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Medicare and Medicaid

Medicare and Medicaid are both government-provided healthcare programs. The main difference between the two is that Medicaid is meant for those in poverty, while Medicare isn’t. Generally disabled individuals who are receiving Supplemental Security Income (SSI) receive Medicaid benefits as their income is so low. When a person receiving SSI also receives Medicaid benefits, it is termed “categorical” eligibility.

It is not possible to apply for Medicaid directly. Individuals must show evidence that they have applied or that they are already receiving SSI benefits. Although Medicaid does pay for prescriptions, it can be difficult to find a doctor willing to treat Medicaid patients because Medicaid pays such low rates.  Medicaid can also be retroactive, going back as far as three months prior to the enrollment date.

Medicare is not based on income. An individual automatically qualifies if they have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child Benefits for at least 24 months.

It is much easier to find a doctor who will treat a Medicare patient as Medicare pays a higher rate than Medicaid. However, Medicare generally does not pay for prescriptions and a person cannot receive Medicare benefits until they have been receiving Social Security disability benefits for at least two years.

It should be noted that while Medicaid is reserved for those receiving SSI and Medicare is only for those who have received Social Security benefits for two years, it is possible to receive both Medicare and Medicaid benefits if the individual is eligible for both SSI and any other type of Social Security benefit.


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