Medicare vs Medicaid Pdf - YB Study -->

Medicare vs Medicaid Pdf

Difference Between Medicare and Medicaid Program

Medicare Medicaid
Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
Medicare is managed by the federal government and is mainly based on age. Medicaid is managed by states and is based on income.
Medicare is an insurance program. Medicaid is an assistance program.
Medical bills are paid from trust funds which those covered have paid into. It serves low-income people of every age. Patients usually pay no part of the costs for covered medical expenses. A small co-payment is sometimes required.
Medicare covers hospitalization, medically necessary services, supplemental coverage, and prescription drugs. It covers a variety of services, including Hospitalization, Laboratory services, X-rays, Doctor services, Family planning, Nursing services
No additional benefits. Each state also has the option of including additional benefits, such as prescription drug coverage, optometrist services, eyeglasses, medical transportation, physical therapy,
Fund long-term care is not covered by Medicare Fund long-term care is not covered by Medicaid



What is the Medicaid program?
Answer: Medicaid is a federal and statewide program that helps pay for the medical expenses of people with limited income and resources, and meets several criteria. People with Medicaid can insure services that are not covered or partially covered
covered by Medicare, such as nursing home care, personal care, transportation to healthcare facilities, home and community services, and also dental services, and services for the treatment of vision and hearing. 

To apply for Medicare in a state, you must be a resident of that state and
US citizen (or have official immigration status). Every state has different eligibility criteria for Medicaid and rules its design. If you are eligible for Medicaid in your
state, you are automatically eligible for extra help paying for Medicare drugs (Part D).
You may be eligible for Medicaid if you have
limited income, or:
  • Age 65 or older
  • Children under the age of 19
  • Pregnant
  • Disabled person
  • Parent or adult caring for the child
  • Adult without dependent children (in some states)
In many states, more parents and other adults are now eligible to participate in the program. If you've been rejected in the past, you can try again times and check if you meet the requirements. If you have Medicaid, you may be eligible for medical
benefits such as:
  • Doctor visits
  • Hospital stay
  • Long-term services and assistance
  • Preventive care, including vaccinations or vaccines, mammograms, colonoscopy, and other necessary assistance.
  • Prenatal and maternity services
  • Psychiatric care
  • Necessary medicines
  • Eye and dental care (for children)

You must apply for Medicaid if you or someone then your family needs medical attention. If you are not sure are you eligible for this program, qualified social worker
services in your state can assess your situation. Ask the Medicaid office
in your state, are you eligible for the program, and what are the steps to
filing an application.


What is the Medicare program?
Answer: Medicare is health insurance for:
  • People aged 65 or older
  • People under 65 with specific disabilities
  • People of any age with end-stage kidney disease (ESRD (chronic renal failure requiring dialysis or kidney transplants)

Structure of the Medicare program: 
The original Medicare program was paid health insurance. 
Consisting of 2 parts: Part A (hospital insurance) and Part B (medical expenses insurance).

Part A helps cover:
  • Inpatient treatment in hospitals
  • Care in a skilled nursing facility
  • Hospice
  • Home health care
Generally, you do not pay the monthly premium for Part A coverage if you or your spouse paid Medicare taxes while they were working. This is sometimes referred to as Part A without paying premiums. If you don't have rights to Part A without paying premiums, then you can pay Part A for your account.

Part B helps cover:
  • Services of doctors and other health care providers
  • Ambulatory treatment
  • Home health care.
  • Durable medical equipment (DME) (disabled chairs, walkers, hospital beds, and other equipment and materials).
  • Many preventive services (scans, shots or vaccinations, annual inspections).
  • Most people pay a standard monthly fee for Part B.
Note: The original Medicare program pays most but not the entire cost of medical services and products. Additional Medicare insurances (Medigap) are sold by private companies and can help in paying for some remaining health care costs, such as co-payments,  co-insurance, and deductible amounts.

Medicare Benefit (Part C):
  • This is an alternative to the original Medicare plan that includes a full insurance package. These "package" plans include Part A, Part B, and usually Part D.
  • Plans may include lower non-reimbursable costs, than the original Medicare plan.
  • Plans may offer additional benefits that the program the original Medicare plan does not cover (for example, vision services, hearing, and dentistry).

Medicare drug coverage (Part D):
  • Helps cover the cost of prescription drugs (including recommended vaccinations or vaccinations).
  • Covered through private drug plans, meeting the requirements of Medicare.
  • It may help reduce drug costs and protect against higher expenses in the future.

Related Posts