What are the differences between Medicare and Medicaid plans? While the names are very similar and both assist on paying for health and medical expenses, the plans are immensely different. Here’s a deeper look into the two programs and what you need to know about both.
What Is Medicare?
Medicare coverage is comprised of individuals aged 65 and above, as well as younger individuals who have specific disabilities. There are four parts (A, B, C, and D) — for some of which you must pay a monthly premium:
- Part A, which includes hospital care (cheaper deductibles and coinsurance)
- Part B, which includes doctors and other medical professionals, medical tests, rehabilitation, and some health equipments
- Part C, or “Medicare Advantage,” is an different option than regular Medicare coverage and is administered by private insurance companies, on an in-network-only basis
- Part D, which covers medicine prescriptions
What Is Medicaid?
Medicaid provides health insurance and long-term care (nursing home, assisted living, adult daycare, in-home care), and is funded by the federal government and the state in which the patient lives. While the states must abide by federal legislation and rules, each state has significant consideration concerning qualification and implementation of the program, and the range of assistance provided. There are notable differences between the states, including allowed procedures to how you become eligible for the program.
Are You Eligible For Both?
Some individuals can qualify for both Medicaid and Medicare, those individuals are known as “dual-eligible.” In this situation, Medicaid is the principal payer for healthcare. Medicaid may cover cost-sharing, including deductibles and co-pays, as well as premium assistance.
The accompanying infographic provides a brief explanation of the differences between the two programs.