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 termed as social protection or social welfare program while Medicare is deemed to be a social insurance program.
The Medicare and Medicaid programs were launched back 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 from each other.
The two programs are supervised and controlled by the Centers for Medicare and Medicaid Services (CMS).
According to the latest statistics, Medicaid has served over 64.5 million individuals while Medicare has assisted more than 58 million people by paying for their medical treatments.
Now let’s take a detailed look at the two so that you can determine the best-suited public health insurance program for you.
What is Medicaid?
Medicaid is a medical and health services program aimed at low-income households with limited resources. Certain criteria determine the eligibility of applicants to participate in this program.
Some of the criteria vary slightly from state to state but the federal government dictates the main eligibility criteria for participating in Medicaid.
In this, the state is responsible for determining other eligibility criteria, deciding the type of service, amount to be paid, 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 need to follow federal requirements to receive appropriate federal funds.
Not every insurance provider will be ready to accept Medicaid though. 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:
Medicare and Medicaid – Eligibility Criteria for Medicaid
- 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 take a closer look at Medicare.
What is Medicare?
Medicare is a health insurance program operated by the federal US government and provides funds to hospitals and healthcare centers to care for the elderly. This public health insurance program also offers cover 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
To avail of benefits under Medicare Part B, you will need to be eligible for it and would need to pay a premium of around US$ 148.50 each month besides meeting the annual deductible of US$ 203 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 in conjunction with private insurance providers who provide some of the coverage. However, each plan is different within the same program and will depend on the eligibility of the individual.
Medicare Part D
Medicare Part D also called the Prescription Drug program is provided with the help of several private health insurance companies. The cost of the plan and coverage varies 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 a minimum of 10 years of contributing payment
Conclusion
Medicare and Medicaid have helped tens of millions of deserving citizens enjoy top-notch healthcare services and medical treatments.
These programs are incredibly useful to allay the cost of expensive medical treatments.
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I am a dedicated healthcare researcher and an enthusiast specializing in medical grants, medical education and research. Through my articles, I aim to empower healthcare professionals and researchers with valuable insights and resources to navigate these critical aspects effectively.
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