you are getting the coverage you need, it is important to review the eligibility criteria for both Medicare and Medicaid and, if necessary, seek assistance from the Social Security Administration.