Medicaid basics

Medicare vs. Medicaid

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Medicare and Medicaid are two different programs. Medicare is federal health insurance, and Medicaid is run by the state. Use our chart to compare the differences. Medicare and Medicaid are both government-sponsored programs designed to help cover healthcare costs. Both programs were established by the U.S. government in and are funded by taxpayers.

Medicare basics

The big choice Medicare beneficiaries face is whether to opt for Original Medicare and purchase a Medicare Part D plan or to enroll in Original Medicare and purchase a Medicare Part C plan to serve as their primary coverage.

Costs may include premiums, deductibles, copays and coinsurance. How do I get it? Many people are enrolled in Parts A and B automatically when they turn You can also contact your local Social Security office to see if you are eligible. A joint federal and state program that helps pay health care costs for certain people and families with limited income and resources. Different programs under the Medicaid umbrella are designed to help specific populations.

What does it cover? Each state creates its own Medicaid programs, following federal guidelines. There are mandatory benefits and optional benefits. Mandatory benefits include, in part:. It depends on your income and the rules in your state.

There are two government-sponsored health insurance programs available to Americans: Medicaid is jointly funded by the states, so eligibility for the program varies.

Medicare eligibility, conversely, is standardized across the nation. Here is a look at the differences between Medicare and Medicaid.

Medicare is the federal health insurance program for Americans and permanent U. However, Medicare is primarily thought of as a social health insurance program designed to help retired Americans pay their medical expenses. Medicare is funded by taxpayer dollars and premiums paid by beneficiaries.

Income does not affect your Medicare eligibility. In fact, Americans 65 and over who are receiving federal retirement benefits are automatically enrolled in Medicare Part A and Medicare Part B jointly known as Original Medicare. Americans who are 65, but not yet on federal retirement benefits, have to enroll in Original Medicare during an month initial enrollment period. It kicks off three months before you turn 65 and ends three months after your 65th birthday.

If you miss initial enrollment, you can only sign up for Medicare during a special or general enrollment period. Learn more about applying for Medicare. Medicare comes in four different parts, each responsible for covering different health care costs:. Your specific coverage varies depending on what route you go. The big choice Medicare beneficiaries face is whether to opt for Original Medicare and purchase a Medicare Part D plan or to enroll in Original Medicare and purchase a Medicare Part C plan to serve as their primary coverage.

Our partner Via Benefits can help you compare and purchase Medicare plans in your area. The cost of Medicare varies, depending on your elections, state and income. However, Medicare beneficiaries are generally expected to pay premiums, deductibles and coinsurance or copays once they enroll. Learn more about the costs of Medicare. Medicaid is a jointly funded federal and state health insurance program for needy Americans. If a state offers Medicaid — and every one currently does — they must meet certain parameters to obtain federal funding.

But they also have a lot of control over eligibility and covered services, which is why Medicaid programs vary so widely from state to state. Having said that, Medicaid qualifications are broadly based on:.

CMS monitors Medicaid programs, but they are administered by their respective states. You can find a state-by-state guide to Medicaid requirements here.

If you qualify, you can apply for the program through Healthcare. That provision was ultimately overturned by the Supreme Court and, like the Medicaid program itself, became optional.

To date, 33 states plus Washington, D. However, several of these states, including Arkansas, Indiana and Kentucky, have added work requirements to their expansion programs.

To keep coverage, low-income individuals in this group must work, train, volunteer, take classes or engage in other job-related activities to keep their coverage. Medicare — which is primarily for retirees — does not have work requirements.

Broadly, Medicaid covers major medical expenses, but specific services and prescription drug coverage varies by state. Each state, however, is required by the federal government to cover the following care in order to receive funding:. Optional covered services include prescription drug, physical therapy, occupational therapy and dental, vision or hearing insurance. Certain Medicaid beneficiaries are exempt from most or all out-of-pocket costs.

These beneficiaries typically include pregnant women, children, terminally ill individuals and patients living in a health care institutions.

These individuals are enrolled in Original Medicare, but receive Medicaid benefits through a Medicare Savings Program. Learn more about Medicare Savings Programs. CMS releases the criteria for each dual-eligibility each year. Given these programs tap Medicaid resources, they are income-driven. You can find requirements here. If you have both Medicare and Medicaid, Medicare serves as your primary form of coverage. Consult a professional to learn what financial products are right for you.

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Medicare vs. Medicaid chart

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