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Difference Between US Medicare And Medicaid

There are some significant distinctions between Medicare and Medicaid in the US:

Eligibility Criteria

Medicare is available to individuals aged 65 and older. Younger persons with disabilities and those with end-stage renal disease (ESRD) may qualify as well.

Medicaid provides health coverage to the people listed below.

  1. Low-income individuals
  2. Families who meet income and eligibility requirements
  3. Pregnant women
  4. Children and parents
  5. Individuals with disabilities

Administration

Medicare is administered by the federal government’s Centers for Medicare & Medicaid Services (CMS). It gets funding from payroll taxes and premiums paid by beneficiaries.

Medicaid is funded jointly by the federal government and the states. Each state is responsible for managing its own Medicaid program in accordance with federal standards.

Coverage of Medicare and Medicaid

Medicare covers the services below.

  • Part A: Hospital care
  • Part B: Medical services and doctor visits
  • Part C: Optional supplemental coverage through private Medicare Advantage plans
  • Part D: Prescription drugs

Medicaid covers a greater range of healthcare services. Check the Medicaid program of your state.

  • Doctor visits
  • Hospital stays
  • Long-term care
  • Preventive care
  • Mental health services

Costs

Medicare beneficiaries may be responsible for the listed costs below.

  • Premiums
  • Deductibles
  • Coinsurance
  • Copayments

Medicaid offers coverage at little to no cost to eligible individuals. States are bearing the majority of the expenditures. Certain Medicaid programs may impose minor copayments for specific services.

Dual Eligibility

Dual eligibility covers Medicare and Medicaid. Below are the types assistance they may receive.

  • Medicare premiums
  • Cost-sharing
  • Coverage gaps through Medicaid

Long-Term Care

Medicare covers limited skilled nursing facility care after a hospital stay. It excludes coverage for custodial care in nursing homes or assisted living facilities.

Medicaid covers nursing home care and home- and community-based services. This coverage is available to those who meet the program’s requirements.

Medicare and Medicaid Scope of Coverage

Medicare is a primary health insurance program that covers medical services and hospitalization.

Medicaid is a means-tested social welfare program. It provides full health coverage. It offers assistance with long-term care for low-income individuals and families.

 

Contact a health insurance agent to determine the best plan for you. Arizonans may visit the website of Arizona Department of Economic Security for welfare program details and eligibility requirements.

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