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What's the difference between Medicare and Medicaid? Find out if you're eligible.

I admit that I didn’t fully understand the difference between Medicare and Medicaid before I started working in health care. I know I’m not alone. It’s confusing, and I’ve come to realize that many people are unfamiliar with how each one works.

It’s important that we understand the options and benefits each program provides, as well as recent changes and enhancements that will offer not only increased access to health care, but better value for North Carolinians.

But first, let’s begin with the basic questions. What is Medicare? What is Medicaid?


Medicare, which is run by the Centers for Medicare & Medicaid Services, has some unique elements:

  • Is a federal insurance program
  • Serves people primarily over the age of 65 regardless of income
  • Serves younger disabled people and dialysis patients

Patients pay part of costs through deductibles for hospitals and other services, as well as a small premium for their non-hospital coverage.


Medicaid is a federal-state assistance program that:

  • Serves low-income people of every age
  • Varies from state to state

Patients usually pay no part of costs for covered medical expenses, though a small co-payment is sometimes required. Medicaid is run by state and local governments within federal guidelines.

Community impact

As we work to transform health care, it’s critical that we provide the help and tools necessary to give every person access to quality health care that’s simpler, better and more affordable.

Women and children represent a large segment of Medicaid enrollees. Access to health care at an early age certainly has an impact on how a child grows up to impact the communities in which they live. For some children, this program gets them off to a healthy start, whereas Medicare, which will hopefully benefit every one of us at some point in life, will be there for us at the finish line.

Similar logic can be applied for seniors who reach Medicare eligibility. Having access to quality health care is an important factor in not only extending life expectancy but also quality of life. Healthier communities are better communities.

With much talk around how to reign in increasing health care costs in the U.S., it’s important to be aware of changes that are happening with Medicare and Medicaid, specifically the ones targeted towards underserved North Carolinians.

Healthy Blue + Medicare

Affordable, quality health care for low-income Medicare beneficiaries shouldn’t be a burden. In fall 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offered $0 premium plans again for Medicare beneficiaries in our Blue Medicare Advantage service area. We also offered drug coverage and enhanced benefits for our 2021 Medicare Advantage (MA) plans.

Blue Cross NC’s Medicare Advantage plans are a great option for those eligible to be on Medicare. But we recognized that more could be done for those who were also eligible for Medicaid. That led Blue Cross NC to launch Healthy Blue + Medicare, a Dual-Eligible Special Needs Plan (D-SNP) that provides a new option for individuals eligible for both Medicare and Medicaid.

Healthy Blue + Medicare will make care more accessible and more affordable. Beyond the $0 premium for eligible enrollees, it provides enhanced benefits, such as access to nutritious food, dental services and eyewear, and $0 primary copays. This plan moves us forward as we work to provide essential, valuable healthcare benefits for the people who really need it.

Medicaid transformation

While our Healthy Blue + Medicare plan addresses needs for our dual eligible population, that still leaves out a large segment of people who aren’t eligible for Medicare but need access to better health care. Significant transformation is underway, and it’s going to change the way people in North Carolina receive Medicaid services. It will impact the health care of more than 1.6 million North Carolinians.

There is a new way to get Medicaid health care in our state.

North Carolina Medicaid is transitioning from fee-for-service to managed care, which will lead to better health outcomes for North Carolinians. Medicaid transformation launching July 1 means more choices for them.

With Medicaid transformation happening, people will get the same Medicaid services that they do today. But for the first time ever, they now have the power to choose a health plan offered by health care companies to manage their care.

As Blue Cross NC continues in its mission of improving the health and well-being of our customers and communities, we have launched Healthy Blue, our Medicaid managed care offering.

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If you live in North Carolina, there is a new way to get Medicaid health care. Most people will get the same medicaid services in a new way through – health plans.

Enrolling in a health plan will save you time and resources in getting your health care. You will have access to a network of providers, you can see your doctor as often as you need and you will also have access to a 24-hour nurse line. You will choose a primary care provider and a health plan that are best for you. A primary care provider is your family doctor clinic or other health care  provider. You will see your primary care provider for all your medical needs. If you need care beyond what your provider can provide, he or she will refer you to a specialist in your health plan.

 You also have a choice of health plans to fit your health care needs. A health plan is a group of doctors, hospitals and other providers. They work together to give you the health care you need. Health plans pay for health care services including doctor's appointments, inpatient and outpatient hospital services, nursing home services, prescription drugs, routine eye exams and more. For a full list of what is covered, visit

In NC, medicaid managed care there are six health plans to choose from: EBCI Tribal Pption, Wellcare of North Carolina, UnitedHealthCare of North Carolina, Healthy Blue, AmeriHealth Caritas North Carolina and Carolina Complete Health.

Most people receiving Medicaid must use a health plan. A small number of  people will not need to choose a health plan because of the type of health  services they need. They will stay in NC Medicaid Direct or they can choose  the EBCI Tribal Option, if they qualify.

NC Medicaid managed care will send you a letter that tells you if you must enroll. Here's what you need to do:

Step 1: choose  a primary care provider. If you want to keep your current  provider, you can ask them which health plans they work with. You can also visit, use the NC Medicaid Managed Care mobile app or call 1-833-870-5500 for a list of doctors and other specialists.

 Step 2: choose a health plan. You can learn more about the health plans  available at

Step 3: enroll. You can enroll by going to where you can chat with an enrollment specialist. You can also use the NC Medicaid Managed Care mobile app, call 1-833-870-5500, or fill out and mail or fax in the  enrollment form you will receive in the mail. You will need to enroll by May 14, 2021. Your health plan coverage will start July 1st, 2021.  If you do not choose a health plan or primary care provider, one will be chosen for you.

You know your needs best so it's better if you choose. After you enroll, you will receive information and an ID card. You will use your new ID card to get health care services. You will have 90 days after your health plan starts to change your health plan or primary care provider.

If you have questions, there are several ways to get more information. For questions about your Medicaid eligibility, your local department of social services, or DSS, can help. You can find contact information at To learn more about choosing or enrolling in a health plan, you can go to for more information or to chat with a specialist. You can also call 1-833-870-5500 to speak with someone. The call is toll-free. If you have questions about your health plan or specific benefits, call your health plan. You can also find contact information  at

Having quality, affordable health care is a must, especially in underserved communities where health disparities are a serious, growing problem that must be urgently addressed. These issues have been brought to the forefront during the COVID-19 pandemic as it further exposed a health system that has failed not only too many North Carolinians, but many Americans across our country.

Whether it’s children, seniors or those who are disabled, access to care is vital in making our communities healthier. Blue Cross NC remains committed to providing quality care to people who’ll benefit from increased access due to recent changes in our state health care landscape.

We’re hopeful these impactful changes will lead to a better, healthier North Carolina.

Brian Edmonds
Brian Edmonds

Communications Officer

Brian is a communications officer with the Blue Cross NC Foundation. He enjoys bringing awareness to the positive impact that Blue Cross NC is making in our local communities.

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