Medicare vs Medicaid
Medicare and Medicaid are both U.S. government-sponsored health insurance programs designed to help American citizens with healthcare costs. They were created to cover the medical bills of two groups of Americans. Medicaid focuses on low-income families and individuals, while Medicare focuses on Americans that have reached age 65 and those collecting SSDI. They have differences in covered services and eligibility requirements. These are just the primary differences between the two health insurance programs.
Difference Between Medicare and Medicaid
Here are some differences between Medicare and Medicaid public health insurance programs:
- Coverage: Medicare is run primarily by the federal government. Medicare coverage depends on if the Medicare beneficiary has Original Medicare or Medicare Advantage. Original Medicare usually includes Medicare Part A, which covers bills for inpatient medical care and Part B, which covers outpatient care bills. MA coverage includes Medicare Part A, Part B, and Part D (prescription drug coverage). Medicaid is a joint health insurance program between the federal and state government. All states are required to cover certain services, including inpatient and outpatient hospital services, physician services, nursing facility services, laboratory and x-ray services, and more. Moreover, each state also has the option of covering optional services such as physical therapy, prescription drugs, dental services, and occupational therapy.
- Eligibility: This is one of the significant differences between the two health insurance programs. The Medicare plan is available for people who reach 65 or older or those under 65 who are already collecting Social Security Disability Insurance benefits or End-Stage Renal Disease. On the other hand, Medicaid eligibility requirements vary from state to state depending on factors such as family size, household income, or disability. You could be eligible for both Medicare and Medicare plan if you meet age and income requirements for each.
- Enrollment Period: You can only apply for Medicare during the Initial Enrollment Period (IEP), Open Enrollment Period, Special Enrollment Period (SEP), and General Enrollment Period (GEP). Medicaid, on the other hand, doesn’t have an enrollment period. Beneficiaries can apply for Medicaid at any time. In many cases, the individuals who qualify for Medicaid may be exempt from a penalty, while those who apply for Medicare outside the enrollment period may be penalized.
How Medicare Works with Medicaid
It is possible to qualify for both Medicare and Medicaid simultaneously. Those who receive benefits from both health insurance programs are called dual-eligible. The individuals eligible for both programs don’t have to worry about which plan will serve as the primary source of coverage. Coordination Of Benefits (COB) decides which program pays first.
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