Medicaid and Medicare are two federally funded healthcare assistance programs in the United States. These two schemes have labels that seem quite similar, which can result in misunderstandings over how they operate and the insurance they give. Both of these schemes were created in 1965 and are supported by public funds.
Medicare vs. Medicaid
Medicare: What is it, and How does Medicare operate?
Medicare is a government scheme that reimburses medical expenses through "sections." The coverage for inpatient hospital care is provided by Part A, whereas coverage for outpatient treatment is provided by Part B. Most of the time, when individuals discuss Medicare, they are referring to the "Original Medicare," which includes both Medicare Part A and Medicare Part B.
Medicare Supplement is often referred to as Part C of Medicare. Also, it is a bundled health insurance plan that combines Original Medicare Parts A and Medicare Part B into a single cash transaction for the beneficiary's convenience. These packages often contain additional perks that Original Medicare does not offer. Private insurance companies that adhere to the rules established federally provide these advantages.
Who Can Get Medicare Benefits?
Individuals entitled to Medicare must be at least 65 years old and either nationals or legal residents of the United States. Most persons qualified to receive Social Security benefits are also qualified to receive Medicare benefits. Individuals under 65 years’ old who are disabled in particular ways are also eligible for this program, as are individuals who are undergoing dialysis treatment or have to undergo any transplant.
What Are the Differences Between Medicare Parts A, Medicare B, Medicare C, and Medicare D?
The original version of Medicare pays for inpatient stays in clinics, assisted nursing facilities, medical care at home, and long-term care covered under Medicare Part A. In addition, it pays for doctor's appointments, preventative care, treatments for psychological health, physiotherapy, physical therapy, laboratory tests, and other outpatient care covered under Medicare Part B.
However, original Medicare does not cover dental services, eyewear, assistive devices, or prescribed drugs. Individuals who opt for the standard version of Medicare, termed as Original Medicare, can obtain prescription medication covered under a separate Medicare Part D plan.
All coverage covered by Original Medicare is also protected by Medicare Advantage. Most Medicare Advantage programs cover prescription drugs and other common benefits such as oral and optical coverage, assistive devices, and physical benefits. The coverages provided by each plan are different.
When Should You Enroll for Medicare?
You have the opportunity to enroll in Medicare beginning 3 months ahead of age 65. However, those with specific impairments that prevent them from reaching the age threshold of 65 might also be eligible. In most cases, you must wait at least 30 days after signing up for coverage to begin.
How to Enroll for Medicare?
During the period for open enrollment for Medicare, you can enroll in Medicare or make changes to your existing coverage. Those who join by December 7 will normally have insurance beginning on January 1 of the following year. The period for open enrollment for Medicare Advantage begins on January 1 and continues through March 31 each year.
Medicaid: What is it?
Medicaid is a plan run jointly by the state and federal governments to ensure that individuals with modest salaries should also have access to medical treatment.
Who is Able to Get Medicaid Benefits?
Medicaid is a government program that assists low-income households with the cost of medical care for their children and other dependents, as well as pregnant women, the aged, and disabled individuals.
The majority of persons who fall under 65 age but who have earned less than 138 percent of the federal poverty threshold will be eligible for Medicaid in several states that consented to implement the most recent expansion of Medicaid. In 2021, the amount for an adult was USD 12,880, while the total for a three-person family was USD 21,960.
Insurance for non-elderly individuals is confined to individuals having a kid, a woman who is conceiving, or handicapped individuals if they reside within 12 different states that elected not to Medicaid Expansion. This includes those who are not eligible for Medicare. Regardless of how low your earnings are, if you are an adult with no children, have non-handicap, and are not pregnant, you won't be qualified for this program.
What Covers Under Medicaid?
Federal regulations mandate that certain benefits be included in all plans, regardless of the state.
- Hospitalization costs are covered.
- Services for hospital outpatients
- Access to diagnostic imaging and laboratory services
- Access to professional family planning services
- Assistance from a nursing home
- Assistance with daily activities at home
- Care Provided by Doctors
- Help to get to the doctor
The following is a list of some of the additional perks that states can decide to offer:
- Prescribed drugs
- Physiotherapy
- Rehabilitation via occupation
- Assistance for those with speech, hearing, and language disorders
- Facilities related to the respiratory system
- Assistance related to optometry
- Endodontic services
Difference between Medicare and Medicaid
Those who meet the requirements for Medicare based on their age or the severity of their impairment. If your qualification depends on your age limit, you can participate in the program at age 65. Those who are living in low-income settings or who are in other rare situations are eligible for Medicaid.
Both plans are for people 65 and over with certain disabilities. However, Medicare is the major source of medical coverage. At the same time, Medicaid is intended for use by persons with a low or fixed income. Hospital treatment, clinically essential treatments, supplementary insurance, and coverage for prescription drugs are the four categories of services that fall within Medicare's insurance umbrella.
