Medicare vs Medicaid: What's Right For Your Client or Loved One

Medicare and Medicaid are two government-sponsored healthcare programs that provide medical coverage to millions of Americans. Though their names sound similar, the two programs have important differences in terms of eligibility, costs, and benefits. This Waiver Consulting Group's Resource Guide, Medicare vs Medicaid: What's Right For Your Client or Loved One, breaks down the key features of Medicare and Medicaid to help you understand how they work.

MEDICARE: HEALTH FOR SENIORS AND PEOPLE WITH DISABILITIES

Medicare is a federal health insurance program primarily for people aged 65 and older and people under age 65 with certain disabilities. There are four parts to Medicare coverage:

Part A covers inpatient hospital care. Most people get Part A premium-free if they or their spouse paid Medicare taxes while working. There is a deductible and coinsurance for long hospital stays.

Part B covers doctor visits, preventive care, lab tests, surgeries, and durable medical equipment. You pay a monthly premium, deductible, and 20% coinsurance for most services.

Part C (Medicare Advantage) plans combine Parts A and B and often include prescription drugs and other benefits. Premiums vary by plan.

Part D provides prescription drug coverage through private plans. You pay a monthly premium and deductible.

MEDICAID: HEALTHCARE FOR LOW-INCOME AMERICANS

Medicaid is a joint federal-state program providing healthcare for low-income individuals. Eligibility and benefits can vary widely by state. Groups covered by Medicaid include:

Low-income adults and children

Pregnant women and new mothers

People with disabilities

Long-term care for seniors

Medicaid recipients typically pay no premiums or healthcare costs. The program is funded through state and federal taxes.

Some Key Differences

While both programs aim to make healthcare affordable, some notable differences exist:

Medicare eligibility is based on age or disability status. Medicaid eligibility is based on income.

Medicare is federally administered with uniform coverage nationwide. Medicaid is run jointly by states, leading to variability.

Medicare recipients can use any doctor accepting Medicare. For Medicaid, you must see doctors within the program.

Medicaid offers more comprehensive benefits but can still have gaps in coverage.

THE TAKEWAY

Medicare and Medicaid play vital yet distinct roles in providing healthcare access for Americans. Understanding how the two government programs differ is key to getting the appropriate coverage.