Medicare vs. Medicaid: What’s the Difference – Understanding the differences and fine distinctions between Medicare and Medicaid can be challenging, especially since both health programs are created to assist individuals with healthcare costs but have different structures and populations.
In this comprehensive guide, we will be discovering Medicare vs. Medicaid: what’s the difference? We will be clarifying all areas like eligibility criteria, coverage, cost, and differences.
What is Medicare?
Medicare is a federal health insurance program for people aged 65 and older. Furthermore, it offers coverage to individuals with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) and certain younger people with disabilities. Medicare works to help disabled and elderly people with the financial burden associated with health care.
What Does Medicare Cover?
The coverage offered by Medicare is divided into different parts. They include:
- Part A (Hospital Insurance)
- This type of Medicare plan covers:
- Hospice care.
- Inpatient hospital stays.
- Home health care.
- Skilled nursing facility care.
- Part B (Medical Insurance)
Meanwhile, this type of Medicare plan covers:
- Some home health care.
- Doctor’s services.
- Durable medical equipment.
- Outpatient hospital care.
- Preventive services.
- Part C (Medicare Advantage)
This type of Medicare plan covers:
- Additional benefits like vision, hearing, and dental.
- Combination of Part A and Part B coverage.
- Part D (Prescription Drug Coverage)
This type of Medicare plan covers:
- Prescription medications.
What Does It Not Cover?
Although a wide range of healthcare services are covered by Medicare, here is what it does not typically cover:
- Cosmetic surgery.
- Long-term care.
- Non-medical transportation.
- Routine eye exams for glasses.
- Acupuncture.
- Most dental care services.
- Hearing aids and exams.
Who is Eligible?
If you fall under any of these criteria, you are eligible to apply for the Medicare program:
- People with ESRD or ALS.
- Individuals aged 65 or older.
- S. citizens or legal residents who have resided in the United States for at least five years.
- People under the age of 65 with a qualifying disability.
How Much Does Medicare Cost?
Since Medicare is available through 4 plans, the prices also differ. Here are the average costs of Medicare healthcare plans:
- Part A
Most people do not have to make premium payments. Meanwhile, there are deductible copays and coinsurance.
- Part B
Premiums are applicable for everybody. On the other hand, most individuals will pay $174.70 per month. In other words, the monthly premiums for Part B plans differ based on income.
- Part C
For plans under this part, they have their premium costs, copays, coinsurance, and deductibles Although some plans cost $0 for premiums.
- Part D
The plans under Part D also have their deductibles, premiums, coinsurance, and copays. However, the average premium per month is $34.50.
What is Medicaid?
Medicaid is a joint state and federal program that offers healthcare coverage services to people and families with low income. What’s more, it was established in 1965 and was designed to give access to healthcare services to people who meet the eligibility and income requirements. Unlike Medicare, this program is managed at the state level, which causes the eligibility and coverage to vary.
What Does Medicaid Cover?
Here is what Medicaid typically covers:
- Long-term care.
- Transportation to medical appointments.
- Hospital and doctor visits.
- Mental health services.
- Laboratory and X-ray services.
- Prescription drugs.
- Home and community-based services.
- Preventive services.
- EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services.
What Does It Not Cover?
These situations or events are not generally covered by Medicaid.
- Regular vision care and eyewear.
- Cosmetic surgery.
- Non-medical transportation.
- Hearing aids and hearing exams.
- Most dental care.
Who Is Eligible?
Although your eligibility for Medicaid depends on the state you are residing in, here are the people generally eligible for this program:
- S. citizens or legal residents.
- Low-income individuals and families.
- People with disabilities.
- Elderly people who need long-term care.
- Pregnant women and children (up to a particular age).
How Much Does Medicaid Cost?
Generally, Medicaid is low-cost or free, but this depends on how you qualify and the rules of your state. The small fees and copayments for certain services can also differ by state.
Medicare vs. Medicaid: What’s the Difference?
In this section, a table will be illustrating the differences between Medicare and Medicaid in major areas or aspects:
| Features | Medicare | Medicaid |
| Coverage | Prescription drugs, hospital stays, and medical services (differ by part) | Mental health, hospital visits, prescription drugs, and long-term care |
| Administered By | Federal Government | State and Federal Government |
| Vision and Dental Care | Not covered | Limited coverage based on state |
| Cost | Deductibles, coinsurance, and premiums (differ by part) | Disabled, low-income individuals, the elderly, and families |
| Who is eligible? | For younger disabled individuals, people with ALS or ESRD, and people aged 65+ | Disabled, low-income individuals, elderly, and families |
| Long-Term Care | Not covered | Covered |
| Eligibility Requirements | Legal residents or U.S. citizens, age, ALS, ESRD, or disability | Must be a legal resident or U.S. citizen and income-based, differ by state |
Now, you have an overview of how Medicaid and Medicare differ in terms of cost, administration, coverage, eligibility, and many more. It will also help you choose a program that is best for your circumstances.