Here are some of the key differences between Medicaid and Medicare:
- Eligibility – Medicaid is for low-income individuals and families, as well as those with disabilities. Eligibility is based on income and asset limits. Medicare is a social insurance program for people aged 65 and older and those with disabilities.
- Funding – Medicaid is jointly funded by individual states and the federal government. Medicare is funded by payroll taxes, insurance premiums and federal budget allocations.
- Coverage – Medicaid covers a broader range of services like long-term care. Medicare primarily covers hospital and medical insurance but beneficiaries can opt for additional coverage.
- Provider Networks – Medicaid managed care plans have restricted networks. Medicare offers more provider choice under Original Medicare since it covers services from any doctor/hospital that accepts Medicare.
- Premiums and Cost Sharing – Medicaid has no premiums for most beneficiaries but copays may apply for some services. Medicare enrollees pay standard monthly premiums along with copays and deductibles.
- Administration – Medicaid is run jointly by state and federal agencies. Medicare is administered solely by the federal Centers for Medicare and Medicaid Services (CMS).
- Supplemental Coverage – Medicaid can be supplemented by private plans but not replaced. Medicare can be supplemented by Medigap or Medicare Advantage plans for added coverage.
So in summary, Medicaid covers low-income groups while Medicare insures seniors – their eligibility and funding structures differ significantly.
Different coverage options under Medicare:
Here are some more details about the different coverage options under Medicare:
- Medicare Part A – Covers inpatient hospital stays, skilled nursing facilities, hospice and some home healthcare. Premium-free for most people.
- Medicare Part B – Covers certain doctors’ services, outpatient care and medical supplies. Standard monthly premium of $170.10 in 2023.
- Medicare Part D – Optional prescription drug coverage offered by private insurers. Monthly premiums vary by plan.
- Medicare Advantage (Part C) – Private plans approved by Medicare that provide Part A, B and usually Part D benefits. Common options are HMOs, PPOs, SNPs.
- Medigap (Medicare Supplement Insurance) – Sold by private insurers to fill “gaps” in Original Medicare coverage like copays, coinsurance, deductibles. Plans A-N offer different benefits/premiums.
- Part A & B with Medicaid – Dual eligible low-income seniors get full Medicaid benefits to supplement Medicare.
- Employer/Union Plans – Retirees under 65 may have access to plans through former employers or unions.
- TRICARE for Life – Military retirees use Medicare as their primary coverage along with Tricare for Life as secondary payer.
So in summary, beneficiaries have choices between the Original Medicare fee-for-service model or managed care Medicare Advantage plans, with options to add drug, Medigap or Medicaid coverage.