The phrases Medicaid and Medicare are sometimes misconstrued or used interchangeably. They sound similar, but these two completely different entities.
Each has its own set of rules and policies, and the programs are for various types of individuals.
To pick the best program for your requirements, it’s crucial to grasp the distinctions between Medicare and Medicaid.
Key Takeaways
- Medicare and Medicaid are two government healthcare programs in the United States.
- Medicare covers people age 65 and older, as well as people with certain chronic diseases or disabilities. Medicaid is for persons with a lower income and it helps provide healthcare services at little or no cost.
What exactly is Medicare?
Medicare is a policy created for U.S. citizens age 65 and older who have trouble financing the expenditures linked to medical care and treatments. This program gives support to older individuals and their families who require financial assistance for medical expenses.
People under the age of 65 living with certain impairments may also be eligible for Medicare benefits. Each case focuses on eligibility requirements and the characteristics of the program.
Original Medicare and Medicare Advantage are the two major divisions of Medicare from which to select.
Original Medicare
Original Medicare is a government-funded medical insurance alternative that many elderly Americans utilize Medicare as their primary insurance. It includes:
- Hospital inpatient services (Medicare Part A). These benefits include hospital visits, hospice care, limited skilled nursing facility care, and home healthcare coverage.
- Outpatient medical services (Medicare Part B). These benefits encompass preventative, diagnostic, and therapeutic services for medical disorders.
Medicare Advantage
Medicare Advantage (Part C) is an insurance alternative for those who desire the coverage of traditional Medicare but with additional coverage options.
Private insurance businesses administer Medicare Advantage plans. Medicare does not cover prescription medication coverage, dental, vision, or hearing care.
What is the Medicaid Program?
Medicaid is a program that combines the efforts of the Federal and State governments of the United States to assist low-income households with healthcare costs. In addition to basic medical care, these expenditures may include hospitalizations and treatments of a serious nature.
Medicare vs Medicaid: Cost
Medicare Costs
Through deductibles, Medicare recipients contribute a portion of the cost for services such as hospital stays. For coverage outside of the hospital, such as a doctor’s visit or preventative treatment, refer to outpatient care.
Medicare has modest monthly premiums. There may also be out-of-pocket expenses for prescription medications and other items.
Here is a comparison of Medicare Original and Medicare Advantage costs:
| Original Medicare | Medicare Advantage | |
| Monthly premium | part A: typically $0; part B typically $170.10 | varies (can start at $0) |
| Deductible | part A: $1,556 each benefit period; part B: $233 | varies (can start at $0); you may have a health and a drug deductible if your plan includes both coverage |
| Coinsurance/copays | part A: $0, $389, or $778+ per day (depending on the length of your stay); part B: 20% of all approved medical services after deductible is met | varies (generally, $0–$50+ per visit) |
| Out-of-pocket max | none | $3.400– $10,000+ |
Source: Healthline.com
Medicaid Cost
In most circumstances, Medicaid recipients do not have to pay for eligible expenditures, but in rare instances, a modest copayment is required.
As a type of cost sharing, states may assess limited premiums and enrollment fees. This pertains to the following groups of Medicaid enrollees:
Those having a family income at or over 150 percent of the federal poverty threshold, including pregnant women and newborns (FPL)
- Qualified disabled and working individuals with an income greater than 150% of the FPL
- Disabled working individuals eligible under the Ticket to Work and Work Incentives Improvement Act of 1999
- Disabled children eligible under the Family Opportunity Act
Medicare vs Medicaid: What are the Qualification?
To enroll in any program, you must fulfill specific requirements.
Medicare Eligibility
In most cases, Medicare eligibility is determined by the applicant’s age. To qualify, a person must be a citizen or permanent resident of the United States and at least 65 years old.
Premiums and eligibility for a particular Medicare plan will depend on the number of years of Medicare taxes paid. Exceptions are made for those younger than 65 with specific recognized impairments.
Individuals who get Medicare benefits also receive Social Security benefits. Medicare benefits are also available to:
- A person qualified for the Social Security disability program who is also a widow or widower and is at least 50 years old.
- The child of a person who worked a minimum number of years in a government employment and paid Medicare taxes and who is eligible for Medicare
Medicaid Eligibility
A person’s eligibility depends on their income and family size.
The Patient Protection and Affordable Care Act has expanded healthcare coverage for those with the lowest incomes by creating a nationwide minimum income criterion. The majority of persons under the age of 65 must have incomes below 133 percent of the Federal poverty threshold to qualify.
Medicaid and the Children’s Health Insurance Program (CHIP) provide greater income thresholds for children based on their state of residence.
There are also specific Medicaid programs that expand coverage to groups requiring emergency help, such as pregnant mothers and individuals with urgent medical requirements.
Coverage Under Medicare and Medicaid
Medicare Coverage
Several Medicare components provide coverage for various elements of healthcare.
- Medicare Part A covers a variety of inpatient medical services, including hospital stays, hospice care, and limited skilled nursing care and home health care.
- Medicare Part B covers outpatient medical services. It provides coverage for things and services such as outpatient hospital treatment, doctor’s visits, preventative care, and certain medical equipment.
- Medicare Part C, often known as Medicare Advantage contains all Medicare Parts A and B coverage. These plans may provide additional benefits, such as dental and vision care, for an additional fee.
- Medicare Part D is administered by federally approved plans and helps pay for prescription medications.
Medicaid Coverage
Medicaid benefits vary by state, although some benefits are included in every state’s program.
These consist of:
- Lab and radiology services
- Adult nursing facility services
- Surgical dental services for adults
- Hospital inpatient and outpatient services
- Family planning services, including contraception and midwifery services
- Kid health checkups and appropriate medical procedures
Because Medicaid varies from state to state, you may need to speak with a caseworker in your state to evaluate your status and receive assistance applying.