Medicare and Medicaid – What is the Difference?

The programs differ significantly in the people that each cover, so it helps to know the difference. Some people do qualify for both Medicare and Medicaid at the same time.

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Medicare

Medicare is designed as an insurance program for people aged 65 and older who have paid into the Medicare trusts through paycheck deductions. Medicare also covers younger disabled people as well as dialysis patients. Those on Medicare must pay certain deductibles and can pay small monthly premiums for non-hospital coverage.

Much of the confusion with Medicare is caused by its parts – there are 4 parts – Medicare Parts A, B, C, and D.

[1] https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

[2] https://boomerbenefits.com/new-to-medicare/parts-of-medicare/

Medicare Part A is free to most people who have worked at least 10 years in the United States or is married to someone who is 62 and has worked that amount of time. This part covers costs associated with hospital stays.

Medicare Part B is medical insurance for outpatient services and covers doctor visits, lab testing and surgeries deemed medically necessary.

When a person signs up for Medicare at the Social Security offices Parts A & B are the parts he/she are signing up to receive.

Medicare Part C are private health care plans that a person can choose as an alternative to Medicare Parts A, B and D. That person would get the benefits of A, B, and D from a private insurer. There are costs associated with these plans because they are private plans.

Medicare Part D is optional and helps to lower the cost of prescription drugs. In order to sign up for Medicare Part D, a person must select one of the Part D plans available in his/her county from private insurance carriers.

The choice of which parts of Medicare, if any, to participate in is entirely up to the people who qualify for Medicare.

 

Medicaid

Medicaid is an assistance program. In Pennsylvania it is usually called Medical Assistance. Eligibility is mainly based on income. Pennsylvania residents, depending primarily on area of residence in the state, access their Medical Assistance (MA) benefits through either fee-for-service or Medicaid managed care. All participants receive an ACCESS card.

Medicaid patients may have more than one type of insurance and some people have both Medicaid and medicare or Medicaid and private insurance. In cases where there are two insurance providers, Medicaid is the secondary insurance.

Eligibility is determined by being part of a particular group such as pregnant women, children, older adults, or disabled adults, and also by meeting financial and citizenship requirements. Some people are eligible because of a temporary disability, or because they are caring for a disabled family member. In this situation the physician plays an important role in helping the patient obtain Medical Assistance[3].


[3] http://www.phlp.org/home-page/providers/provider-faq/medical-assistance-in-pa-frequently-asked-questions