US government-sponsored programs like Medicare and Medicaid help certain Americans with their healthcare bills. Unfortunately, these two taxpayer-funded programs have similar names causing confusion related to the services they offer. So, it is important to understand the differences between the two.
The main difference between Medicare and Medicaid is that Medicare is a federal program providing healthcare and coverage to US citizens over 65 and to citizens under 65 with disabilities. Medicaid on the other hand is a state and federal program for any citizen with a low income.
This blog post will further discuss the differences in more detail. We will also discuss the impact of these healthcare programs on American residents and citizens.
What is Medicare?
Medicare is a government-sponsored healthcare program launched by the US federal government. It is specifically meant for senior American citizens over the age of 65 and American citizens under 65 but with disabilities or impairments.
Most American citizens have their healthcare through their jobs. However, once people retire, healthcare becomes an expensive option few can afford. This is where Medicare helps them.
What is Medicaid?
Medicaid is also a US state government-sponsored healthcare program meant for people with minimal incomes. While the eligibility criteria differ from state to state, generally, pregnant women, children, and older people can apply for it too.
Medicaid aims to provide healthcare packages to people who cannot afford health insurance or miscellaneous health-related costs.
Differences between Medicare and Medicaid
Difference in costs
Medicare beneficiaries must pay deductibles for some expenses, such as hospital stays, to cover a portion of the cost. Medicare charges minor monthly premiums for coverage for services outside the hospital, such as a doctor's appointment or preventative care. Additionally, there can be some out-of-pocket expenses for things like prescription medications. Medicaid beneficiaries frequently don't have to make any payments for approved expenditures, although they must make a small co-payment in rare circumstances. As a type of cost-sharing, states are permitted to impose minimal premiums and enrollment fees.
Difference in eligibility criteria
The applicant's age often determines Medicare eligibility. To be eligible, a person must be 65 years of age or older and a citizen, or either a permanent resident of the United States. Depending on how many years of Medicare taxes have been paid, premiums and eligibility for a particular Medicare plan will vary.
People below 65 with disabilities or impairments documented are the exception to this rule. People who get Medicare benefits typically also receive Social Security benefits.
Medicaid eligibility is determined by income. People with incomes lower than 133% of the federal poverty line can qualify. Based on the unique requirements of their state of residency, children are given greater income levels for Medicaid and CHIP.
Additionally, specific Medicaid initiatives provide coverage to groups requiring emergency help, such as expectant mothers and others with urgent medical needs.
Difference in coverage
The Medicare program is divided into multiple components that provide coverage for various facets of healthcare. Numerous inpatient medical services, including hospital stays, hospice care, a small amount of skilled nursing care, and home healthcare, are covered by Medicare Part A.
Outpatient medical care is covered under Medicare Part B. It provides coverage for various goods and services, including outpatient hospital treatment, doctor visits, preventative care, and some medical equipment.
All the advantages of Medicare parts A and B are included in Medicare Part C, often known as Medicare Advantage, which licensed commercial insurers administer. For an additional fee, these plans may also have other benefits, such as prescription drug coverage, dental, and vision care.
In accordance with government regulations, authorized plans manage Medicare Part D, which gives assistance for prescription drugs.
Medicaid coverage varies in every state, although every program provides some benefits. The coverage generally consists of:
- X-ray and lab services.
- Hospital inpatient and outpatient services.
- Services for family planning, such as birth control and nurse-midwife services.
- Health examinations and pediatric therapies as necessary.
- Adult nursing facility services.
- Adult surgical dental treatments.
You might wish to contact a caseworker in your state to examine your condition and seek assistance applying for Medicaid because the program differs from state to state.
Comparison Chart: Medicare Vs Medicaid
|Eligibility||Must be 65+. People under 65 with disabilities can apply too.||Low-income, under the poverty line.|
|Signing up||3 months before or after turning 65.||At any time. No time-bound restrictions.|
|Benefits||Inpatient stays, home healthcare, and hospice services.||Inpatient and outpatient services and other types of assistance.|
|Costs||Partly deductible||Completely sponsored|
Similarities between Medicare and Medicaid
The key similarities between Medicare and Medicaid are that they are US government initiatives to provide healthcare to various groups of people. They also offer low to no-cost health insurance programs for the disabled, women, and children. In certain circumstances, people can have both Medicare and Medicaid at once.
How do I sign up for Medicare?
Individuals with social security benefits are automatically enrolled in Medicare. If you do not have social security benefits, you can apply for Medicare online or at 1-800-772-1213 on weekdays.
What are the different verticals of Medicare?
Medicare has four different verticals, namely:
- Hospital insurance
- Medical insurance
- Medicare Advantage plans
- Prescription drug coverage
How do I sign up for Medicaid?
To sign up for Medicaid, you must first ensure that you are eligible for it. You can do so by enquiring at the State’s Medicaid office. You can apply for Medicaid with them or through the Health Insurance Marketplace.
How is Medicaid funded?
The federal government matches each state's Medicaid funding. Therefore, Medicaid will have a $10 billion budget if a state spends $5 billion on its program and the federal government also contributes $5 billion.
Both Medicare and Medicaid are helpful in providing healthcare assistance to US citizens who cannot afford them. While the eligibility criteria for both programs differ based on many verticals, they are a great boon for the people.