If you have ever been confused about the difference between Medicare and Medicaid, you are definitely not alone. Many people get the two mixed up, and it doesn’t help that they both can be difficult to understand on their own.
Both Medicare and Medicaid are government-run health insurance programs, but they cover very different things and have very different requirements to qualify to use them. To help you understand which may be applicable to you, we have broken down the differences between Medicare versus Medicaid, so that you can better understand what they are, what they cover, and how you may use either in the future.
Medicare covers people who are 65 and older and individuals with certain disabilities. It is run by the federal government and is broken out into four parts. Parts A and B are referred to as “Original Medicare,” and most people get these coverages if they qualify free of charge. This is because most people pay into the system that covers Original Medicare during their working years through their taxes.
Part A of Medicare focuses on inpatient care at hospitals and facilities. While Part B covers preventative medical care like doctors visits. Many people find that they need or want more coverage than what the first two parts can offer. That’s where Medicare Advantage plans come in.
Medicare Advantage Plans, or Part C, are optional plans that are offered by private insurance companies. These Advantage plans focus on offering additional healthcare coverages and better options for your care. Finally, Part D focuses on outpatient prescription drug coverage. Part D is sometimes included in Advantage Plans, but you can also purchase Part D plans on their own.
Because Original Medicare is run through the government, Parts A and B are consistent throughout the United States. Parts C and D are optional and variable since they are offered through private companies, but many people choose to enroll in them for additional coverage.
Unlike Medicare, qualifying for Medicaid is not dependent on someone’s age. Medicaid is instead focused on providing healthcare coverage for people who have low incomes and certain children, people with disabilities, and people who are pregnant. Medicaid is also funded through the federal government, but many state governments have their own Medicare programs, so the way that Medicare works can vary state by state. This means that outside of the mandatory benefits that these programs have to offer, coverage isn’t the same everywhere and can be dependent on where you live.
The mandatory benefits that Medicaid is required to have includes inpatient and outpatient hospital care, labs, X-rays, certain screenings, and family planning. Some states also have options to cover additional benefits like prescriptions drugs, clinic visits, dental care, vision care, and therapy. It is important to review thoroughly what your specific state offers you, to make sure you understand what costs you may be responsible for when seeking healthcare treatments.
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To qualify for Medicare, the focus is on your age. Medicare coverage starts for those who are 65 and older, except for the few people that qualify through specific disabilities and diseases. People with higher incomes will pay more for Medicare, but the eligibility isn’t limited by someone’s income. Payment for Parts A and B is typically handled through the taxes that people paid during their working years. Payment for Parts C and D are charged directly with the patient who took out the coverage.
Qualifying for Medicaid simply requires that someone has a lower income. These income limits typically focus on people who make less than the federal poverty level. Medicaid coverage is not is not dependent on someone’s age. For those that qualify, Medicaid is either free, or at a very low cost.
Some people actually may qualify for both Medicare and Medicaid. In this case, the plans work together to cover health care. If you believe that you may qualify for both, then it is important to see where coverage may overlap and to understand how your state’s Medicaid coverage may play into what you receive via Medicare.
It is so easy to mix up Medicare and Medicaid, but we hope that this outline has helped you keep things straight. It is important to understand your medical needs in addition to which programs you may qualify for, so that you can get the best set up for your coverage as possible. You should also feel comfortable asking any questions you may have on what is or isn’t covered under your plans, so that you can feel confident that your healthcare needs can be met in a way that you can afford.
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