What are the distinctions between Medicare and Medicaid? While the names look extremely similar and both help pay for health and medical costs, the programs are vastly different. Here’s a closer look at the two plans and what you should know about the two.
What Is Medicare?
Medicare coverage includes individuals aged 65 and over, as well as younger adults who have specific disabilities. It has four parts (A, B, C, and D) — some of which require a monthly premium:
- Part A, which covers hospital care (lower deductibles and coinsurance)
- Part B, which covers physicians and other providers, medical tests, rehabilitation, and some health supplies
- Part C, or “Medicare Advantage,” is an alternative to regular Medicare coverage and is offered by private insurance companies, on an in-network-only basis
- Part D, which covers prescriptions
What Is Medicaid?
Medicaid provides health insurance and long-term care (nursing home, assisted living, adult daycare, in-home care), and is financed by the federal government and the state in which you reside. While the states must comply with federal laws and guidelines, each state has significant discretion concerning eligibility and implementation of the program, and the range of services provided. There are notable variations among the states, including allowed techniques to become eligible for the program.
Are You Dual-Eligible?
Some people qualify for both Medicaid and Medicare, these individuals are referred to as “dual-eligible.” In this case, Medicaid is the primary payer for healthcare. Medicaid may cover cost-sharing, including deductibles and co-pays, as well as premium aid.
The accompanying infographic provides a quick reference to the distinctions between the two programs.