Medicare vs Medicaid
The distinction between these two government programs can be confusing because of the similarity in name and in benefits.
Each program is designed to help someone in need of health care, whether they are disabled, elderly, or living below the poverty line and cannot afford health care and prescription drugs through other health insurance outlets. Breaking down the components of Medicare and Medicaid will help you to understand your benefits you are entitled to as a citizen of the United States.
What is Medicare?
Medicare is a social insurance program funded by the federal government for those who are age 65 or older, people under 65 with certain disabilities, and those who have End-Stage Renal Disease. There are four different parts of Medicare.
- Part A covers Hospital Insurance such as nursing facilities, inpatient hospital care, hospice, and home health care.
- Part B covers Medical Insurance such as outpatient care, home health care, health care provider services, medical equipment, and some preventative health service.
- Part C is Medicare Advantage which includes all benefits and services provided under Parts A and B. Typically, Medicare prescription drugs coverage (part D) is part of the plan. Private insurance companies that are approved by Medicare run Medicare Advantage. Paying extra for additional benefits and services is optional.
- Part D is Medicare prescription drug coverage which helps cover the cost of prescriptions, thus lowering drug costs. Medicare approved private insurance companies run part D as well.
Part A and B are considered Original Medicare, without the additional benefits of Part C that cost extra (Medicare Advantage). HMO and PPO plans are included in Part C, or Medicare Advantage Plan. With an HMO plan, or Health Maintenance Organization, a Primary Care Physician (PCP) must be chosen from a network of local health providers who in turn refer specialists and hospitals for you. A PPO health insurance plan, or Preferred Provider Organization, allows more choices in your health care providers.
What is Medicaid?
Medicaid helps low income or disabled individuals and families acquire health resources in the United States. The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care”. Medicaid is a state and federal program that may also help cover services not covered by Medicare, such as long term personal care services and long term support services. Each state has different eligibility and application rules. Qualifying for Medicaid in your state means that you automatically qualify for help paying your Medicare prescription drug coverage (Part D). Parents and other adults who were turned down from Medicaid in the past are becoming more qualified for the program than before and are encouraged to reapply.
To qualify for Medicaid you must be:
- Age 65 or older
- A child under 19
- An adult without dependent children (in some states)
- A parent or adult caring for a child
- An eligible immigrant in various states
Upon enrollment, these healthcare benefits are provided:
- Doctor visits
- Hospital stays
- Preventative Care/mammograms, immunizations, colonoscopies, and other care
- Long term support services
- Prenatal and maternity care
- Vision and dental care for children
- Mental health care
For more information on Medicaid, visit http://HealthCare.gov/do-i-qualify-for-medicaid or https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html
Some people are considered “dual eligibles” if they are eligible for both Medicare and Medicaid. Eligibility for both helps cover the majority of medical costs.
If you have Medicare and full Medicaid, Medicare covers your Part D prescription drugs. Medicaid can cover some drugs and other care that Medicare doesn’t cover.
Medicaid never pays first for Medicare covered services. Medicare, employer group health plans, or Medicare supplement insurance pay first.