Medicare and Medicaid

Medicare and Medicaid are two government-sponsored programs that provide access to healthcare. While their names are similar, the two programs are very different.

What is Medicare?

Medicare is a federal program that provides health insurance for people over the age of 65 (as well as individuals with certain disabilities under age 65). Original Medicare is comprised of Medicare Part A and Part B. Part A pays for inpatient hospital services while Part B pays for outpatient medical services.  Beyond that, individuals can also access Medicare Advantage Plans (Part C) through private insurance companies. Part D provides prescription drug coverage.

What is Medicaid?

Medicaid is a program that is managed by individuals states that provides health insurance and services to individuals with lower-incomes and individuals who meet other eligibility criteria. Colorado has a wide variety of Medicaid programs depending on an individual’s needs.

How do Medicare and Medicaid Work Together?

When a person qualifies for both Medicare and Medicaid, they are known as dually eligible. In this situation, Medicare is the primary payor source which means that Medicare pays first. Medicaid then picks up the balance.

What about long-term care?

Long-term care (LTC) comprises the spectrum of care options available including in-home care, home health, rehab, and skilled nursing. Medicare pays for qualified inpatient rehabilitation stays but does not pay for LTC. In addition, Medicare pays for qualified home health services but does not pay for in-home personal care services. Luckily, Colorado has a robust LTC Medicaid program. Under the LTC Medicaid program, individuals can receive care through Home- and Community-Based Services (HCBS), Assisted Living and/or Skilled Nursing.

Medicare and Medicaid at Eaton

Eaton is passionate about empowering residents to age-in-place in independent living. Many of our Wellness Providers work with both Medicare and Medicaid. Furthermore, Eaton’s Service Coordinator can help you navigate these benefits programs to find the right one for you. Many Eaton residents are dually eligible and access in-home care services through Medicaid’s LTC program. Medicare and Medicaid are two important components to support individuals as they age in community.

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