They got bored the same day, Medicare and Medicaid are not identical twins. And even though they have been around for 55 years, many still confuse the two government-backed health care programs.
On July 30, 1965, President Lyndon Johnson signed laws making Medicare and Medicaid as part of his Great Society programs to address issues of poverty and inequality, hunger and education. Both Medicare and Medicaid provide health care support, but they do so very differently and mostly in different constituencies.
According to the Medical Rights Center:
- Medicare is a federal program that provides health coverage to people age 65 and older, or to those under age 65 who have a disability, not in relation to personal income.
- Medicaid is a United States and federal program that provides health coverage to very low-income people regardless of age.
Some people may be eligible for both Medicare and Medicaid, who are considered medically eligible, and may qualify for both programs. The MRC states that the two programs work together to provide health coverage and lower costs. And although both Medicare and Medicaid are government-administered health insurance programs, there are differences in the ways they share the services and costs they cover.
Medicare is a federal health insurance program. According to the Department of Health and Human Services, the program pays medical bills from trust funds that working people have paid during their employment. It essentially provides the same coverage and cost everywhere in the United States and oversees the Centers for Medicare & Medicaid Services, an agency of the federal government.
Medicare is primarily designed to serve people over 65, whatever their income, and young disabled people and dialysis patients with end-stage kidney disease (permanent renal failure dialysis or Transplantation required) is diagnosed. Patients have to pay a portion of their medical costs through deductions for hospital and other services. They pay small monthly premiums for non-hospital coverage.
Medicare has two parts. Part A includes hospital care, and Part B includes other services such as doctor appointments, outpatient treatment, and other medical expenses. HHS states that you are eligible for premium-free Part A if you are 65 years of age or older and you or your spouse has paid Medicare taxes for at least 10 years. You can get Part A at age 65 without paying premium:
- You receive retirement benefits or are eligible to receive benefits from the Social Security or Railroad Retirement Board.
- You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without paying the premium:
- You are entitled to Social Security or Rail Service Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
HHS states that most people do not have to pay premiums for Part A, but all have to pay premiums for Part B. It is deducted monthly from your social security, railway retirement or civil service retirement check; Those who do not receive any of these payments are billed for their Part B premium every three months.
Prescription drugs are covered under Medicare Part D. Everyone with Medicare, regardless of income, health status, or drug use, can receive prescription drug coverage for a monthly premium.
While the federal government administers what is known as basic Medicare, it is also possible to purchase a Medicare plan from some private insurance companies. These plans are known as Medicare Advantage. These include Part A and Part B coverage, but may or may not include prescription drug coverage.
Medicaid is a government assistance program administered by both the federal government and state governments. As such, its coverage terms and costs vary from state to state.
It serves low-income people, families and children, pregnant women, the elderly and disabled people of all ages. Income levels are usually based on federal poverty levels, but each state can determine who is eligible and who is not.
According to HHS, patients typically do not pay any for covered medical expenses or small co-pays. Some states have covered all income group adults below a certain income level, HHS says. Since the Affordable Care Act came into force, states have been allowed to expand their Medicaid programs to cover all people with household incomes below a certain level. Some states have done so, while others have not.
Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. HHS states that, in states that have expanded Medicaid coverage, you may qualify for Medicaid if your household income is below 133% of the federal poverty level. However some states use a different income limit.
Being a government program, both Medicare and Medicaid can be complex, confusing and challenging for some people to navigate.
Once you turn 65, Medicare automatically becomes your primary insurance payer, that is to say, Diane Omdahl, president and founder of the Medicare consulting firm 65Incorporated. If you also qualify for Medicaid, it becomes your secondary payer. “It works like a supplemental plan, which does not cover Medicare Part A and B,” she says. However, she recommends speaking with a counselor or a representative of your state health insurance support program, known as SHIP, for guidance. “Talk to someone about what needs to be done, because you can’t assure that it will be done automatically,” she says.
When choosing a Medicare or Medicare Advantage plan, the options can be overwhelming. How flexible is the coverage? Is your doctor included in the plan? Does it cover your needs, say eye care or mental health care? “It is important that you look at the type of coverage you want to decide on which path you want to go,” California Health Advocate, a medical advocacy organization that also works as a consultant with its local people , Consults with. SHIP in Chico, California.
Some beneficiaries say they want the cheapest plan, but it is not [necessarily] A good choice, ”she says. If you live in a large metropolitan area, you can have up to 100 Medicare Advantage plans to choose from – each quite different than the others. “The devil is in the details,” says Fasix. She also recommends speaking with a local broker, Medicare Advocate or a SHIP representative.