Medicare and Medicaid: All You Need to Know

Have you found it difficult to understand what is Medicare and Medicaid? Understanding in detail these federal programs is crucial for those who may be eligible or already enrolled. 

This blog post shares what Medicare and Medicaid are, exploring eligibility requirements, covered services, and costs. 

Medicare and Medicaid: A Quick Overview and Key Takeaways

Medicare and Medicaid, both are government federal healthcare programs that provide vital medical coverage to millions of Americans. It was established in the year 1965 and funded by the taxpayers. While they may sound familiar, there are distinct differences between these two. 

• Medicare: It is medical coverage for people aged 65 and above, and those with disabilities.
• Medicaid: it is a joint federal and state program, designed for people of all ages with limited income and is for people with limited resources and assets.

Key Takeaways:

• Both are government federal programs to help cover the healthcare costs of certain American citizens.
• Medicare is medical coverage for senior citizens and those with disabilities.
• Medicaid is designed for all aged people and with limited resources & assets.

Medicare

Medicare is a health insurance program that the US Government designs primarily focused on people aged 65 and above. Also, this program subsidizes healthcare services for people with disabilities and patients with end-stage renal disease. 

Medicare coverage is for specific areas of health care, some of which those who are insured must pay for. While this allows the program to provide participants with more cost and coverage options, it also adds complexity to the sign-up process. Medicare has four parts that cover each thing:

• Part A – For Hospitalization Coverage
• Part B – For Medical Insurance
• Part C – For Medicare Advantage Plans
• Part D – For Prescription Drug Coverage

4 Parts of Medicare to Know About

1. Part A (Hospitalization Coverage)

Part A of Medicare provides hospitalization coverage for people aged 65 and above, regardless of income. 

For eligibility, the individual and their spouse must have worked and paid taxes for at least 10 years to qualify for this program. Most people don’t have to pay a premium for part A if they or their spouse paid Medicare taxes while working.

2. Part B (Medical Insurance)

Those who are all qualified for Part A of Medicare will also qualify for Part B. This part of Medicare covers medical services provided by doctors and types of equipment. This includes:

• Facility visits
• Lab work
• X-rays
• Wheelchairs
• Walkers
• Diagnostic tests
• Certain therapies
• Preventative care

Beneficiaries are required to pay a monthly premium for Part B coverage, which is deducted from the Social Security benefits or billed directly if they don’t receive any Social Security.

3. Part C (Medical Advantage Plans)

People who are all eligible for Part A and Part B of Medicare are likewise eligible for Part C which is Medicare Advantage Plans. Private companies offer the Part C plan of Medicare which Medicare has approved.

Medical Advantage Plans typically bundle Part A and Part B, and sometimes Part D as well into a single plan, offering vision, hearing, and dental coverage. Some also cover prescription drug coverage which is Part D of Medicare. Medicare Advantage Plan benefits some individuals but can lead to a huge cost for others due to deductibles, copays, and coinsurance. The Beneficiaries must have been enrolled in Part A and Part B to join the Medicare Advantage Plan.

4. Part D (Prescription Drug Coverage)

The private companies approved by Medicare offer Medicare Part D plans. It provides coverage for prescription drugs,  including both brand names and generic medications.

Beneficiaries must enroll in a separate Part D plan and pay an additional monthly premium unless they have a medicare advantage plan that includes prescription drug coverage.

Medicaid

Medicare is a joint federal and state healthcare program that is designed to help all ages of American individuals with limited income and resources. 

It is a public health insurance program that is funded jointly by the federal government and states. It is operated at the state level which means the coverage can vary from state to state. 

This health insurance coverage program is available for individuals with specific income-based criteria. Medicaid is a cost-effective program for both recipients and the government, typically less expensive than private insurance.

1. Eligibility and Costs

The Primary eligibility criteria for Medicaid is American individuals with limited income and resources. The income threshold is set at a percentage of the federal poverty level, which varies from family size.

In most states, the income limit for Medicaid eligibility is around 138% of the FPL for adults and higher for children and pregnant women. Additionally, certain categories of individuals are eligible for Medicaid:

• Children under the age of 19
• Pregnant women
• Elderly individuals (age 65 and above)
• Individuals with disabilities

As Medicaid is jointly funded by the federal and states, the federal government covers a significant portion of the costs (typically between 50% and 83% depending on states’ per capita income), while the states contribute the remaining amount.

Beneficiaries are required to pay premiums, deductibles, or co-payments based on their income and the state’s Medicaid program restrictions.

2. Benefits

Medicaid offers a vast range of medical benefits which include:

• Doctor visits
• Hospital stays
• Mental health services
• Prescription drugs
• Telehealth coverage
• Preventative care (like check-ups and immunizations)
• Long-term care services (in some cases)

Related: University Of Maryland: A Telehealth Grant Program Success Story

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