What are Medicare and Medicaid?

Medicare and Medicaid are two common government programs available to the elderly or disabled in the United States. Chances are that you have heard of these programs, but have not entirely explored these options for your medical needs or the needs of your loved ones. This page will provide comprehensive information on both programs, as well as some important similarities and differences that you should be aware of. Ultimately, this information can help you determine if one of these programs is right for your family’s situation.

What is Medicare?

Medicare is a program provided by the federal government. The program runs through the Centers for Medicare and Medicaid Services (CMS). It is funded in a few different ways; by the federal budget, premiums required from those who use Medicare services, Medicare taxes, and Social Security.

Medicare is a type of health care coverage available to the following types of people:

  • American citizens ages 65 and older
  • American citizens who are under the age of 65 but who get Social Security Disability Insurance (SSDI)
  • American citizens who are under the age of 65 but live with End Stage Renal Disease (ESRD).

If you fit in one of these categories and are eligible for Medicare, you then need to choose the Medicare benefits that you want. There are four major types or parts of Medicare that people can choose from. These include:

  • Part A, which covers hospital care;
  • Part B, which covers additional services such as doctor services and outpatient care;
  • Part C, which covers everything outlined in Part A and Part B, as well as Advanced Plan Services, and;
  • Part D, which provides coverage for prescription drugs.

Choosing the right type of Medicare for you is essential in getting the services you need at an affordable price. Let’s take a look at these plans in more detail.

Medicare Part A

At its core, Medicare Part A provides hospital care for those who have it. Most people who use this type of Medicare do not have to pay a premium for access, since they previously paid for it through their Medicare taxes when working. If you have not paid Medicare taxes, you can buy access to Medicare Part A instead. In addition to hospital care, Medicare Part A can cover stays in nursing homes, hospice care, and at home health services if you meet certain requirements. Part A falls under the “Original Medicare” plan.

Medicare Part B

This is an optional form of Medicare that requires a monthly fee. In addition to the monthly premium, deductibles and copayments can apply to the services covered by Part B. As mentioned above, Medicare Part B covers certain things that Part A does not. Popular services include doctor’s services, services that are medically necessary, some types of preventative services, and outpatient care. Like Part A, Part B falls under the “Original Medicare” plan.

Medicare Part C

Private services can offer Medicare Part C, so long as they are approved by Medicare. This type of Medicare provides advanced treatment plans. Part C gives coverage for everything in Part A, Part B, drug prescription, and additional services. Some benefits include:

  • Health Maintenance Organizations Plans (HMO)
  • Preferred Provider Organization Plans (PPO)
  • Special Needs Plans
  • Private Fee for Service Plans (PFFS)
  • Medicare Medical Savings Account Plans (MSA)

Medicare Part D

Medicare Part D refers to coverage for prescription drugs. You can get a prescription drug plan with a Medicare-approved private company. This type of coverage is optional and it requires a monthly fee.

What is Medicaid?

Medicaid differs from Medicare in some ways, though they are both government funded programs. Medicaid runs through the federal government’s partnership with states that will cover people who have limited income. Like Medicaid, Medicare is a form of health insurance.

Medicaid varies a bit from state to state. In some states, everyone who fall below a set income level will qualify for Medicaid. In other states, Medicaid is reserved for those who are below a certain income level and have additional health concerns, such as pregnancy or disability. Again, this differs from Medicare because people do not need to pay for Medicaid. Some people are eligible for both Medicare and Medicaid services.

In the majority of the states, a person becomes eligible for Medicaid when they become eligible for Supplemental Security Income (SSI). In most states, the application for SSI is also the application for Medicaid. In a few other states, eligibility for these services is the same, but there are separate applications.

The remaining states have a separate process for Medicaid than for SSI and eligibility is different. In the state of New York, eligibility as well as the application for SSI is the same as for Medicaid.

Getting Help

Determining which of these programs is right for you can be a complex process. Each separate part needs to be considered so that you can make sure that you get the coverage that you need. In order to fully sort through these options and find the best one for you, you can contact my office. I am happy to answer any specific questions that you have about Medicare or Medicaid and help you find the right coverage for you.

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