Medicare vs. Medicaid- Both Government sponsored health insurance

  • Medicare’s beneficiaries are primarily age 65 and older or meet other exceptions. Beneficiaries have paid into the Medicare system through payroll taxes over their working life.
  • Medicaid’s beneficiaries are low to moderate income individuals. This program is dependent on income.


  • Part A- Most people receive this “premium free”
  • Part B- $164.90 (2023) per month
    • Could be more based on prior income
  • Part D- Depends on chosen plan
    • Could be more based on prior income


  • Part A- Hospital Deductible: $1,600 (2023) for each benefit period
    • A Benefit period starts the day you are admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you have not received inpatient hospital care or skilled care in SNF for 60 days in a row.
    • If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins.
  • Part B- $226 (2023) per year
  • Part D- Depends on chosen plan


  • Part A:
    • Days 1-60: $0 coinsurance after you pay your Part A Deductible
    • Days 61-90: $400 Per day
    • Days 91 and beyond:
      • $800 for each lifetime reserve day (up to 60 over your lifetime)
      • All costs after you use your lifetime reserve days
    • Part B: 20 % of the Medicare-approved amount after you pay your deductible
    • Part D: Depends on chosen Plan
      • Depending on costs of prescriptions taken, you may be subjected to the Coverage gap pricing, also known as the donut hole

What’s covered? A few examples:

  • Part A:
    • Inpatient hospital care
    • Inpatient skilled nursing care, after qualifying event(s)
  • Part B:
    • Medically necessary doctors’ services
    • Medically necessary Durable Medical Equipment (DME)
    • Many preventative services
  • Part D:
    • Prescribed medication on a list of covered drugs (Formulary)


  • Original Medicare, you can add a supplemental plan and Part D
  • Medicare Advantage (Part C)- some include or you can add on extra coverage such as vision or dental

When to sign up:

  • If you are collecting Social Security, you’ll automatically be enrolled when you turn 65
  • If not, you’ll need to enroll yourself during your Initial Enrollment Period or Special Enrollment Period (SEP).
    • Initial enrollment period- the 7 month period that begins 3 months before and ends 3 months after the month you turn 65
    • Special enrollment period- a period of time that exempts/excuses you from late enrollment penalties because you were covered under a group health plan based on current employment.
      • This is an 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

Important things to know:

  • You can no longer contribute to an HSA once you sign up for Medicare.
    • Could have up to a 6-month look-back, where you are not able to contribute if you sign up after you turn 65.
  • You could have higher premiums based on “Income Related Monthly Adjustment Amount” (IRMAA), calculated annually using your tax return information from 2 years prior
  • If you miss the enrollment period, you could be subjected to a late enrollment penalty, which could be in place for the entire time you have Medicare.