Medicare and Medicaid are two distinct U.S. government health coverage programs designed for different groups of people and funded differently:
Medicare
- Who is eligible? Primarily people aged 65 and older, and some younger individuals with certain disabilities or medical conditions, regardless of income
- Funding: Funded entirely by the federal government through payroll taxes and trust funds
- Coverage: Medicare has four parts:
- Part A covers hospital stays and inpatient care.
- Part B covers outpatient medical services like doctor visits and preventive care.
- Part C (Medicare Advantage) and Part D (prescription drugs) are offered by private insurers to supplement Parts A and B
- Costs: Beneficiaries usually pay premiums, deductibles, copays, and coinsurance, with Part A often premium-free if eligibility criteria are met
Medicaid
- Who is eligible? People of any age with limited income and resources, including low-income families, children, pregnant women, elderly, and people with disabilities
- Funding: Jointly funded by federal and state governments, with states administering the program within federal guidelines
- Coverage: Medicaid covers a broad range of health services, often including benefits not normally covered by Medicare, such as nursing home care and personal care services. Coverage details can vary by state
- Costs: Costs to beneficiaries vary by state and income but may include premiums, deductibles, and copays; some or all costs may be covered for eligible individuals
Interaction Between Medicare and Medicaid
- Some people qualify for both programs (called "dual eligibles"). In these cases, Medicare pays first for covered services, and Medicaid helps cover costs Medicare does not, such as copays and premiums
- Dual eligibility offers more comprehensive coverage at lower out-of-pocket costs
In summary, Medicare is primarily an age- or disability-based federal health insurance program, while Medicaid is an income-based program jointly run by states and the federal government to assist low-income individuals and families
