Are Medicaid and Medicare Advantage the Same?
The terms "Medicare" and "Medicaid" often get used incorrectly, even by those who are enrolled in one or both of the programs. We can see why - they start the same way and both "-care" and "-aid" basically mean the same thing. It's no wonder most people can't keep them straight!
Also, individuals who are eligible for Medicaid can also get a special type of Medicare Advantage plan called a Special Needs Plan (SNP). Let's jump into an overview of each program.
Medicaid
The Medicaid program is designed for individuals and families who need financial assistance. It is administered by each state according to the federal guidelines and is funded by both the state and federal governments. Medicaid will provide health insurance and other financial assistance for those who qualify.
There are five main eligibility criteria. Eligibility is based on:
- Categories: children, families, individuals with disabilities, seniors, etc
- Income: different thresholds for each category
- Resources: those with disabilities and seniors with limited income
- Immigration status: available for legal U.S residents only
- Residency: based on the state you reside
The two main groups that Medicaid serves are healthy individuals and families with low incomes and individuals with disabilities or chronic conditions.
The Federal Poverty Level (FPL) is used to determine if an individual will qualify for Medicaid. The FPL is the minimum amount a person or family will need for the necessities: food, clothing, transportation, shelter, etc. The FPL is recalculated each year.
The Medicaid program has many different facets, but for our purposes, just understand that individuals of any age can qualify for Medicaid.
Medicare Advantage Special Needs Plan
To be eligible for Medicare, you must meet certain criteria. Most people "age into" Medicare when they turn 65. You can also be eligible if you are on disability for two years or have been diagnosed with End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease. The Medicare program itself is not designed for those who need financial assistance like the Medicaid program is.
Medicare Advantage is one way that Medicare beneficiaries can get their Medicare benefits. While individuals who are on Medicaid do not have to enroll in an Advantage (Part C) plan, there is one plan designed specifically for individuals who are eligible for both programs: Medicare Advantage Special Needs Plan.
SNPs are designed for certain eligible beneficiaries. They are for people who have chronic conditions like diabetes, ESRD, dementia, chronic heart failure, or HIV/AIDS. They are also for people who live in institutions like nursing homes. Lastly, they are for individuals who are eligible for both Medicare and Medicaid. These plans are called D-SNPs for short. (The "D" stands for "dual-eligible.")
If you qualify for a D-SNP plan, the cost of the monthly premiums will usually be provided by the government. Requirements and regulations are different in each state, so you will need to reach out to your local department to determine if you qualify.
