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Understanding the Difference Between Medicare and Medicaid

Many people confuse Medicare and Medicaid. While many of the benefits from these federal healthcare programs are similar, the programs themselves are very different. They apply to different people, and they offer various levels of benefits. The main distinction is that Medicare is considered an insurance program while Medicaid is an assistance program.

How Does Medicare Work?

Medicare primarily serves those over the age of 65, regardless of their income levels. It is also available to younger people who are considered disabled. This insurance program is generally accessible to people who have paid into the program over the many years, often decades, in which they have worked. People on Medicare will still pay premiums and deductibles, just like a traditional medical insurance program. However, the rates are often lower than what would otherwise be available in the regular market.

Medicare is a federal program that is run by the federal government. It is essentially the same throughout the United States, and it is administered by the Centers for Medicare & Medicaid Services.

Medicare Coverage

The type of coverage you will receive from this program will vary depending on the plan you have. The overarching programs include:

  • Part A: Home care, hospital, and post-hospital charges
  • Part B: Doctor fees, outpatient care, labs and testing costs
  • Part C: (Medicare Advantage): varies by the provider (private insurers)
  • Part D: Prescription drug plans

Many people will have more than one program that applies to them at one time.

Costs Associated with Coverage

Like a traditional insurance plan, there are costs associated with each type of program. In general, there is a yearly deductible. Copays that are a portion of the cost of the care you receive will also be required. If you use very few services, for example, your total cost will be far less than someone who must frequently see the doctor or receive medical services.

How Does Medicaid Work?

Medicaid offers medical benefits for those who are considered “low income.” In most circumstances, people will pay no or very little part of the costs associated to receive medical care, but there is sometimes a small co-payment necessary for some services. It is only available to those who meet certain income restrictions.

Medicaid is administered by individual states or local governments, but those states must follow precise federal guidelines. However, the requirements to receive this type of assistance will still vary slightly from state to state.

Medicaid Coverage

Medicaid will help users pay for most basic healthcare costs, including hospital stays and routine visits to the doctor. However, it also covers things that might surprise you, like hearing aids and eyeglasses. It will also cover nursing home care for those who qualify as well. In fact, many people take steps to plan for their long-term care by making arrangements for Medicaid to address these costs.

Costs Associated with Coverage

Occasionally Medicaid will charge a small fee for some services, but there are no premiums or copays like Medicare. However, it is possible that individuals qualify for both Medicare and Medicaid, and Medicaid will sometimes pay for the costs that Medicare will not address.

Medicare and Medicaid planning should be a part of your long-term care planning, even if you are healthy today. To see how we can help, contact our team today at 800-491-6556.