Medicare vs. Medicaid: What’s the Difference?

With only two letters distinguishing Medicare from Medicaid, the two healthcare-coverage programs might seem interchangeable at first. However, there are distinct differences between them that could save you a lot of hassle in your efforts to meet your healthcare needs. What is is the difference between Medicare vs. Medicaid?

The first major difference between Medicare and Medicaid lies in who administers each program. While Medicare is a federally run program, Medicaid is overseen by individual states. That difference alone accounts for much of the confusion surrounding Medicaid coverage and eligibility. While Original Medicare’s regulations are enforced nationally, Medicaid’s differ between states. If you move (link) between states, you will need to update or re-enroll in all state run portions of your health care plan—including Medicaid.

The next difference between Medicare and Medicaid regards who is eligible for each program. Medicare is meant for the elderly, the disabled, and the terminally ill, regardless of their income level. Medicaid, on the other hand, is designed to meet the healthcare needs of a large range of people with low income and few financial resources. Because of this, people that could never receive Medicare could still have their needs met with Medicaid. These people can include non-disabled minors, pregnant women, parents, guardians, and even young single adults. The specific eligibility requirements for Medicaid differ from state to state, so you should consult with your state Medicaid office to find out if you qualify.

Medicaid also tends to cover a broader range of services than Medicare. Both programs can pay for hospital stays, prescription drugs, and outpatient services like doctor visits. Yet one crucial service Medicaid covers that Medicare doesn’t is long-term healthcare services and support. (link) Medicare only provides short-term skilled nursing support, and will not cover even medically necessary long-term nursing home care or lengthy stays at assisted living facilities. Medicaid will help with costs for certain long-term care facilities. It’s for this reason that most nursing home patients rely on Medicaid to help pay their long-term healthcare costs after exhausting their savings.

Depending on the state you live in, Medicaid may provide even more benefits. States have the option to include complete, free coverage for medical transportation, dental care, eye care, physical therapy, prescription drugs, and prosthetics. Yet while Medicaid fully covers a lot of items Medicare doesn’t, it may not cover everything Medicare does. Some services all Medicaid plans are mandated to include in their coverage when medically necessary are:

  • Laboratory services and X rays
  • Hospitalization costs
  • Costs for outpatient and clinic treatment, along with doctor’s visits
  • Family planning and midwife services
  • Nursing services and nurse practitioner services,
  • Surgical dental services, like root canals
  • Nursing facility services (if over 21)
  • Screening, diagnosis, and treatment (if under 21)

While it’s possible to have Medicare without Medicaid (and Medicaid without Medicare) you can qualify for both. If you have Medicare and have gaps in your medical coverage, or Medicaid and are elderly or disabled, you could consider becoming a “dual eligible” patient and get benefits from both programs. If you are in both programs Medicare’s premiums, copayments, and coverage will take precedence before Medicaid’s coverage. But Medicaid can be invaluable in filling gaps like the prescription drug Donut Hole (link).

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