What is the Difference between Medicare vs Medicaid

words Alexa Wang

In the US, there are two government-funded health insurance covers that the citizens can enjoy. The two are very different in their ways. Medicare insurance cover is for the elderly, while Medicaid is for low-income Americans. Both of the covers provide general health insurance benefits. Knowing how each of them works and what sets them aside is important.


What is Medicare?

Medicare insurance cover mostly covers patients who are above 65 years old. There is an exemption for people who are disabled and those suffering from end-stage renal failure. According to statistics, about 64 million Americans are covered by Medicare. Most insurance covers in the US are tied to one job, and if one retires, they are not covered. So many retired people are not well financially, so affording health care is a big issue. That is why the government came up with solutions to take care of the health of the elderly.

Medicare came to life in 1965 when the legislators came up with the idea.

Medicare is divided into three sections.

  • Hospital stays
  • Routine medical care
  • Prescription drugs

Most people don’t need an insurance premium for a hospital stay. If you have routine medical care, you are supposed to pay a premium according to one’s income. With prescription drugs, many different plans have different prices. If you are a holder of hospital stay, routine medical care, and prescription drugs, you can visit any health care provider who supports Medicare.

How is Medicare Funded?

When you are working, your employer pays a 1.45% tax that helps pay for Medicare. The premiums that medicare enrollees contribute also help fund this health care insurance.

When Should You Enroll In Medicare?

If you want to be covered in the Medicare plan, you must enroll https://clearmatchmedicare.com/blog/medicare/medicare-advantage-enrollment three months before turning 65 or three months later. Any time later than that is not acceptable. If you don’t apply during that time, you might experience delays and panel; ties. You might need to go without health coverage for some time.

Benefits of Medicare

The three sections discussed above should provide a baseline of coverage. Here are the benefits of Medicare covered by the section.

Hospital Stay

  • Nursing home care
  • Inpatient hospital care
  • Hospice services
  • Part-time in-home healthcare
  • Skilled nursing facility care

Routine Medical Care Benefits

  • A yearly check-up
  • Cancer screening
  • Vaccinations
  • Smoking cessation assistance
  • Medical equipment
  • Ambulance rides

You should know that Medicare does not cover long-term care in the home. It also does not cover hearing aids, foot care, eye care, and dental care.

What is Medicaid?

As seen before, Medicaid coverage is meant for people with low income. Pregnant people, persons with disability, older people, and some children are given exemptions. As of 2021, around 78 million Americans have enrolled for Medicaid.

Medicaid came to life at around the same time as Medicare to provide health care coverage for people who could not afford private health insurance and those who couldn’t afford out-of-pocket health care.

The main difference between Medicare and Medicaid is that eligibility requirements vary from state to state for Medicaid.

The children’s health program is meant to care for children from low-income families. In some states, the program is not attached to Medicaid, but to some, it is considered part of Medicaid.

With Medicaid, most people don’t pay for premiums, but if an appointment is required, co-pay comes in place. Again this is different from state to state.

How Is Medicaid Funded?

Both state and federal governments fund Medicaid. The federal government matches the same amount if one state allocates $4 billion for Medicaid.

How Do You Sign Up For Medicaid?

When you feel eligible to sign up for Medicaid, you need to apply to your state’s Medicaid program. There is a set time for Medicaid, like Medicare.

Benefit of Medicaid

Even though the eligibility of Medicaid varies from state to state, there are services that each coverage should have.

  • X-rays
  • Lab services
  • Inpatient hospital services
  • Outpatient hospital services
  • Doctor visits
  • Certified nurse visits
  • Nursing facility care
  • Transportation to receive medical care
  • Family planning aid
  • Rural health clinic care
  • Tobacco cessation support for pregnant women

The services listed below may vary depending on your state.

  • Hospice care
  • Dental care
  • Physical therapy
  • Prescription drugs
  • Occupational therapy
  • Podiatry
  • Prosthetics

So, Can You Get Both Medicare and Medicaid?

The answer to that is yes. You may use both Medicare and Medicaid health insurance coverage. If you are using both covers, you will need to exhaust Medicare. After the exhaustion, you will be allowed to use Medicaid to cover the remaining expenses. In many states, dual plans are allowed to make your health care experience less tiring.

How Do You Qualify For Both Medicare And Medicaid?

To enroll in both Medicare and Medicaid health care insurance, you need to meet the income criteria set by your state for Medicaid. It would help if you also reached the age to enroll in Medicare.

What Is Covered By Both Medicaid and Medicare?

In both medical care insurance programs, you are covered for hospitalization, doctor, and medical care. Medicaid is known to be comprehensive, while Medicare is known to combine multiple parts to form one.

With Medicaid, long-term care in the facility home is covered, unlike in Medicare and other private health insurance policies. Medicaid is known to cover those older people who have exhausted their savings to pay for health care and have no other source of income.

Health care is very important. In the US, anyone is eligible to be covered under insurance cover. Medicaid has its back for small children and families with low income. Older people who have already retired are guaranteed to have medicare insurance coverage as long as they are 65.


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