Medicaid vs. Medicare in Florida: What's the Difference?

Medicaid and Medicare are both well-known health programs in Florida but have distinctive features that set them apart.

Medicare

Medicare is a federal program that provides health coverage for people aged 65 or older and certain younger individuals with disabilities or conditions. It has four parts: Part A (hospital insurance), Part B (outpatient insurance), Part C (Medicare Advantage), and Part D (prescription drug insurance). Most Medicare plans have premiums, deductibles, and/or copayments.

‍To be eligible for Medicare in Florida, you must:

• Be 65 years of age or older.
• Be a legal resident of the U.S. AND
• Be either a U.S. citizen OR a legal alien who has resided in the U.S. for at least five consecutive years.

OR if you are under 65, you may be eligible if you have:

• End-stage renal disease (ESRD)
• ALS (also called Lou Gehrig's disease)
• Certain disabilities

To see eligibility specifics, click here.

‍Medicaid

Medicaid, on the other hand, is a joint federal and state program that provides health coverage for individuals with low income, including some low-income adults, children, pregnant women, elderly adults, and those with disabilities. Medicaid helps cover several services that Medicare doesn't, such as long-term care and specific home and community-based services. Since Medicaid is for individuals with low income, it is usually less expensive than Medicare.

In Florida, to be eligible for Medicaid, you must:

• Be a state resident and a U.S. citizen (or a legal alien).
• Have an income below a certain amount. For instance, the Medicaid limit for an individual's monthly income is $2,829 before taxes (as of 2024). The limit is slightly higher for couples and families with children.
• Have a total asset value below a certain amount ($2,000 for individuals, as of 2024). This limit is also higher for couples and families.

Medicare vs. Medicaid Coverage

Medicare in Florida

Original Medicare, which includes Part A and Part B, provides comprehensive coverage for health care needs.

• Part A pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and home health care.
• Part B covers specific doctor's services, outpatient care, medical supplies, and preventive services.
• Part C provides the same coverage as Parts A and B combined while also providing additional coverage, such as routine dental, hearing, or vision, or other benefits, such as fitness membership discounts.
• Part D provides coverage for prescription drugs.

Medicaid in Florida

Medicaid covers essential healthcare services such as:

• Hospital visits
• Doctor appointments
• Prescription drugs
• Laboratory tests
• Nursing home care
• Long-term care services and support for eligible seniors who need help with daily activities

Can I Have Medicare and Medicaid?

Yes, it is possible to have both Medicare and Medicaid. Individuals eligible for both programs are known as "dual eligibles." These beneficiaries must meet the eligibility requirements for both Medicaid and Medicare. Dual eligibility is very beneficial because dual eligibles can use both programs simultaneously to receive maximum health benefits.

It's important to note that the Medicaid program must pay secondary to Medicare, employer-sponsored insurance, and other sources of health coverage. Since Medicaid is the secondary payer, it can only assist with the remaining out-of-pocket costs after other insurance (such as Medicare) provides coverage.

How to Choose the Best Health Care Coverage for You

When choosing between Medicare and Medicaid, it's vital to consider your circumstances and healthcare needs. However, note that you can only use Medicaid if you have a low income. You will not be eligible if your income exceeds the Medicaid limit.  

Here are a few reasons why someone eligible for both Medicare and Medicaid might choose one program over the other:

Choosing Medicare:

• If you want comprehensive coverage, Medicare covers many health services, including hospital stays, doctor's services, outpatient care, and preventive services. Medicare can be a good fit for those who often require healthcare services.
• If you've had ten years of past employment. You may be eligible for premium-free Part A if you've worked and paid taxes for at least ten years. However, you must still pay your Part B premium, copayments, and deductibles.

Choosing Medicaid:

• If you have low income and assets. If your income falls within a specific range and your total assets do not exceed the limit, Medicaid may be a better choice due to lower cost-sharing on your part.
• If you need coverage for long-term care. Medicaid covers long-term care services and support for eligible seniors who need help with daily activities. If you anticipate needing long-term care, Medicaid may be necessary since Medicare does not cover this.
• If you lack other health coverage. If you don't have employer-sponsored insurance or other health coverage, Medicaid can provide primary or secondary coverage.

Bottom Line

Understanding the differences between Medicaid and Medicare is essential, especially for Florida residents. While both programs offer health coverage, they differ in eligibility criteria, coverage options, and benefits. Eligible individuals can have both Medicare and Medicaid to complement their healthcare needs and ensure comprehensive coverage.