What's the Difference between Medicare and Medicaid?

Tue, Oct 27, 2020 6:16 PM Medicare

Medicare and Medicaid are U.S. government-sponsored services intended to help American citizens pay healthcare costs. These two programs, founded in 1965 and subsidized by taxpayers, have similar-sounding names, which may create confusion about how they operate and the coverage they provide.
 

What is Medicaid?

Medicaid is a joint federal and state initiative that aims to pay for the expenses of medical and long-term custodial care for low-income Americans of all ages. The Children's Health Insurance Program (CHIP), which has its own set of rules and conditions, covers children who need low-cost coverage but whose families earn too much to qualify for Medicaid.

Eligibility and Costs of Medicaid

50 separate Medicaid services emerge from the federal / state arrangement, one for each state. President Barack Obama sought to extend healthcare coverage to more Americans through the Affordable Care Act by making the Federal Government pay much of the expense of Medicaid at the state level for individuals with an income level below 133 percent of the level of federal poverty.

A study from Healthcare.gov stated: "It turns out to be 138 percent of the federal poverty level because of the way this is measured." A separate income cap is used by a few states. "While 33 states have opted into the program, political attempts to roll back coverage continue."

For covered programs, people covered by Medicaid pay zero. Medicaid has stringent eligibility criteria that differ by state, unlike Medicare, which is available to almost any American aged 65 years and over.

However, since the program is intended to benefit the vulnerable, many states mandate beneficiaries of Medicaid to have liquid assets of no more than a few thousand dollars in order to qualify. There are wage limits as well.  

They remain eligible for Medicaid and even become eligible for Medicare when Medicaid recipients reach 65 years of age. Medicaid coverage can vary at that time, depending on the income of the beneficiary. People with higher incomes may find that their Medicare Part B premiums are covered by Medicaid. Persons with lower incomes can continue to receive full benefits.

Benefits from Medicaid

Medicaid benefits vary by state, but coverage for a range of programs is required by the Federal government, including:

• Nursing services
• Nursing facility services
• Home healthcare for people eligible for nursing facility services
• Clinic treatment
• Pediatric and family nurse practitioner services
• Midwife services
• Hospitalization
• Laboratory services
• X-rays
• Doctor services
• Family planning

Additional benefits, such as prescription drug coverage, optometrist services, eyeglasses, medical transportation, physical therapy, prosthetic devices, and dental services, can also be provided in each state.

Medicaid, which is not provided by Medicare or by other private health insurance plans, is also sometimes used to support long-term care. In fact, Medicaid is the largest single source of long-term care support for the country, mostly covering the expense of nursing facilities for those who are depleting their savings to pay for health care and have no other means of paying for nursing care.

 

 

What is Medicare?

Medicare helps provide U.S. citizens who are 65 years of age or older with healthcare benefits, as well as those with some disabilities. Includes the four-part program:

Medicare Part A: Hospitalization Coverage

Part A of Medicare offers hospitalization benefits to persons who, irrespective of income, are 65 years or older. You or your partner must have worked and paid Medicare taxes for at least 10 years in order to apply. For Medicare Part A, most persons do not pay a premium, but deductibles and co-insurance apply.

Medicare Part B: Medical Insurance

Many qualified for Part A of Medicare also apply for Part B, which includes facilities and supplies that are medically required. This includes trips to the doctor's office, laboratory work, x-rays, wheelchairs, walkers, and outpatient surgery, as well as preventive care such as screening for illnesses and flu shots.

The regular Part B premium is $144.60 for 2020 (usually deducted from benefits for Social Security or Railroad Retirement). Coinsurance and deductibles apply. 1 People who receive more than $87,000 a year are obligated to pay more for this service,$174,000 for a couple.

Individuals are not required to sign up for Medicare Part B as soon as they are qualified, given that they are already protected by benefits from their employer. Due to a late-enrollment penalty, it can cost more to enter later in life, however.

Medicare Part C: Supplemental Insurance

Individuals applying for Part A and Part B of Medicare are also qualified for Part C, also known as Medicare Advantage. Plans for Medicare Part C are provided by Medicare-approved private entities.

Medicare Part C provides vision, hearing, and dental coverage in addition to providing coverage provided by Part A and B. In this way, it operates much like the health maintenance organizations (HMOs) and preferred provider organizations ( PPOs), from which many individuals during their working years receive medical services.

The cost of buying services separately can be minimized by enrolling in Part C. Individuals should assess their medical needs carefully since the participants in Part C normally pay out-of-pocket for the relevant services.

It is worth noting that Medicare Supplement Insurance, known as Medigap, can be obtained to help offset costs that are not covered by Medicare Parts A and Part B, such as copayments, coinsurance, and deductibles. However, Medigap is still not approved by doctors who do not take Medicare.

Medicare Part D: Prescription Drugs

Prescription drug coverage is offered by Medicare Part D. Participants pay out-of-pocket for Part D programs, and for some prescriptions, they must pay regular monthly premiums, annual deductibles, and copayments. Many participating in Part C of Medicare are usually Part D eligible.

Also Read: What will it Cost You When you Join Medicare?

 

TAKEAWAYS

1. For many people aged 65 and older and others with a disability, Medicare is the main medical coverage provider. Medicare eligibility has little to do with the amount of income.
2. Medicaid is intended for limited-income families and is often a last-resort service for those lacking access to other services.
3. Part A of Medicare provides hospitalization coverage, regardless of income, to persons who are 65 years or older.
4. Part B of Medicare includes medically required facilities and supplies, including visits to the doctor's office, laboratory work, x-rays, wheelchairs, walkers, and outpatient operations.

 

---

Related Articles:

7 Ways to Lower Your Medicare Premiums

• #Health Insurance