Difference Between Medicare and Medicaid (With Table)

Providing adequate medical facilities and healthcare is a norm for any country. Insurance is vital in providing the best healthcare. The various income group of a country augments the challenge in providing health coverage. These programs work in collaboration to provide the best health care and medical facilities to the citizens.

Medicare vs Medicaid

The difference between Medicare vs Medicaid is that Medicare is a federal program that provides healthcare coverage to U.S. citizens and for citizens with certain disabilities. The income level of an individual does not decide the eligibility for Medicare and Medicaid is a program that works in collaboration with the state and federal government.

Medicare has four basic categories covering various overheads. The broad categories are hospitalization, necessary medical services, prescription drugs, and supplementary coverage.

On the other hand, Medicaid assists in health care facilities for lower-income groups. It assists millions of citizens.

People with disabilities, children, and adults avail the services. It covers the cost of nursing facilities for those who have no means of paying for it.

Comparison Table Between Medicare and Medicaid

Parameter of ComparisonMedicareMedicaid
MeaningIt is a Federal Insurance program.It is a state and federal program to assist lower-income groups.
Criteria65 years and above, and younger people get the facilities based on specific disabilities.There are no age criteria. It is based on income.  
CostsThe citizens pay part of the cost through deductibles. Medicare requires a small number of monthly premiums.They may or may not pay for the expenses incurred. A small fee is paid at the time of enrollment.
CoverageMedicare is divided into various parts to cover different aspects of health care.The benefits vary in every state. Some basic expenses are covered by all states.
Administered ByThe federal government forms uniform rules for Medicare at a national level.The state manages its own Medicaid program.

What is Medicare?

A national health insurance program that began in 1965 is Medicare. It is a program in the United States which was part of the Social Security Act. Medicare aims at subsidized healthcare services. It even gives coverage to senior citizens above 65 who have no insurance cover. The plan targets senior citizens aged 65 and above. Citizens below 65 with specific disabilities also qualify for Medicare.


There are few definite eligibility criteria for Medicare. Anyone legally living in the United States for more than five years and is aged 65 or above qualify for Medicare. Citizens under the age of 65 who receive Social Security Disability Insurance (SSDI) also qualify for Medicare. Anyone with ALS (Lou Gehrig’s disease) automatically qualifies for Medicare.


Four different Medicare programs are available to citizens. Broadly it is divided into Part A, Part B, Part C, and Part D. Basic coverage primarily is covered in Part A and B.

Let us briefly understand each of these divisions:

Medicare Part A:

It covers the regular billings by the hospital or similar in-patient settings. It can even get utilized in nursing facilities or home-based healthcare. It does not cover long-term costs. Coverage is spontaneous for every one part of the Social Security Benefit. Enrollment is compulsory for those who do not receive Social Security.

Medicare Part B:

It takes care of the outpatient cover cost. Doctor’s visit, Ambulance charges, and specific medical equipment are taken into consideration. Explicit drug prescriptions covered are in Part B. A standard monthly premium is charged based on the annual income.

Medicare Part C:

This plan is also named Medicare Advantage. It can get purchased through private insurers. They could include insurance even while traveling out of the States. Many offer dental or ophthalmology care.

Medicare Part D:

This plan is for supplementary prescription drug coverage. Many in the primary inclusion opt for Part D to receive subsidies for prescription drugs. These drugs originally are not covered in the Medicare plan.

What is Medicaid?

This healthcare program is designed to help in the healthcare costs for people with limited income and resources. This venture in the United States is both a federal and state program. Medicaid offers benefits that are generally covered by Medicare. Medicaid coverage is not limited to regular medical aids.

It includes intricate and even ensures the expensive medical needs of the citizens. Let us now discuss the basic features of Medicaid:

  1. Medicaid is a national health care program to provide quality medical services to the lower-income group. For many citizens, this is the principal source of affordable health care.
  2. Medicaid is funded jointly by the government and the states. There are two basic agreements for Medicaid- all American citizens are authorized for coverage. The States are guaranteed financial assistance without any bound on eligible enrollees.
  3. There has been a significant expansion in the coverage of Medicaid. Many working adults are insured through Medicaid before the ACA (Affordable Care Act) had no preferences for affordable health care.
  4. Medicaid is a boon for millions of Americans. Beneficial for people who cannot have the funds for health and long-term medical care. 
  5. Medicaid covers long-term services and support to home or community-based services. Citizens can avail themselves of Medicaid facilities in the comfort of their community or home.
  6. Medicaid beneficiaries are blessed with better medical access. Deferral of medical care or living with medical issues due to monetary constraints is now history.
  7. Senior citizens or people with disabilities are the significant recipients of Medicaid in comparison to children or adults.  

Main Differences Between Medicare and Medicaid

  1. Medicare and Medicaid provide healthcare facilities based on the age of the citizen. Medicare insurances citizens aged 65 years and above. Any citizens with chronic conditions or disabilities get to be included in the Medicare facility. Medicaid provided is for those with lower income with minimal or no cost.
  2. There are different cost factors involved in both these plans. Citizens availing Medicare benefits pay part of the costs incurred. Any costs incurred outside the hospital are payable. A monthly premium paid is to benefit from the Medicare facility. There are pocket costs for prescription drugs. There is no payment for any of the covered expenses in Medicaid. In exclusive cases, there could be a minimal copayment. The States charge a limited premium as enrollment fees.
  3. To avail the benefit of the system there are few specific eligibility criteria, and the age of the citizen determines the benefits of Medicare available. The person must be a citizen or a permanent resident of the United States. Any younger person with a specific disability can gain Medicare assistance. Medicaid eligibility depends on the income and size of the family.
  4. The medical coverage of the schemes is very distinctive. Medicare is divided into basic-four parts, covers different phases of healthcare. The Medicaid benefits vary state-wise. There are selected benefits which is the core of the program. Offered in all the states, Medicaid is available everywhere.
  5. Both the program is funded and governed in different methods. Medicare is a federal insurance program. The bills paid are through the funds, and insurers finance them. Medicaid is a State and a Federal program, and it is an aid program. The Patients customarily do not pay for the costs covered. 

Conclusion

Both Medicare and Medicaid are available to the elderly, disabled, adults, and children. They are even at hand to low-income individuals and families. They are both supported by the government. Each of the programs is unique in its characteristics and coverage. Similarly, both work in coordination to provide the best health care facilities to the citizens.

It aims to offer better health care facilities for the citizens. The individual availing the facilities has a right to quality care and feels secure while receiving the care. Medicaid gives the uninsured the right to care and treatment. Anyone eligible can apply for either Medicare or Medicaid depending on the situations in their lives.

Medicare and Medicaid are considered the most efficient and well-managed health insurance in the world. They strive to enhance their performance to create a world-class health care system. They believe in providing better care. Spending intelligently results in healthy citizens.

References

  1. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2009.0494
  2. https://pubmed.ncbi.nlm.nih.gov/20677415/
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