Difference Between Medicare and Medicaid

By Bob Bailey, Information Specialist for the Council on Aging of Central Oregon

I am often asked about the difference between Medicaid and Medicare, as many people are uncertain about which program they or a family member have. It is important for older adults and their loved ones to be aware of both, and to understand which program provides their medical coverage. In some cases, it might be a combination. Medicare and Medicaid can be complex and confusing, but knowing the distinction can go a long way toward helping individuals and their support team determine the best course of action. When individuals have coverage information readily available, I am better able to recommend the most appropriate resources and services in my role as an Information Specialist for the Council on Aging’s Information and Referral program.  

Difference Between Medicare and Medicaid

Here are some of the basic differences between Medicaid and Medicare:

Medicaid – This program, also called the Oregon Health Plan (OHP), is jointly funded by the State of Oregon and the Federal Government for low-income individuals. Medicaid is administered by the Oregon Health Authority (OHA). There are several different programs within Oregon Medicaid for low-income residents who are 65 and older. Medicaid provides medical coverage and could also include in-home care, skilled nursing, assisted living, or adult foster care. In general, qualifications are based on “income” and “assets.” To determine if you or a loved one are eligible for Medicaid, or for other questions, please contact your local Department of Human Services office. In Central Oregon, you can call the Department of Human Services Aging and People with Disabilities (APD) at (541) 388-6282.

Medicare – This program is the federal health insurance program for people who are  65 or older. Individuals need to start researching options prior to turning age 65 to avoid penalties for late enrollment. In certain situations, people under the age of 65 may qualify for Medicare, if they are on Social Security Disability (SSD) or have permanent kidney failure.

Medicare Part A, B, C, and D

For those turning 65, Medicare starts with Part A to cover care in a hospital setting and a nursing facility following a hospital stay. Part A is free for most people.

Part B helps pay for doctor services and several outpatient medical services. It requires a monthly premium and annual deductible.

Part C, referred to as Medicare Advantage, involves receiving benefits through a private insurance company. These plans combine all of the Part A and Part B benefits into a single package  with a premium and co-pays.

Part D provides for prescription drug coverage, and can be in conjunction with a Medicare Advantage plan or as a stand-alone plan with Part A and Part B. Part D could include a premium as well as co-pays and deductibles.

If you qualify for Medicare, find out which coverage option is best for you. 

Do you need guidance in understanding your Medicare options?

Our Senior Health Insurance Benefits Assistance (SHIBA) provides free local informational counseling and assistance to guide individuals through Medicare options. Free help is available for anyone ready to sign up for Medicare for the first time, or for those already on Medicare, and informational counseling sessions can include caregivers and advocates. Certified counselors will help Medicare enrollees and recipients make informed decisions about health insurance.

Medicare Annual Open Enrollment Period for 2019
October 15th – December 7th

To schedule a SHIBA appointment in Central Oregon call (541) 678-5483, Ext. 211. Appointments are available in both English and Spanish. Callers will be asked to leave a message, which will be returned by a certified SHIBA counselor, usually by the end of the next business day. 

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