Medicare & Medicaid

Difference Between Medicare & Medicaid

Understanding what insurance coverage you have for the care that you need is very important. Medicare and Medicaid are often confused.

Medicare = care for elders over 65 and people who are disabled.
Medicaid = aid for people with low income and limited assets.

Medicare

Medicare is a short-term medical coverage insurance for people over the age of 65 or disabled. Medicare focuses on short-term, acute care for conditions that are expected to improve. Medicare does not cover long-term care.

Qualifying for Medicare

There are several different ways to qualify for coverage. In general, to qualify you:

Are over age 65
Have End Stage Renal Disease
Are disabled

Check the Medicare website for more details on how to qualify. The Centers for Medicare and Medicaid Services (CMS) website also offers information on qualifying for Medicare.

Medicare Coverage Plans

Medicare Part A

Medicare Part A is usually free for those who have been employed or whose spouse was employed. Medicare Part A is often referred to as hospital coverage. It covers inpatient hospital stays, skilled nursing facilities, skilled home health care, and hospice.

Medicare Part B

Medicare Part B is not free. It helps cover certain doctors’ services, outpatient care, medical supplies, and preventive services. It may also provide additional coverage for physical and occupational therapy and some home health care if a doctor certifies that the services are medically necessary. You can drop Medicare Part B at any time; however, you can only enroll during specified enrollment periods.

Medicare Part C

Medicare Part C, also known as Medicare Advantage Plans, is administered through a private health insurance company that has a contract with Medicare.

Medicare Part D

Medicare Part D is prescription drug coverage.

Additional Medicare Information

Medicaid

Medicaid is a federal and state-funded health insurance program that pays for medical and health-related services for people with a low income and very few assets. This includes inpatient and outpatient hospital care, preventive services, durable medical equipment, and many other services and benefits.

If you qualify, Medicaid will help pay for:

The cost of Medicare premiums
Home and community-based services such as adult day care or home care
Long-term residential care such as assisted living facilities or nursing homes

Qualifying for Medicaid Long Term Services and Supports

You must be a resident of Rhode Island to submit an application for Rhode Island Medicaid. The Medicaid program looks back 5 years to see where your money went. Medicaid can identify assets, such as property, that you own in another state.

Documents to Gather

Gather the following documents, if available:

Photo ID
Social Security Card
Medicare Card
Health coverage card and proof of monthly premium and amount paid
Verification of all monthly income
6 months verification of all bank accounts, including checking, savings, CDs, annuities, stocks, bonds, and trusts
Insurance policies indicating the cash value
Prepaid burial information, including name of mortuary, location of burial plot, and deed
Copies of power of attorney, guardianships, and conservatorships
Lease or property taxes if living in the community or owning a home
Car, motorcycle, boat, and RV registrations
Proof of any other property, income, or assets
Receipts for services, medical equipment, or home modifications that allowed you to stay home longer, if available
All documents and receipts for any money given away, or property sold, transferred, deeded, or given away in the last 5 years

Free Help with Medicaid Applications

The agencies listed below provide free help to complete the Medicaid application.

The POINT

50 Valley Street
Providence, RI 02909
401-462-4444

Aging and Disability Resource Center (ADRC) for all of Rhode Island

Diocese of Providence, Office of Community Services and Catholic Charities

Serving elders and adults with disabilities in Providence in partnership with:

United Way of Rhode Island

50 Valley Street
Providence, RI 02909
401-519-0360

St. Martin dePorres Senior Center

260 Cranston Street
Providence, RI 02907
401-274-6783

Tri-County Community Action Agency

1126 Hartford Avenue
Johnston, RI 02919
401-709-2635

Serving elders and adults with disabilities in the following communities: Burrillville, Glocester, Foster, Scituate, Woonsocket, North Smithfield, Smithfield, Johnston, Cranston, Cumberland, Lincoln, and North Providence.

Westbay Community Action Program

224 Buttonwoods Avenue
Warwick, RI 02886
401-732-4660

Serving elders and adults with disabilities in the following communities: Warwick, West Warwick, Coventry, East Greenwich, and West Greenwich.

East Bay Community Action Program

610 Waterman Avenue
East Providence, RI 02914
401-435-7876

Serving elders and adults with disabilities in the following communities: Central Falls, Pawtucket, East Providence, Barrington, Warren, and Bristol.

Child & Family Services of Newport County

31 John Clark Road
Middletown, RI 02842
401-849-2300

Serving elders and adults with disabilities in the following communities: Portsmouth, Tiverton, Little Compton, Middletown, Newport, and Jamestown.

South County Community Action Inc.

1935 Kingstown Road
South Kingstown, RI 02879
401-789-3016

Note: This agency is also part of Tri-County CAP.

Serving elders and adults with disabilities in the following communities: Exeter, Hopkinton, Richmond, Westerly, Charlestown, North Kingstown, South Kingstown, Narragansett, and New Shoreham (Block Island).