Medicare and Medicaid are insurance programs that are designed to benefit the people of the United States in various ways. In simple words:
The two terms Medicare and Medicaid are often confused or used. These two programs sound extremely similar but have vastly different schemes.
In this article, we will be talking about the various benefits of Medicare and Medicaid while also speaking about various other articulates that revolve around those two terms.
Medicare is a national health insurance program in the United States that was established in 1965. It was under the Social Security Administration and is now administered by the Centres for Medicare and Medicaid Services which is an agency of the federal government.
Medicare plays a pivotal role in helping people with disabilities. Medicare also provides health and financial security to 60 million older people in the United States. It covers many basic health services such as hospital admission, physician services and prescription drugs.
There are two branches that stem from the umbrella of Medicare.
Medicaid is a public health insurance/ assistance program in the United States that is a joint federal and state program. It provides effective health coverage to low-income individuals of all ages. Medicaid is available only to those families that meet the low-income criteria which vary from state to state.
People above the age of 65 will be served primarily and their medical bills are paid from trust funds, whatever their income. It also serves younger people, under 65, who are disabled and have undergone / are undergoing dialysis (people who are receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or and with End-Stage Renal Disease (ESRD)).
Medicaid is eligible for U.S Immigrants, permanent residents or legal immigrants. As of September, 2020, Close to 70.6 million people were covered by Medicaid. Medicaid provides health coverage to:
The eligibility qualifies for free or low-cost care for the people of the United States based on the family’s income and size while medicaid happens to be the single most largest source of health coverage in the United .
Medicare program consists of several parts that offer coverage to different aspects of healthcare. Details are listed in the table below:
|MEDICARE PART – A||Provides coverage for many inpatient medical care such as hospital stays, hospice services, limited skilled nurse care and home healthcare.|
|MEDICARE PART – B||Provides coverage for outpatient medical care such as for items and services including outpatient hospital care, physician appointments, preventive care and for certain medical equipment.|
|MEDICARE PART – C OR MEDICARE ADVANTAGE||Is run by approved private insurers that includes all the benefits of parts A and B while also including benefits for an extra cost like dental, vision and prescribed drug coverage.|
|MEDICARE PART – D||Is run by approved plans according to federal rules and helps pay for prescribed drugs.|
Medicaid programs’ benefits vary from state to state but there are few benefits included in every program as listed below:
Since Medicaid varies from state to state, it is always advised to consult with a caseworker in each state to get to know about the coverage that applies.
Getting a Medicare plan could be a rather major milestone. Here’s a heads-up to get started on that journey.
There are two ways to apply for Medicaid:
In the table below, the costs of Medicare are broken down into four parts:
|Part A premium||Most people don’t pay a monthly premium for Part A . If you buy Part A, you’ll pay up to $471 each month in 2021. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $471. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $259.|
|Part A hospital inpatient deductible and coinsurance||You pay:
$1,484 deductible for each benefit period
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $371 coinsurance per day of each benefit period
Days 91 and beyond: $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: all costs
|Part B premium||The standard Part B premium amount is $148.50 (or higher depending on your income).|
|Part B deductible and coinsurance||$203. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (DME)|
|Part C premium||The Part C monthly premium varies by plan. Compare costs for specific Part C plans.|
|Part D premium||The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.|
According to a recent analysis, National Healthcare Expenditure (NHE) grew 4.6% to $3.8 trillion in 2019. That makes it $11,582 per person. States have the liberty to charge premiums and cost-sharing for Medicaid enrollees.
Medicaid also kicks in for seniors on Medicare whose income is insufficient to cover premiums, deductibles, and other insurance costs.
In cases of emergency services, family planning requirements, pregnancy-related and some preventative services for children, Medicaid offers zero costs and co-pays.
As discussed above, every coin has two sides and so does Medicare. Here’s a short analysis of the pros and cons of Medicare.
Both the pros and cons of Medicaid vary from situation to situation and we have listed down few highlights below.