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Medicare vs Medicaid: What's the Difference? 

Have you asked yourself, “Am I on Medicaid or Medicare?” In discussions of government healthcare, these two words always come up and can even sometimes be mistaken for each other. In discussing Medicare vs Medicaid, the distinct difference between the two programs is how to qualify: Medicare is for individuals age 65 and older or on Social Security Disability, while Medicaid is entirely income and asset based. There is no competition between the two; they serve completely different groups of people however you can have Medicare and Medicaid if you meet the qualifications for both!

Who Qualifies for Medicare? 

For most American citizens, Medicare is the health insurance from the government after reaching the age of 65. To qualify for Medicare in the state of New Jersey, you need to be a naturalized American citizen or permanent legal resident for at least five years and: 

  • Aged 65 years or older, or;
  • You're under age 65, but have been receiving disability benefits from Social Security for at least two years, or;
  • You're under age 65, but you have end-stage renal disease, or;
  • You're under age 65, but you have Lou Gehrig's disease.

Who Qualifies for Medicaid? 

Medicaid is entirely income and asset based. In the state of New Jersey, you must meet a list of criteria in order to be eligible for subsidized healthcare, including: 

  • You must be a New Jersey resident, US citizen, or permanent legal resident for at least five years.
  • You must meet a certain low-income level to justify assistance. 

Children age 18 and younger may be eligible for NJ FamilyCare/Medicaid if their family's total income before taxes is at or below 350% of the Federal Poverty Level. For example, in a family of four, that would be $6,723 per month.

Parents may also be eligible if earned income is at or below 133% of the Federal Poverty Level ($2,555 monthly for a family of four). 

This chart illustrated the income qualifications for the various Medicaid programs 2020 Income Qualification chart

You can find help applying for Medicaid in your county at this website. Apply for NJ Family Care in your county.

What’s covered with Medicare vs Medicaid?

Medicare has multiple parts which cove doctor, hospital, and prescriptions.  Medicare does not pay for all bills associated with medical care, an example is that Medicare pays for only 80% of doctor bills.

Medicaid coves most healthcare related services including things that Medicare doesn’t pay for such as dental and vision.  The state of New Jersey runs its Medicaid program through NJ Family Care which contracts with five HMO programs, WellCare, UnitedHealthcare, Aetna, Horizon BCBS, and AmeriGroup.  The HMO plans have a network of doctors and hospitals that it contracts with and anyone enrolled in that plan must see doctors that accept the insurance.   

Medicare vs Medicaid: When Do Medicare and Medicaid Intersect? 

When comparing Medicare vs Medicaid, these differences tend to keep the two programs separate. However, sometimes you might be receiving both. For instance, you might age into Medicare but find that you still require financial assistance to be able to afford the healthcare you need. There are types of Medicaid plans for Medicare recipients in every state, but there are a few programs that are available in New Jersey, such as:

To discuss these plans or other low-income assistance programs for Medicare recipients in your area, contact an agent with New Jersey Medicare Brokers. They are available to provide unbiased information on plans that are available to you.

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