Medicare is a U.S. government health program that offers medical coverage primarily for seniors 65 years and older.
Medicare also caters to younger counterparts with specific disabilities who are eligible for Social Security Disability Insurance.
Also, the program covers under 65 persons who have permanent kidney failure and those with Lou Gehrig’s disease.
Typically, Medicare Insurance coverage works similarly in all the American states.
Therefore, an individual’s coverage choice is constant regardless of whether they travel from state to state.
The history of Medicare dates back to 1965, when President Lyndon Johnson signed it into law on 30th July.
Conversely, Medicaid is a joint federal and state health insurance program that covers people with limited resources to cater to their medical needs. Unlike Medicare, Medicaid coverage varies depending on the state where you reside.
This means your choice of coverage remains unchanged only if you live in the state where you made your application.
Medicaid offers some of the services not applicable to Medicare Insurance, the common ones being nursing facility services and home health services.
This program came into establishment together with Medicare in 1965.
Medicare
How Does Medicare Work?
Medicare covers most of your health services.
Typically, Medicare funding partly comes from the federal government, taxes that one pays for Medicare services, and beneficiaries.
There are two main options regarding Medicare coverage, Original Medicare and Medicare Advantage.
Original Medicare
The Original Medicare cover comprises two health insurance plans.
They include the hospital and medical insurance.
With Original Medicare, you pay 20% deductibles at the beginning of every year.
This plan will cover most but not all of your healthcare services.
Thus, you will have to make out of pocket payments partly.
To reduce pocket payments, you can sign up for other insurance coverages, such as Medigap.
This private insurance program contracts with Medicare and can cover other services not applicable in the Original Medicare program.
Medicare Advantage
Medicare Advantage comprises hospital insurance, medical insurance, and drug coverage.
Original Medicare and Medicare Advantage slightly differ in cost, coverage, and service providers.
For instance, concerning cost, you will pay deductibles, coinsurances, and premiums for both plans.
However, Medicare Advantage reduces out of pocket payments by a great range.
Regarding insurance providers, Original Medicare gives the chance to receive services from any physician in the U.S. who accepts Medicare. Medicare Advantage, on the other hand, operates based on a particular network of health providers.
Medicare Plans
Part A
Also known as hospital coverage, this is a premium free plan.
It covers in patient services, hospice, nursing facility care, and home health care.
Most people 65 years and above do not pay for this plan, especially if they paid Medicare taxes for at least 10 years.
Other parties that are also eligible for this plan include those who are already receiving disability services and individuals who applied for Medicare before 65 years of age.
Part B
It also refers to medical insurance.
This plan covers preventive health care, laboratory services, doctor’s visits, some medical supplies, and other outpatient services.
Individuals eligible for the Part A plan are also suitable candidates for the Part B.
Typically, you must pay for the part B plan every month.
The providers often deduct this bill from your Social Security benefit, Railway Retirement Board, or Civil Servant benefits.
Part C
It is also known as Medicare Advantage, a plan funded by private insurers.
Part C is applicable for individuals with Part A and B plans.
It can also cover vision, dental, and prescription drug fees.
This plan significantly reduces out of pocket payments.
However, you might pay high costs due to coinsurance and deductibles.
Part D
This is the Prescription Drug Coverage, and it varies by plan.
It covers generic and brand name prescription medicines.
Concerning the Part D plan, you will pay out of, pocket.
However, you may have to pay deductibles and copayments for certain medications.
Medicaid
How Does Medicaid Work?
Medicaid pays for most of the expenses not covered by Medicare.
Nevertheless, you may have to contribute a small percentage in copayments for a few medical items and services.
Also, the rules and regulations associated with Medicaid vary from state to state.
Generally, it would help if you met a particular state limit regarding income and resources to be a suitable candidate for this plan.
Below are the groups eligible for Medicaid.
The qualifications apply to the citizens of the United States.
- Pregnant women below the standard poverty line of the United States.
- Parents and guardians below the poverty line in the United States.
- Underage children from low income families.
- Older adults with low income who receive financial assistance through Supplementary Security Income.
- People living with disability who get help through Supplementary Security Income.
What Does Medicaid Pay For?
- Laboratory services
- Physician care
- Hospital care
- Nursing facility healthcare
- Home health care
- X ray services
- Coinsurance
- Copayments
- Deductibles
What if You Are Eligible for Medicare and Medicaid?
If you already have Medicare coverage, Medicaid will help pay for Part A and B plans, deductibles, coinsurance, and copayments.
The Key Differences between Medicare and Medicaid
Medicare is a government funded program, while the government and the state jointly fund Medicaid.
Medicare primarily covers individuals 65 and older and younger individuals with certain chronic conditions, while Medicaid’s coverage varies across all age groups.
Medicare offers the same plan choice in different states, while Medicaid’s service plans vary from state to state.
Medicaid provides services not covered by Medicare, such as nursing facility health care and home care.
