Difference between Medicare and Medicaid


These are programs sponsored by the US government to provide medical coverage to certain categories of citizens. They are both financed by the tax payers and were started in 1966. In this article, we will go through both of these insurance programs in order to get a better understanding of their differences.
What is Medicare?

This is the most common healthcare plan for seniors. It is a governmental medical program that provides cover to the people above the age of 65 years. This insurance plan additionally covers the younger persons living with disabilities or people with intense health conditions such as dialysis patients. The trust funds which the insured paid into are used to cover for the medical bills. The patients covered by this plan only pay a part of the total medical costs through the hospital deductibles plus other costs. In case of non-hospital coverage, small premiums that should be paid monthly are required. This medical plan is essentially similar in all the states of the US and is managed by a federal government agency referred to as Centers for Medicaid and

Medicare services.

Since this is a government healthcare program, the US federal government funds various medical expenses by directly paying the hospitals, doctors plus other health service providers. This health insurance program was established under Social Security Administration in 1966. The Medicare health insurance consists of four parts namely part A, B, C and D. Part A covers skilled nursing, hospice services and hospital costs for the inpatients who are formally admitted while the pat B covers the outpatient medical services. Part D on the other hand provides coverage to the prescription drugs while part C enables patients to acquire Medicare insurance coverage that provides the same coverage as part A & B through the various private insurance firms.

What is Medicaid?

This is a joint state and federal government medical insurance program that covers citizens with low incomes regardless of their age. It is mostly used in affiliation with the Medicare insurance plan. It provides coverage to the people in need for particular medical services or the prescriptions that the Medicare plan may not cover. With this type of health insurance plan, the patients are not required to pay any amount of money so as to cover for the medical expenses. However, sometimes a small co-payment may be required. Unlike the Medicare insurance plan, the Medicaid insurance plan differs from one state to the other. It is also worth noting that Medicaid is controlled within the federal guidelines by the local and state governments.
It worth noting that there is a certain program referred to as Children’s health insurance. This program helps to provide medical coverage to children who require low-cost health care and their families earn a lot of money thus disqualifying them for the Medicaid. This insurance program for children has a set of complex guidelines and rules.
Since Medicaid is a partnership program of the state and federal government, each and every state in the US tends to have its own Medicaid program. However, the federal government authorizes coverage for various services such as x-rays, family planning, clinic treatment, midwife services, nursing services, laboratory, doctor services and hospitalization.
Each state may also include extra benefits like optometrist services, medical transportation, prescription drug coverage, physical therapy, dental services and prosthetic services.
Additionally, Medicaid is used to finance long term health care not covered by many private medical insurance policies or Medicare.

Main differences between Medicare and Medicaid

• Medicaid is developed for citizens with low income while Medicare provides coverage to senior citizens above the age of 65 or young disabled people.
• Medicaid varies from state to state while Medicare is similar in all the states.
Can I have Medicare and Medicaid?
It is possible for a person to be covered by both the Medicare and Medicaid. This is referred to as dual eligibility for people who qualify to be covered by both of these health insurance programs. If Dual eligible patients happen to have claims, the Medicare insurance pays first while Medicaid pays last.
Qualification for both programs is determined by the state of residence, though qualification for Medicare program only is determined by the government.


Both of these programs are very useful in providing medical coverage for seniors, disabled young people and low income earning citizens.

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