Medicare v. Medicaid—Similar Names, Different Benefits
This post was reviewed by our Director of Clinical Excellence and Oversight.
If you’re old enough to remember Peter Pan collars and Sandy Koufax’s perfect game against the Cubs, you probably remember a time before Medicare and Medicaid. These programs were signed into law by President Lyndon Johnson on July 30, 1965, although the idea of universal, national healthcare dates back to President Truman in the 1940s. In fact, as an acknowledgement of President Truman’s role in developing the new insurance coverage, President Johnson issued the first two Medicare cards to Truman and his wife, Bess.
While the similarly named government programs both provide health insurance, they differ in two key ways: who the program serves and how it is funded. Medicare is federally funded and is intended for people over age 65, no matter what the person’s income might be. Medicaid is managed by each state and primarily serves low-income individuals.
Even those who receive Medicare and Medicaid benefits say they get confused about the programs. So don’t be concerned if you’re not totally clear on the differences. We’re here to set you straight and make sure you understand the benefits you’re entitled to!
“This great nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.”
~ President Harry Truman
Similar Name, Different Purpose
Here’s a basic overview of the two programs:
Medicare
Medicare is the federal health insurance program for people 65 years or older, or those under 65 with a qualifying disability or end stage renal (kidney) disease. About 63 million Americans receive the benefits. There are two types of Medicare, Original Medicare and Medicare Advantage.
Original Medicare has two parts. Part A covers hospital visits, hospice care, and some skilled nursing and home care. The second part of Original Medicare is Part B, which provides medical services from doctors and other providers (preventive, diagnostic/screening, and treatment) for conditions including diabetes, cancer, heart disease, and others. Many people use original Medicare as their primary health insurance.
Medicare Advantage, also known as part C, is for people who want the coverage included in Original Medicare, but also seek additional options for coverage. Medicare Advantage plans often cover prescription drugs, vision, dental, and hearing care, which are not included in Original Medicare. Part D is prescription drug coverage.
The federal government pays for Parts A and B, while Parts C and D are separate policies sold by private insurance companies. You apply for Medicare Parts A and B directly by enrolling with Social Security at www.ssa.gov when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. If you do not apply during this time, you can also apply during open enrollment, which runs from November 1-December 15. Sign up for Part C or D through the private insurance company that offers the plan you want.
A few other facts about Medicare:
- The cost of Medicare, more than $650 billion(!) per year, is paid by trust funds that you and other working people pay into over the course of your employment. Medicare recipients also contribute through co-pays and small monthly premiums.
- Coverage is basically the same across the United States. If you live in Illinois your Medicare benefits are similar to those of a friend who lives in New Hampshire.
- Medicare is run by a federal government agency known as the Centers for Medicare and Medicaid Services.
- Original Medicare pays for most, but not all healthcare services and supplies. Additional coverage known as Medigap policies, sold by private insurers, can help with some of these other costs, like co-pays, and deductibles.
- Detailed information about Medicare can be found at www.medicare.gov.
“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”
~President Lyndon Johnson
Medicaid
Medicaid is a joint state and federal government assistance program that helps low-income households with their healthcare expenses. About 72 million people currently participate. In order to receive Medicaid benefits, you must have an income below 133% of the federal poverty level.
What does that mean? For 2021 that translates to about $12,880 for an individual, and $26,500 for a family of four.
You also must be a resident of the state you’re applying in and be a US citizen or have the proper immigration status. Medicaid benefits are available to those with a limited income who are 65 years or older, 19 or younger, pregnant, living with a disability, or caring for a child. In some states, you can be an adult without dependent children.
Medicaid is considered a more comprehensive health insurance program than Medicare. Free or low-cost services include routine healthcare such as doctor visits, hospital stays, preventive care (mammograms and colonoscopies), mental health care, and medications. Medicaid may also cover nursing home care, medical-related transportation, and dental, vision, and hearing services, which are not normally covered by Medicare. Some medical supplies, such as incontinence supplies, which are not covered by Medicare, will be covered by Medicaid.
A few other facts about Medicaid:
- Medicaid services do not usually require a co-pay, though individual states can charge fees to certain groups of recipients.
- Eligibility for Medicaid is based on income. The amount you pay depends on your income and the size of your family.
- While Medicaid benefits differ from state to state, every program includes labs, X-rays, inpatient and outpatient hospital services, family planning, dental surgery, nursing facility services, health screenings, and applicable medical treatments for children.
- You can sign up for Medicaid any time during the year.
- Detailed information about Medicaid is available at www.medicaid.gov.
One important thing for those covered by Medicare, Medicaid, or private insurance to know is that Home Care Delivered accepts all these types of insurance and can ship your approved medical supplies right to your door.
Can You Receive both Medicare and Medicaid benefits?
Yes, you can, and it’s known as being dual eligible. You might have original Medicare (Parts A and B) or a Medicare Advantage plan (Part C), with Medicaid covering prescriptions under Part D.
Whether you’ve received assistance for years or have just become eligible for Medicaid or Medicare due to age, income, or health status, it’s important to understand how these programs work. One important thing for those covered by Medicare, Medicaid, or private insurance to know is that Home Care Delivered accepts all these types of insurance and can ship your approved medical supplies right to your door.
No driving to the store, no endless waiting on the phone. Just the blood pressure-lowering satisfaction of speaking to a compassionate human being who understands your needs! If you live with diabetes and have been thinking about switching to a Continuous Glucose Monitor and have the OK from your doctor, we’ve got the latest devices from Dexcom and FreeStyle Libre.
It’s easy to get started. Simply call 804-885-4101 and enroll by phone in minutes.
Just like Medicare and Medicaid, HCD is here to keep you healthy today, and in the future!
