Medicare vs. Medicaid

Barbara K. Armstrong
Paralegal

I am often asked what the difference between Medicare and Medicaid actually is. So, I decided to do a little summary on the differences that I hope you will find helpful in the event that you, a relative, or a friend has questions. 

MEDICARE:

Medicare is a federal health insurance program for individuals 65 or older, under 65 with certain disabilities, or any age if they have End Stage Renal Disease or ALS. The federal government provides coverage and it is paid for from payroll tax.  The coverage depends on the type of plan you choose and may include the following:

• Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
• Doctor visits, care and services received as an outpatient, and some prevent care (Part B)
• Prescription drugs (Part D)

Medicare Advantage plans (Part C) combine A and B coverage, and often will include drug coverage (Part D) as well. Medicare costs depends on the coverage that is chosen.   The costs may include premiums, deductibles, co-pays and coinsurance. Upon reaching the age of 65 years, many people are enrolled in Part A automatically.   To be sure of your eligibility, you should contact your local Social Security office.

MEDICAID:

Medicaid is a joint federal and state program that helps pay health care costs for people and families who have limited income and resources.  There are different programs that are designed for specific populations. Although Medicaid is a joint program, it is governed by the state you reside in.  Each state creates its own Medicaid programs, which have to follow federal guidelines. Mandatory benefits include, in part:

• Care and services received in a hospital or skilled nursing facility
• Care and services received in a federally qualified health care center, rural health clinics of freestanding birth centers (licensed or recognized by the individual state)
• Doctor, nurse midwife, and certified pediatric and family nurse practitioner services

Medicaid costs depends on income and the rules of your state. Costs may include premiums, deductibles, co-pays and coinsurance. Certain groups are exempt from most out-of-pocket costs. Eligibility for Medicaid depends upon the state that you live in. If you think that you may qualify, you should call your State Medical Assistance (Medicaid) office to inquire.