The Difference Between Medicare And Medicaid


There is a common misunderstanding about what Medicare and Medicaid really are, as they sound so similar.

Unlike Medicare, which is solely a federal social insurance program, each state operates its own Medicaid system, which however must follow federal guidelines. Medicaid is sometimes also referred to as ‘Medical Assistance’.

Medicare provides health insurance for seniors 65 years or older, people under 65 with certain disabilities, and persons of any age with End-Stage Renal Disease (ESRD). There are 4 different parts of traditional Medicare, each helping cover specific health services: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (also known as Medicare Advantage), and Part D (Prescription Drugs) offering health plan options run by government-approved private insurance companies.

Medicaid on the other hand is a needs-based social welfare program, available to certain persons and families with limited income and resources. Eligibility may also depend on age and and other factors such as pregnancy, or whether you are blind or have other disabilities, and whether you are a U.S. citizen. Eligibility is largely determined by income and the rules for counting an applicant’s income and eligibility differ significantly from state to state, although all states must be in line with the federal regulations. As a joint federal-state program, Medicaid provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care. In some states persons who receive Medicaid benefits are charged a small co-payment for health care services.

A few states have their own names for Medicaid, like “Medi-Cal” in California, “MassHealth” in Massachusetts, “Oregon Health Plan” in Oregon, “TennCare” in Tennessee, or “Soonercare” in Oklahoma. While state participation in Medicaid is voluntary, all states are currently participating. As a result, there are 56 different Medicaid programs, one for each state, territory, and the District of Columbia. Medicaid is in some states subcontracted to private insurance providers, wheras other states allow private insurance companies or health maintenance organizations to directly contract with the state Medicaid department at a fixed price per enrollee.

If you have limited income and resources, you may qualify for Medicaid help paying your Medicare health care and/or prescription drug coverage costs. Even if you are not sure whether you qualify, if your income is limited, and you or somebody in your family needs medical care, you should apply for Medicaid and have a qualified case worker in your state look at your situation. People with Medicaid who are disabled or elderly may also get coverage for services such as nursing home care or home and community-based services. For more information, visit, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance office.

If you have questions about Medicare, visit, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you qualify for both Medicaid and Medicare, most of the expense for your medial and health care will be covered, even approved prescription drug coverage.

By: Joseph Rosario

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