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What Is The Difference Between Medicare, Medicare Advantage, Medicaid And Medicaid Waiver?

Medicare, Medicare Advantage, Medicaid and Medicaid Waiver programs are distinct in the coverage and care they can provide you. They can also provide you with a healthy dose of confusion! Let’s take a look at these health insurance programs for better understanding.

What are Medicare and Medicare Advantage? 

Medicare can be administered in 2 different ways–Original Medicare (or just “Medicare”) and Medicare Advantage.

MedicareMedicare Advantage
Medicare is a federal major medical health insurance policy available in the United States and is government-run. It is available for individuals who are 65 and older, some individuals who are disabled, and for individuals diagnosed with End State Renal Disease (ESRD). Private health insurance companies sell Medicare Advantage plans and the federal government regulates them. Companies like AARP, Clover Health, Aetna, and Blue Cross sell Medicare Advantage plans. The plans are required to cover at least the same level of benefits that Medicare covers and usually offer additional coverage for routine vision, dental, hearing, and prescription drugs. Consumers pay these companies directly for their insurance and all claims are processed and paid through them.

Medicare plans and Medicare Advantage plans have three parts:

  • Part A – Hospital
  • Part B – Outpatient/Medical Coverage
  • Part D – Prescription Drug
  • Where’s Part C?
    Technically, a Medicare Advantage Plan is considered Part C, even though a Medicare Advantage plan still has offerings for Parts A, B, And D. You can learn more about Part C here.

How Much Do Medicare and Medicare Advantage Plans Cost?

  • For Part A, most individuals do not pay a premium for Medicare. The Medicare program is primarily funded by taxpayer dollars. 
  • For Part B, all individuals pay a premium, and the amount depends on the amount of coverage you have. 
  • For Part D, all individuals pay a premium, and the amount depends on the amount of coverage you have.

Original Medicare typically covers 80% of expenses, which is why many individuals choose to also purchase a Medigap policy which can help cover the other 20%. 

Premiums for Medicare Advantage plans vary by company. To compare Medicare and Medicare Advantage plans, use this helpful online Plan Finder tool

Which One is Better–Medicare or Medicare Advantage?

This is a personal decision. Many Medicare Advantage plans have “add-on” items that may be appealing to you. For instance, in-home care benefits, handyman services or dental and vision are examples of services you may be interested in. Depending on your area, there may be Medicare Advantage plans that are also more cost-effective for you. 

Medicaid

Medicaid is a federally created, state-run, and joint-funded (federal and state) major medical health insurance policy that provides coverage to children and adults who are eligible. Medicaid is the single largest source of health coverage in the United States.

Who is Eligible for Medicaid?

There are non-financial and financial factors to eligibility. Non-financial factors include being a resident of the state from which you are getting coverage and being a US citizen or of a specific US legal status. Financial eligibility looks at Modified Adjusted Gross Income (MAGI).

Additional covered groups are state-dependent. 

Medicaid Waiver

Many individuals confuse Medicaid Waiver programs with Medicaid. In reality, most Medicaid Waiver programs have very distinct eligibility requirements and provide specific services. Medicaid Waiver programs are not major medical insurance. 

For older adults, understanding this difference is absolutely crucial. An older adult may have Medicare and still be eligible for a Home and Community-Based Care program to assist in paying for home care. 

In Delaware, there are four Medicaid Waiver programs: 

  1. Elderly and Disabled
  2. Assisted Living
  3. AIDS/HIV
  4. Developmental Disabilities

Each of these programs is a Home and Community-Based Service (HCBS) waiver program providing different services to different groups of individuals. 

Each of the 4 programs have their own non-financial and financial factors for eligibility. Financial eligibility is different from Medicaid eligibility. 

Two corporate companies administer home care under the Elderly and Disabled Home and Community-Based Care waiver–Amerihealth and Highmark. Silver Lining Home Healthcare participates with both companies to offer the best of home care to these clients, with these clients paying no fees when authorized care is implemented. Visit Home & Community Based Services Authorities to learn more.

Visit our website, particularly the Resources Page, for more information on services we offer, our Level of Need calculator, and ways to pay for home care!

Additional Resources: 

What’s Medicare?
What is Medicare Part C?
Medicaid: Policy and Program Topics
Home & Community Based Services Authorities

Here’s to life to the fullest,
Tiffany Rubin, Founder/CEO

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Call: 302.724.7902
Email: jackie@silverlininghealthcare.com
Recruitment Email: recruitment@silverlininghealthcare.com
Address: 24 Hiawatha Lane
Dover DE 19904