Medicare vs. Medicaid: What’s the difference?

As people age, healthcare becomes an even more critical part of their lives. For seniors, Medicare and Medicaid are two programs that can provide assistance in paying for healthcare. However, many people often confuse these two programs, and it is essential to understand the differences between them.

In this blog post, we will explore the key differences between Medicare and Medicaid, including what they cover, who is eligible, and how they are funded.

 

What is Medicare?

Medicare is a federal health insurance program that provides coverages for people over the age of 65, those with certain disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) or ALS (Lou Gehrig’s disease). The program has four parts, including:

  • Part A: Hospital Insurance Part A covers inpatient hospital stays, hospice care and skilled nursing care.
  • Part B: Medical Insurance Part B covers medical services such as doctor visits, outpatient care, and medical equipment.
  • Part C: Medicare Advantage Part C is an optional program that provides an alternative to traditional Medicare coverage. It is offered by private insurance companies and combines Parts A, B, and often Part D (prescription drug coverage).
  • Part D: Prescription Drug Coverage Part D covers prescription drugs and is offered by private insurance companies. It also covers other health related items, including:
    • Biological products
    • All immunizations not covered by Part B, including Tdap (tetanus, diphtheria, pertussis), Zoster (shingles), Varicella (chickenpox) and Hepatitis B
    • Syringes, needles, alcohol swabs and gauze
    • $35 for select insulins

 

What does Medicare cover?

Medicare covers a arrange of medical services, including hospital care, doctor visits, medical tests, medical equipment and prescription drugs (if enrolled in Part D). However, there are often gaps in coverage, such as deductibles, copayments and coinsurance, which beneficiaries are responsible for paying.

 

What is Medicaid?

Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals and families. It is funded by both federal and state governments, and each state sets its own eligibility requirements and coverage options.

 

Who is eligible for Medicaid?

To be eligible for Medicaid, you must have a low income and fall within certain categories, such as being a child, a pregnant woman, a parent, seniors or a person with a disability. Eligibly requirements vary by state, but generally individuals must earn less than 138% of the federal poverty level.

Learn more about Medicaid eligibility here.

 

What does Medicaid cover?

Medicaid covers a wide range of healthcare services, including hospital care, doctor visits, preventative care, prescription drugs, and long-term care. Some states also offer additional benefits, such as transportation and home-based care.

 

What are the key differences between Medicare and Medicaid?

  • Eligibility: Medicare is available to seniors over the age of 65, those with certain disabilities, and people with end-stage renal disease. Medicaid is available to low-income individuals and families who fall within specific categories, such as being a child, a pregnant woman, parent, or person with a disability.
  • Coverage: Medicare covers a wide range of medical services, but beneficiaries are often responsible for paying deductibles, copayments, and coinsurance. Medicaid covers a similar range of services, but beneficiaries typically do not have to pay for any out-of-pocket costs.
  • Funding: Medicare is funded by the federal government, while Medicaid is jointly funded by the federal and state governments. Each state sets its own eligibility requirements and coverage options for Medicaid, which can lead to variations in benefits across the country.
  • Cost: Medicare is not free, and beneficiaries are responsible for paying premiums, deductibles, copayments, and coinsurance. Medicaid, on the other hand, is free or low-cost, and beneficiaries typically do not have to pay any out-of-pocket costs.

 

Want to learn more about Medicare and Medicaid? Schedule a free, no-obligation consultation with a Senior Financial Group benefits consultant. Click here to learn more.

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