Medicare vs Medicaid



Medicare vs Medicaid - Medicare






Medicare vs Medicaid - I have always had trouble remembering the difference between medicare and medicaid. I've outlined the differences on this page. Not only to assist my readers but also as a reference for myself.

Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare. Use the links on this page for additional updated information.



Medicare has two segments: hospital insurance, known as Part A, and supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor. If you are eligible for Medicare, Part A is no cost, but you must pay a premium for Part B.

Medicare vs Medicaid - Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs (please check the latest changes). There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse.

Medicare usually operates on a fee-for-service basis. HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations.

Some people who are covered by Medicare buy private insurance, called "Medigap" policies, to pay the medical bills that Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles; most pay the coinsurance amount. Some also pay for health services not covered by Medicare. There are 10 standard plans from which you can choose. (Some States may have fewer than 10.) If you buy a Medigap policy, make sure you do not purchase more than one.




Medicare vs Medicaid: Medicaid

Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are aged, blind, or disabled or certain people in families with dependent children. Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered.

Medicare vs Medicaid - Medicaid - Examples of several of these categories include:

  • Children and Pregnant Women - Low income pregnant women and children through age 18 may be eligible for Medicaid. The income guideline for pregnant women and children under the age of 6 is 133% of the federal poverty guideline. Children ages 6 through 18 are eligible if their family incomes do not exceed 100% of the federal poverty guideline.


  • Parents - Low income parents and other caretakers of children may qualify for Medicaid.


  • People with Disabilities- People who receive SSI because of disability or because they are 65 years of age or older are automatically eligible for Medicaid in thirty-nine states. Eleven states, including Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, Oklahoma, and Virginia, are known as 209(b) states and each can set its own eligibility criteria for Medicaid that is different than the SSI criteria.

    In addition, individuals who meets the level of care requirement for nursing home care and whose incomes do not exceed 300% of the SSI benefit amount may be eligible for Medicaid nursing home services or Home and Community-Based Waiver Services.


  • Children in Foster Care - Children in foster care under Title IV-E of the Social Security Act and certain recipients of adoption assistance are eligible for Medicaid. In addition, youth between the ages of 18 and 21 who were in foster care may be eligible for Medicaid through the Foster Care Independence Act of 1999.


  • Medicare beneficiaries - Certain Medicare beneficiaries with low incomes and limited resources may be eligible to receive full Medicaid benefits. Other Medicare beneficiaries whose income exceeds the level for full Medicaid eligibility may be eligible to receive limited Medicaid benefits to cover some Medicare cost-sharing expenses such as premiums, deductibles, and coinsurance.


  • Medically Needy Individuals - Medically needy programs provide Medicaid coverage to some individuals who have income or resources above the required limits set by their state but who have incurred or paid sufficient medical expenses to allow them to meet the "spend down" test.

Medicare Defined

Medicare vs Medicaid


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