22+ Differences Between Medicare And Medicaid

Medicare and Medicaid are two healthcare insurance schemes that prevail in the United States of America. The motive behind such programs is to make sure healthcare is accessible for older, disabled, and poor folks.

The Medicare program helps with the healthcare costs for those American citizens who are disabled and above the age of 65. On the other hand, the Medicaid program helps with the healthcare costs for those people who have a really low income.

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Key Differences –

Medicare –

  1. Medicare is an insurance program run by the Federal Government of the United States of America. Since it is run by Federal Government, this program stays the same in every state of the USA. 
  2. People enrolled in this program have to pay small amounts, which is more than that of the Medicaid Programme. 
  3. It provides almost free healthcare to senior and disabled citizens. 

Medicaid –

  1. Medicaid is a social welfare program that is run by the State Government of the USA.
  2. Since it is run by the State Governments of the USA, this program differs from state to state in the United States. 
  3. People enrolled in this program have to pay little to no amount. 
  4. It provides free healthcare to citizens having very low incomes. 

Comparison Between Medicare And Medicaid

Type of programmeIt is a type of Insurance Program.It is a type of Assistance Program. 
Run ByIt is run by the federal government of the United States of America. It is run by the state governments of the United States of America. 
Focuses on It focuses on people over an age of 65, people with disability, or people with ALS and ESRD. It focuses on people with a lower income. 
TypesIt is categorized into two parts, i.e., Original Medicare and Medicare Advantage. It has no type. 
FundingIt is funded by Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund.It is funded by the federal and state governments of the United States of America. 
Rules and RegulationsThe Rules and Regulations of Medicare are the same all over the country. The Rules and Regulations of Medicaid vary from state to state. 

Major Differences Between Medicare And Medicaid

What exactly is Medicare?

Medicare is an insurance program started on July 30, 1965, that is run by the federal government of the United States of America.

This program aims to provide free healthcare to people above the age of 65, who are disabled or with end-stage kidney disease. This insurance program is funded by Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund.

This program is divided into two categories, i.e., Original Medicare and Medicare Advantage. These two categories are further divided into four categories, i.e., Part A, B, C, and D. 

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Features of Medicare –

  1. Insurance Programme. 
  2. Ran by the federal government of the USA. 
  3. Rules and Regulations stay the same all over the nation. 
  4. Provides healthcare support to Senior and disabled citizens. 
  5. Funded by Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund. 

What exactly is Medicaid?

Medicaid is a social welfare or assistance program started in July 1965 that the state government of every state runs in the United States of America.

Due to this reason, the rules and regulations of this program vary from state to state. Medicaid aims to provide free healthcare to people who have a very low income. This program is funded by the State and Federal governments of the USA.

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Features of Medicaid –

  1. Assistance Programme. 
  2. Ran by the State Governments of the USA. 
  3. Rules and Regulations vary from state to state. 
  4. Provides healthcare support to people having low incomes. 
  5. Funded by the State and Federal Governments of the USA.

Contrast Between Medicare And Medicaid

Meaning

  • Medicare – Medicare is an Insurance Programme that aims to provide healthcare help to senior citizens in the United States of America. 
  • Medicaid – Medicaid is an Assistance Programme that aims to provide healthcare help to people with a very low income. 

Type Of Programme

  • Medicare – Medicare is a type of Insurance Programme. 
  • Medicaid – Medicaid is a type of Assistance Programme. 

Provides Help To

  • Medicare – Medicare provides healthcare help to senior citizens and people with disabilities or end-stage kidney disease. 
  • Medicaid – Medicaid provides healthcare help to people having low incomes. 

Eligibility Criteria

  • Medicare – The eligibility criteria of Medicare demand a person to be a US citizen or someone living in the US for more than five years. He should be 65 years old.

    If someone is applying for disability, they should be receiving disability benefits for at least two years. If someone is a sufferer of ALS or End Stage Renal Disease, they immediately become eligible for Medicare. 
  • Medicaid – The eligibility criteria of Medicaid only consider a person’s income. Since Medicaid varies from state to state, it is up to different states on what they consider as low income.

    The income criteria are largely based on MAGI (Modified Adjusted Gross Income). Apart from the income, a person should be a US citizen or should be living in the US for more than five years to be eligible for Medicaid. 

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Eligibility Criteria for Medicare and Medicaid –

Medicare –

  1. Should be a US citizen or a certified Non – US citizen. 
  2. Should be 65 or older than 65. 
  3. In the case of a Disabled person, he should be receiving Disability benefits for at least 24 months. 
  4. Someone with ALS (Amyotrophic Lateral Sclerosis) or ESRD (End Stage Renal Disease).

Medicaid –

  1. Should be a US citizen or a certified Non – US citizen. 
  2. Any person, including women and children, with a very low income. 

Benefits

  • Medicare – Medicare benefits include Hospital & Nursing Facility care, Hospice care, Home care, therapies, doctor’s appointments, labs & scans, Mental Health care, prescribed drugs & medicines, dental care, vision care, and hearing care, etc. 
  • Medicaid – Medicaid benefits include Hospital & Nursing Facility care, Home Health care, prescription drugs & medicines, dental care, vision care, podiatry care, optometry care, speech & hearing care, labs & scans, hospice care, etc. 

Funding

  • Medicare – The Medicare program is funded by the Hospital Insurance Fund Trust and the Supplementary Medical Insurance Trust Fund. 
  • Medicaid – The Medicaid program is funded by the federal and state government of the USA. 

Rules And Regulations

  • Medicare – The rules and regulations of the Medicare program stay the same all over the nation. 
  • Medicaid – The rules and regulations of the Medicaid program vary from state to state. 

Types

  • Medicare – Medicare is further into Original Medicare and Medicare Advantage, which are further divided into two parts each. 
  • Medicaid – There are no sub-types of Medicaid. 

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Medicare is categorized into two main categories –

  1. Original Medicare – The Federal Government of the USA provides Original Medicare. It comprises two separate parts, i.e., Part A and Part B. 
  • Part A – It is concerned with the inpatient services offered to patients in Hospitals and Nursing facilities. It is also referred to as Hospital Insurance. 
  • Part B – Part B of Original Medicare aims at providing secondary healthcare services such as Doctors’ appointments, therapies, counsellings, labs, scans, etc. It is also referred to as Medical Insurance.
  1. Medicare Advantage – The Private Insurance companies provide the Medicare Advantage. Just like Original Medicare, it consists of two parts, i.e., Part C and Part D. 
  • Part C – This Part C provides mixed benefits of Part A and B Medicare and some additional benefits like medicines coverage and dental and vision benefits. 
  • Part D – Part D is known for providing the prescribed medicines and drugs to the patient. It should be noted a person cannot have Part C and D altogether. If a person has Part C, he can not apply for Part D, as Part C already covers medicines and drugs. 

Cost

  • Medicare – Medicare generally involves higher costs in the form of premiums. 
  • Medicaid – Medicaid is generally free; however, if someone is receiving social security benefits, they might have to pay a premium. 

Enrolment

  • Medicare – In general cases, a person has to enroll in this program three months before turning sixty-five. 
  • Medicaid – Enrolments in this program are open all the time. 

Conclusion

Medicare and Medicaid are two programs that were started back in July 1965 with the aim of providing almost free healthcare to senior citizens and those with lower incomes.

The major difference between Medicare and Medicaid is that the former is an insurance program while the latter is an assistance program.

Medicare focuses on providing healthcare to senior citizens, whereas Medicaid focuses on providing healthcare to those with a lower income.


Frequently Asked Questions (FAQs)

Q1. What are the eligibility criteria for Medicare and Medicaid?

Following are the eligibility criteria for Medicare and Medicaid

The common eligibility criteria of Medicare and Medicaid

A person should be a citizen of the United States of America or should be a certified US non-citizen living in the USA for more than five years. 

Unique points of criteria for Medicare

A person should be 65 or older. 

A Disabled person is receiving disability benefits for at least 24 months. 

A person should either have ALS (Amyotrophic Lateral Sclerosis) or ESRD (End Stage Renal Disease).

Unique points of criteria for Medicaid

Q2. Can you have Medicare and Medicaid both?

Yes, it is possible to have Medicare and Medicaid, but a person must be eligible for both in such a case. 

Q3. What are the major differences between Medicare and Medicaid?

The following are the major differences between Medicare and Medicaid.

1. Medicare is a type of Insurance Programme, whereas Medicaid is a type of Assistance Programme. 
2. The Rules and Regulations of Medicare are the same all over the country, while the Rules and Regulations of Medicaid differ from state to state. 
3. Medicare focuses on the Senior and Disabled population, while Medicaid focuses on people with low incomes. 


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