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July 20, 2021

Medicaid and Medicare are frequently misunderstood or used interchangeably. These 2 programs appear to be very similar, yet they are rather distinct.

Each is governed by its own set of laws and policies, and the programs are typically tailored to certain groups of individuals. It is possible, though, to be eligible for both programs.

It’s critical to grasp the have a clear idea of Medicare vs Medicaid in order to choose the right program for your requirements.

What is Medicare?

Medicare is a healthcare insurance program for those 65 and older in the United States who are having trouble paying for medical care and treatments. This program assists seniors and their families who require financial assistance for medical expenses.

Medicare benefits may be available to those under the age of 65 who have certain disabilities. Each case is assessed based on the program’s qualifying standards and specifics.

Those who are in the terminal stages of kidney disorders can also apply for Medicare coverage.

Original Medicare and Medicare Advantage are the 2 primary branches of Medicare to choose from.

Original Medicare

Original Medicare is a government-funded medical insurance program that many seniors use as their primary coverage. Inpatient hospital services are covered (Medicare Part A).

Hospital visits, hospice care, limited skilled nursing facility care, and at-home healthcare are all covered under these benefits.

Medical treatments are provided on an outpatient basis (Medicare Part B). These advantages include coverage for health-related preventive, diagnostic, and treatment services.

Medicare Advantage

Medicare Advantage (Part C) is a health insurance option for people who desire original Medicare coverage but with more options.

Medicare Advantage plans are provided by private insurance providers. Many of these plans include services that aren’t covered by basic Medicare, such as prescription medication coverage, dental, vision, and hearing care.

What is Medicaid?

Medicaid is a program that combines the efforts of the federal and state governments in the United States to help low-income families with healthcare costs. Major hospitalizations and treatments, as well as ordinary medical care, may be included in these costs.

Every year, the program serves millions of adults, children, and persons with disabilities. In November 2020, 72,204,587 people had signed up for Medicaid, while 6,695,834 children had signed up for the Children’s Health Insurance Program (CHIP).

What is the cost of Medicare vs. Medicaid?

Medicare Costs

For things like hospital stays, people who receive Medicare coverage pay a portion of the cost through deductibles.

Medicare mandates minor monthly charges for coverage outside of the hospital, such as a doctor’s appointment or preventative treatment. Prescription medicines, for example, may have some out-of-pocket expenditures.

The following is a breakdown of expenditures for both Original Medicare and Medicare Advantage:

Original Medicare Medicare Advantage
Monthly premium Part A: typically $0

Part B: typically $148.50

It varies (can start at $0)
Deductible Part A: $1,484 for each benefit period.

Part B: $203

It varies (can start at $0).

If your plan covers both health and medication coverage, you may have a health and drug deductible.

Coinsurance/copays Part A: $0, $371, or $742+ per day (depending on the length of your stay).

Part B: After the deductible is met, 20% of all approved medical treatments are covered.

It varies (generally, $0–$50+ per visit).
Out-of-pocket expenses (max) None $3.400–
$10,000+

 

Medicaid Costs

Medicaid recipients normally don’t have to pay anything for eligible services, although in rare situations, a small copayment is required.

As a form of cost sharing, states might impose limited premiums and enrollment fees. This is true for certain types of Medicaid recipients, such as:

  • Pregnant women and infants with a household income at or above 150% of the federal poverty level (FPL).
  • Medically needy individuals
  • Working individuals and qualified disabled with an income above 150% of the FPL.
  • Disabled working individuals who are eligible under the Ticket to Work and Work Incentives Improvement Act of 1999.
  • Disabled children who are eligible under the Family Opportunity Act.

The Takeaway

When it comes to Medicare vs Medicaid, these are basically 2 government programs in the United States that are designed to assist diverse populations in gaining access to healthcare.

Medicare normally covers people aged 65 and up, as well as those with certain chronic illnesses or disabilities, whereas Medicaid eligibility is determined primarily by income and need.

chris dsouaz

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National Senior Services is not connected with or endorsed by the US government or the federal Medicare program; Medicare has neither reviewed nor endorsed this information. We are a licensed and approved Medicare Service Provider.

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