The Easy Guide: Medicare vs Medicaid

Medicare and Medicaid are both government-sponsored programs that are designed to help cover the healthcare costs for U.S. citizens. They were both established in 1965 and funded by taxpayers.

Their similar-sounding names can often trigger confusion about how they work and the coverage they provide.

Medicare gives you medical coverage if you are aged 65 and older and also gives medical coverage to those with a disability. Eligibility for this coverage has nothing to do with income level, and is also designed for people with limited income.

Part A: Hospitalization Coverage

The first of the 4-part coverage Part A gives hospitalization coverage to those who are 65 years or older, regardless of income. To qualify, the applicant or their spouse must have worked and paid Medicare taxes for at least 10 years.

Part B: Medical Insurance

Those who are eligible for Medicare Part A also qualify for Part B, which will cover medically necessary services and equipment, including doctor’s office visits, wheelchairs, walkers, lab work, x-rays, and outpatient surgeries, as well as some preventive services like disease screenings and flu shots.

Part C: Medicare Advantage Plans

Those who are eligible for both Medicare Part A and Part B are also eligible for Part C, which is also known as Medicare Advantage. These plans are offered by private companies that have been pre approved by Medicare.

Part D: Prescription Drug Coverage

Medicare Part D covers prescription drugs and this is paid for out-of-pocket. Those with Part D must pay the monthly premiums, a yearly deductible, as well as copayments for specific prescriptions.

What is Medicaid?

Medicaid is also a joint federal and state program helping low-income Americans of all ages afford costs associated with medical and long-term custodial care.Families earning too much to qualify for Medicaid but having children who need low-cost care are covered through CHIP, or the Children’s Health Insurance Program, which has its own list of rules and requirements.

The benefits vary by state, but the government mandates the coverage for a variety of services such as:

– Hospitalization

– Laboratory services

– X-rays

– Doctor’s services

– Family planning

– Nursing services

– Nursing facility services and home healthcare

– Clinical treatment

– Pediatric and family practitioner services

– Midwife services