Medicaid & Medicare Guide

Learn how to access free or low-cost health insurance through Medicaid and Medicare programs

90 Million

Americans on Medicaid

65 Million

Americans on Medicare

$0-$0

Monthly Premiums Available

Medicaid vs Medicare: What's the Difference?

Medicaid

👥 Who: Low-income individuals and families

💲 Cost: Usually FREE or very low cost

🏛️ Run by: State governments

🏠 Age: Any age (income-based)

Medicare

👤 Who: People 65+ or with disabilities

💲 Cost: Premiums vary by plan

🏛️ Run by: Federal government

🏠 Age: 65+ or qualifying disability

Medicaid: Free Health Insurance

Medicaid provides free or low-cost health coverage to millions of Americans, including families, children, pregnant women, seniors, and people with disabilities. It's funded jointly by the federal government and states.

Medicaid Eligibility (2024)

Income Limits (138% of Federal Poverty Level)

1 Person: $1,732/month ($20,783/year)

2 People: $2,343/month ($28,120/year)

3 People: $2,954/month ($35,456/year)

4 People: $3,565/month ($42,792/year)

Who Qualifies Automatically

Children under 19

Pregnant women

People with disabilities

Parents/caretakers

✅ What Medicaid Covers:

Doctor visits and checkups
Hospital stays
Prescription drugs
Dental care (varies by state)
Vision care
Emergency services
Mental health services
Pregnancy and childbirth

How to Apply for Medicaid

Online Application

Visit your state's Medicaid website or Healthcare.gov

Phone Application

Call your state's Medicaid office

In-Person

Visit your local benefits office

Medicare: Health Insurance for Seniors

Medicare is federal health insurance for people 65 and older, and for younger people with certain disabilities or conditions. It has different parts that cover different services.

Part A

Hospital Insurance

• Hospital stays
• Skilled nursing
• Hospice care
• Home health care

Usually FREE

Part B

Medical Insurance

• Doctor visits
• Outpatient care
• Medical equipment
• Preventive services

$174.70/month

Part C

Medicare Advantage

• All Part A & B
• Often includes Part D
• May include extras
• Private insurance

Varies

Part D

Drug Coverage

• Prescription drugs
• Private plans
• Formularies vary
• Extra Help available

$0-$50+/month

Medicare Eligibility

Automatic Enrollment

🏛️ Age 65+ - You'll be automatically enrolled if you receive Social Security

♿ Disability - After 24 months of disability benefits

ESRD - End-stage renal disease (any age)

🏠 ALS - Amyotrophic lateral sclerosis (any age)

Enrollment Periods

Initial Enrollment: 3 months before to 3 months after 65th birthday

General Enrollment: January 1 - March 31 (coverage starts July 1)

Special Enrollment: If you have employer coverage

Open Enrollment: October 15 - December 7 (for Part C & D)

Medicare Cost Calculator

Typical Monthly Costs

Part A Premium:

If you worked 10+ years

Part B Premium:

Standard premium (2024)

$174.70

Part D Premium:

Varies by plan

$0-$50+

Medigap:

Optional supplemental

$50-$300+

Ways to Save Money

Extra Help (LIS)

Low-income subsidy helps pay Part D premiums and drug costs

Medicaid Dual Eligibility

If you qualify for both, Medicaid may pay your Medicare costs

Compare Plans

Use Medicare Plan Finder to find the cheapest options

Pro Tips to Maximize Your Benefits

Don't Miss Enrollment Deadlines

Missing Medicare enrollment can result in permanent penalties and gaps in coverage.

Use Free Resources

SHIP counselors provide free Medicare counseling. Call 1-800-MEDICARE for help.

Compare Plans Annually

Plans change yearly. Review your coverage during Open Enrollment (Oct 15 - Dec 7).

Review Drug Formularies

Make sure your medications are covered before choosing a Part D plan.

Keep Medical Records

Maintain detailed records of all medical expenses for tax deductions and appeals.

Preventive Care is Free

Annual wellness visits, screenings, and vaccines are covered at no cost.

Common Mistakes to Avoid

Missing Initial Enrollment

Delaying Medicare enrollment can result in permanent late enrollment penalties.

Assuming Medicaid Covers Everything

Medicaid benefits vary by state. Check what's covered in your state.

Not Understanding Medigap Timing

You have only 6 months after Part B starts to get guaranteed Medigap coverage.

Not Reporting Income Changes

Changes in income can affect your Medicaid eligibility and Medicare costs.

Get Help and Apply

Medicaid Resources

Healthcare.gov:

www.healthcare.gov

Medicaid Hotline:

1-800-318-2596

Find Local Office:

www.medicaid.gov/state-resources

Medicare Resources

Medicare.gov:

www.medicare.gov

Medicare Hotline:

1-800-MEDICARE (1-800-633-4227)

SHIP Counselors: