Everything About Medicare and Medicaid

Everything about Medicare and Medicaid

Medicare and Medicaid are two government-sponsored programs that offer medical and health-related services to eligible individuals within the US.

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicare is a federal program that provides health coverage if you are 65, older, or under 65 and have a disability.

The Medicare and Medicaid programs were launched in July 1965 when then-President Lyndon B. Johnson signed amendments to the Social Security Act.

Medicare and Medicaid have helped make healthcare affordable for tens of millions of beneficiaries but the two programs differ significantly.

The Centers for Medicare and Medicaid Services (CMS) supervise and control the two programs.

According to the latest statistics, Medicaid served over 82 million individuals, and Medicare served over 60 million people. Note: These numbers continually change; please verify with current statistics for accuracy.

Now, let’s take a detailed look at the two so that you can determine which public health insurance program is best for you.

What is Medicaid

Medicaid is a medical and health services program for low-income households with limited resources. Certain criteria determine applicants’ eligibility to participate in this program.

States have significant flexibility to determine their own Medicaid eligibility, benefits, and payment rates, although they must adhere to federal guidelines to receive federal funding.

In this case, the state is responsible for determining other eligibility criteria, the type of service, the amount to be paid, the duration of treatment, and the scope of funding.

In addition, the states are also responsible for determining the rate of payment and administering the program.

Medicaid covered healthcare services

Although the final decisions rest with the specific states, they must follow federal requirements to receive appropriate federal funds.

However, not every insurance provider will be ready to accept Medicaid. It is advisable to check their coverage before applying for this insurance program.

Some of the major medical services provided under Medicaid are:

Prescribed medications
Prosthetic devices
Diagnostic services
Nursing services for children and adults under 21 years
Optometrist services, eyeglasses
Transport services
Medicaid dental coverage
Rehabilitation and physical therapy services

Eligibility Criteria for Medicaid

Every state dictates its guidelines for being a part of the Medicaid insurance program.

The program is mainly intended to assist individuals who belong to low-income households. However, there are other eligibility criteria too, including:

Age
Assets
Pregnancy status
Citizenship
Disability status (if any)

There are several provisions given in this program that allows other categories of people to receive benefits under Medicaid health insurance, such as:

Adults and seniors with limited resources or low income
Children, pregnant women and parents earning income over the required coverage limits
People living in institutions or having low income
Adults with vision or other disability and earning income less than the FPL
Individuals with no children and near FPL
Medically needful people with limited resources and qualifying within the state’s eligibility criteria

Now that you have sufficient knowledge about Medicaid, let’s examine Medicare more closely.

What is Medicare?

Medicare is a health insurance program operated by the federal US government that provides funds to hospitals and healthcare centers that care for the elderly. This public health insurance program also offers coverage to people with disabilities.

The Medicare program includes:

Part A & Part B – For hospital and medical insurance
Part C & Part D – For prescription drugs and flexible healthcare services

Medicare Part A

Medicare Part A, also called Hospital Insurance (HI), pays for the cost of the beneficiary’s hospital stay and other related services, including:

Supplies
Meals
Semi-private room
Testing
Physical therapy
Speech therapy
Occupational therapy
Care in a skilled nursing facility
Medical equipment for the elderly and the disabled, such as wheelchairs, walkers, etc.

Medicare Part A is funded through payroll taxes and usually does not require you to pay a monthly premium.

Medicare Part B

Medicare Part B, also called Outpatient Medical Insurance, helps beneficiaries by paying for their:

Outpatient hospital visits
Medically necessary doctor’s visits
Services for the disabled and elderly care
Home healthcare costs
Preventive care services
Doctor and nursing services
Durable medical equipment, such as wheelchairs, walkers, scooters and canes
Blood transfusions
Vaccinations
Certain ambulance services
Chemotherapy
Immunosuppressive drugs after organ transplant
Eyeglasses
Prosthetic devices
Certain hormonal treatments

For benefits under Medicare Part B, you will need to be eligible for it and would need to pay a premium of around US$ 174.70 each month besides meeting the annual deductible of US$ 240 a year before Medicare starts providing funds for your treatment

Enrollment in Medicare Part B is completely voluntary.

Medicare Part C

Medicare Part C, also known as Medicare Advantage Plans or Medicare+ Choice, is a customized insurance plan.

Under this, the insurance provider covers everything covered under Medicare Part A and Part B, and may also offer certain additional services, such as hearing, vision or dental treatment coverage.

This plan is provided by private insurance providers, who provide some coverage. However, each plan is different within the same program and will depend on the individual’s eligibility.

Medicare Part D

Medicare Part D, also known as the Prescription Drug program, is provided by several private health insurance companies. The cost of the plan and coverage vary from company to company.

The eligibility criteria for Medicare Part D require the applicant to pay an additional fee, the Part-D income-related monthly adjustment amount. The exact fee amount will depend on the applicant’s income range.

Mostly, your Social Security check will be utilized to deduct the premium. On the other hand, some insurance providers may send you a bill directly from Medicare.

Eligibility Criteria for Medicare

If you wish to apply for Medicare, then you must be:

Over 65 years old,
Under 65 years but having medically proven disability,
End-stage renal disease or permanent kidney failure which requires regular dialysis or transplant as treatment,
A US citizen or permanent legal resident for 5 years, consequently,
Eligible for Social Security benefits for at least 10 years of contributing payment (enough work credits).