The Difference Between Medicare and Medicaid

Medicare and Medicaid are both federal healthcare programs intended to help those in need and/or who've reached a certain age, but there are some key distinctions. The differences between Medicare and Medicaid generally can be boiled down to who runs them, who qualifies for them, how much users pay, and what services they cover. The following article will help you get a handle on the key differences between the two.

Medicaid and Medicare: The Basics

Medicaid is a federal program that is administered separately by each state. This is not the only difference between it and Medicare, however. Medicaid covers low-income people who don't have the financial means to afford healthcare on the private market, regardless of age, while Medicare applies to everyone who has paid into the system and reached the point of eligibility (age 65 or older).

Medicare seeks to address the problem of the elderly having high medical bills, but increasingly limited means. Medicare recipients pay into Medicare through payroll or self-employment taxes.

While it's possible to qualify for both at the same time, each program has its own set of requirements; this means you won't necessarily be able to enroll in one just because you qualified for the other.

Medicare vs. Medicaid: A Comparison

The following table contains a clear breakdown of the key differences between Medicare and Medicaid.

 

Medicaid

Medicare

Who Runs It

Medicaid is a federal program administered by the states. Information is available at your state's health services office.

Medicare is a federal program with uniform, national rules.

Eligibility

Low-income people are eligible for Medicaid, regardless of age.

Medicare benefits can begin as early as age 62, or even earlier in the case of serious disability covered by Social Security.

Coverage

Medicaid covers basic health care costs such as visits to the doctor and hospital stays, but can also cover things like the cost of eyeglasses.

Medicaid also pays for nursing home care for those in need.

Part A: Hospital and post-hospital facility charges, as well as home health care.

Part B: Doctor fees and lab costs, outpatient care (can include physical therapy and medical equipment )

Part C (Medicare Advantage): Provided through private insurers; coverage varies by provider.

Part D: Prescription drug coverage.

Costs

Medicaid sometimes charges its users small fees for certain services.

Medicaid will often pay for Medicare deductibles and premiums, and it can cover the 20% of medical costs that Medicare will not pay for.

There is a yearly deductible for all three Medicare plans.

Part A: Copayments for lengthy hospitalizations.

Part B: 20% to 35% of medical bills, plus a monthly premium.

Part C (Medicare Advantage): Costs for Medicare Advantage vary by provider.

Part D: For 2018, there is a coverage gap such that Medicare will not cover total drug costs after they exceed $3,750, but will resume coverage once total drug costs reach $5,000.

Beneficiaries must also pay a monthly premium and 25% of drug costs once the deductible is met.

Get Legal Help With Your Medicare or Medicaid Concerns

Taking charge of your health care and medical needs is perhaps the most important thing you can do for yourself. But since Medicaid and Medicare are governed by sometimes-confusing and often-changing regulations, it can be difficult to decipher it all. If you have specific questions pertaining to these regulations, an experienced health care attorney in your area can help.

Next Steps

Contact a qualified health care attorney to help navigate legal issues around your health care.

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