Medicare and Medicaid are government-backed healthcare programs that serve different groups of people and have different eligibility requirements.
It’s important to understand the differences between them and how each one works,
so that if you’re eligible for either or both, you can receive all the benefits offered to you.
What Is Medicare?
Medicare is a federal program that provides healthcare coverage in “parts.”
Part A provides coverage for hospital insurance, and
Part B provides coverage for outpatient services.
Medicare Advantage, also known as Medicare Part C,
covers everything included in Original Medicare and bundles Part A and Part B into a single plan.
These plans usually include additional benefits that Original Medicare doesn’t offer, provided by private insurers who follow guidelines set by the federal government.
Who Is Eligible for Medicare?
- People 65 + years of age who are U.S. citizens or permanent residents
- Most people eligible for Social Security are also eligible
- People younger than 65 with certain disabilities qualify, as well as those who are on dialysis or have had a kidney transplant.
What Does Medicare Cover?
(Part A) Original Medicare covers
- hospital stays
- skilled nursing
- home health care
- hospice care
(Part B) Also, covers
- doctor’s visits
- preventive care
- mental health services
- physical therapy
- occupational therapy
- lab services and other outpatient services
It doesn’t cover (unless performed in the hospital under Part A).
- prescription drugs
- hearing aids
- dental care
People who choose Original Medicare can buy prescription drug coverage with a standalone plan known as Part D.
Medicare Advantage covers everything included in Original Medicare.
Also includes prescription drug coverage and frequently offer dental and vision coverage, hearing aids and fitness benefits.
What Is Medicaid?
Medicaid is a joint program between federal and state governments that makes sure people with low incomes have healthcare access.
Who Is Eligible for Medicaid?
Medicaid provides health coverage for
- families & children
- pregnant women
- the elderly
- people with disabilities
- some people with low incomes.
In the 39 states that agreed to implement the latest expansion of Medicaid.
Most adults under the age of 65 who have an income lower than 138% of the federal poverty level are eligible.
In 2021, that amount is $12,880 for an individual and $21,960 for a family of three.
If you live in one of the 12 states that chose not to expand Medicaid.
Coverage for nonelderly adults is limited to people
- who have a child
- pregnant women
- people who have a disability
What Does Medicaid Cover?
Some benefits must be offered in all plans across all states, according to federal guidelines, including:
- Coverage for hospital stays
- Outpatient hospital services
- Laboratory and X-ray services
- Family planning services
- Nursing facility services
- Home health services
- Doctor visits
- Transportation to medical care
Some of the optional benefits states can choose to offer include:
- Prescription drugs
- Physical therapy
- Occupational therapy
- Speech, hearing, and language disorder services
- Respiratory care services
- Optometry services
- Dental services
If you think you might be eligible for Medicaid or are making sense of your Medicare options, understanding what these programs cover and who they’re forwill help you choose the option that works best for you.
For more information, visit the Medicare and Medicaid websites.
Special Thanks to Kate Kelly from Forbes for this amazing content