Medicare and Medicaid
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Medicare vs Medicaid
Don’t get confused, these US-based health care
programs are not the same:
- Medicare is a health insurance program which is funded by the federal government and largely serves individuals 65 and over, with some exceptions (including certain disabilities and people of all ages with endstage renal disease).
- Medicaid is a joint federal and state program that helps eligible low-income individuals or families pay for the costs associated with long-term medical and custodial care.
Medicare
The Medicare Program is divided into four sections
which include Medicare Part A which covers
hospital bills, Medicare Part B which covers
medical insurance coverage and Medicare Part D
which covers prescription drugs.
Medicare Part C is Medicare-approved health
insurance plan options offered by private health
insurance companies, including and includes combined
coverage of Parts A and Part B.
Medicaid
Although the majority of funding comes from the
federal government, Medicaid is administered by
states and program benefits may vary.
Individuals who are eligible for both Medicaid and
Medicare are known as Medicare dual eligibles.
Medicaid is a program that is not only funded at the federal level, but at the state level as well, with states
providing up to half of the funding for Medicaid. In some states, counties will also contribute funds. Although
not required, all states have participated in the Medicaid program since 1982. Unlike Medicare, Medicaid is
need-based, with eligibility determined largely by income. The primary factor in determining Medicaid
eligibility is limited income and financial resources, a factor which plays no role in determining Medicare
coverage.
Medicaid is the largest source of funding for medical and health-related services for people with low income
in the United States. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include
low-income adults, their children, and people with certain disabilities.
Medicaid also covers a wider range of health care services than Medicare. Since Congress passed Medicare
into federal law in 1965 as part of the Social Security Act, coverage has been expanded to include additional
benefits and increased who is eligible to receive Medicare benefits.
Quick Comparison
| MEDICARE | MEDICAID | |
|---|---|---|
| Source Of Funding | Federal Goverment | Federal & State Goverment |
| Who is Eligible | Individuals 65 & Older with exceptions for certain disabilities and individuals with end stage enal disease of all ages | Individuals & Families ofall ages whose eligibility is need-based and mainly Idetermined by income |
| What is covered | Part A provides hospital insurance coveragePart B provides medical insurance coveragePart Cis, offered by private health insurance| companies and includes Parts A & B as well as additional plan optionsPart D provides prescription drug coverage | Mandatory benefits include (states may provide additional benefits:inpatient hospital services Out patient hospital services EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services Nursing Facllity Services Home health services Physician services Rural health clinic services Federally qualified health center services Laboratory and X-ray services Family planning services Nurse Midwife services Certified Pediatric and Family Nurse Practitioner services Free standing Birth Center services (when licensed or Jotherwise recognized by the statey Transportation to medical care Tobacco) cessation counseling for pregnant women |
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Everything You Wanted to Know About Medicare
- Learn Medicare 101: coverage, eligibility, enrollment requirements and more.
- Discover your Medicare options based on your needs.
- Find out how you can save on premiums.
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