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When it comes to healthcare in the United States, two of the most popular programs among seniors are Medicare and Medicaid. Both programs help millions of Americans, but they have different structures and purposes. Medicare is a federal program that provides health insurance for people over the age of 65, as well as certain individuals with disabilities. Medicaid, on the other hand, is a joint federal-state program that provides health insurance for individuals and families with low incomes.

Medicare and Medicaid can be traced all the way back to 1965 when both programs were created as part of President Lyndon B. Johnson’s initiative, known as the “Great Society” program. The purpose of this initiative was to tackle issues related to poverty and inequality in the United States. Medicare and Medicaid have undergone several changes and amendments over the years. However, their main purpose remains the same, which is to provide access to healthcare for vulnerable groups in the society.

Now let’s explore the key differences between these two programs, including their eligibility requirements, coverage, and cost.

Who is eligible for Medicare?

Eligibility for Medicare and Medicaid is a key difference between the two programs. Medicare is available to any individual over the age of 65, as well as to certain individuals with disabilities. This includes individuals who have been receiving Social Security disability benefits for at least two years, individuals with end-stage renal disease, and those with Amyotrophic Lateral Sclerosis (ALS).

Who is eligible for Medicaid?

Medicaid, on the other hand, is only available to individuals and families with low incomes. Each state sets its own income guidelines for eligibility, and these guidelines are subject to change. The eligibility for Medicaid is determined by the state and the individual’s income, assets, and household size. Medicaid is a joint federal-state program, and each state has a different income threshold to determine eligibility, so it is essential to check with the state program to know if you are eligible.

What does Medicare cover?

Coverage is another important aspect that distinguishes Medicare from Medicaid. Medicare is a comprehensive program that covers a wide range of medical services, including hospital stays, doctor visits, and prescription drugs. It also covers preventive care services such as screenings and vaccinations. Additionally, it offers several options for prescription drug coverage and some plans include additional benefits like vision, hearing, and dental coverage.

What does Medicaid cover?

Medicaid also covers a wide range of services, but the scope of coverage may be more limited than Medicare and can vary between states. Services typically include hospital stays, doctor visits, prescription drugs, and long-term care. Some states may have limits on the number of days of inpatient hospital care covered under Medicaid or may not cover certain services such as dental care or vision services. Therefore, it is important to check with your states program to find out the specific coverage that is offered by Medicaid.

How much does Medicare cost?

The cost of both Medicare and Medicaid is an area of significant difference. Medicare is funded by a combination of payroll taxes, premiums, and general revenue. Beneficiaries of Medicare must also pay for certain out-of-pocket expenses such as deductibles, co-insurance, and co-payments, depending on the type of Medicare plan they have. Additionally, some beneficiaries may also have to pay extra for certain services such as prescription drugs.

Medicare Part A, which covers hospital insurance, does not have a monthly premium for most people. If you have worked and paid Medicare taxes for at least 10 years, you can get Part A coverage without paying a monthly premium. However, if you have not paid Medicare taxes, you may be required to pay a premium up to $506 per month. Medicare Part B, which covers medical insurance, has a monthly premium which is based on your income. In 2023, the standard Part B premium is $164.90 per month, but can be as high as $560.50 per month (for high income earners).

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare and typically includes Part A, Part B, and sometimes Part D. The cost of Medicare Part C plans varies depending on the plan and the coverage offered. Medicare Part D, which covers prescription drugs, has a monthly premium that also varies depending on the plan and your yearly income.

How much does Medicaid cost?

Medicaid is primarily funded by the federal government, but with significant contributions from the states. The cost of the program varies depending on the state, and the income of the individual or family, as some beneficiaries may be required to pay a small share of the cost, known as a co-pay. The cost of the program also depends on the specific services covered and the type of services that you require. In general, Medicaid is a less expensive program than Medicare, but it also provides less comprehensive coverage.

Conclusion

While Medicare and Medicaid are not the same, you may be eligible for both. According to CMS (Centers for Medicare and Medicaid Services), more than 11 million Americans qualify for Medicare and Medicaid.

If you are eligible for Medicare and Medicaid, you are considered dual-eligible. In some areas, there are Medicare Advantage Plans built specifically for dual- eligible beneficiaries. You can call and speak with a Senior HealthCare Solutions agent about these plans.

Medicare and Medicaid are both essential government programs that provide essential health care coverage to millions of Americans. While they share some similarities, they have significant differences in terms of who is eligible, what services they cover, and how much they cost. This makes it essential if you qualify for either program to understand the distinctions between the two. That way you can make informed decisions about your health care coverage. Not only can this help ensure that you have the coverage you need, but it can also help you save money by avoiding unnecessary expenses.

For personalized help with Medicare or Medicaid, please speak with a Senior Healthcare Solutions Medicare expert at 866-MEDIGAP (866-633-4427). We can provide advice and guidance to help you maximize the value of your coverage and ensure that you are getting the most out of your policy.

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