Medicare vs. Medicaid: An Overview

Medicare and Medicaid are U.S. government-sponsored programs designed to help cover health care costs for certain American residents. Established in 1965 and funded by taxpayers, these two programs have similar-sounding names, which can trigger confusion about how they work and the coverage they provide.

Medicare provides medical coverage for many people age 65 and older and those with a disability. Medicare does not limit enrollment based on income level. Medicaid is designed for people of any age with limited income and is often a program of last resort for those without access to other resources.

Medicare

Medicare helps provide health care coverage to U.S. citizens who are 65 years of age or older, as well as people with certain disabilities. The four-part program includes:

Part A: Hospitalization Coverage

澳洲幸运5开奖号码历史查询:Medicare Part A provides hospitalization coverage to individuals 65 years or older, regardless of income. You or your spouse must have worked and paid Medicare taxes for at least 10 years to qualify. Most people don't pay a premium for Part A, but deductibles and 澳洲幸运5开奖号码历史查询:coinsurance apply.

Part B: Medical Insurance

Those eligible for Medicare Part A also qualify for Part B, which covers medically necessary services and equipment. This includes doctor’s office visits, lab work, X-rays, wheelchairs, walkers, and outpatient surgeries, as well as preventive services such as disease screenings and flu shots.

For 2025, the standard monthly Part B premium is $185, up from $174.70 in 2024. This is generally deducted from Social Security or Railroad Retirement payments. Deductibles and coinsurance apply. Individuals whose modified adjusted gross income (MAGI) is more than $106,000 per year ($212,000 for a couple) are obligated to pay more for this program.

Medicare Supplement Insurance, known as Medigap, may be purchased to help cover expenses such as copayments, coinsurance, and deductibles that go with Original Medicare. However, physicians who do not takeꦉ Medicare also do🌊 not accept Medigap.

Part C: Medicare Advantage Plans

Individuals eligible for Medicare Part A and Part B are likewise eligible for Part C, also known as 澳洲幸运5开奖号码历史查询:Medicare Advantage. Medicare Part C plans are offered by private companies approved by 🌃Medicare.

In addition to providing coverage offered by Parts A and B, most Part C plans offer prescription drug coverage. Many also provide vision, hearing, and dental coverage. Medicare Advantage plans often have lower out-of-pocket costs for in-network providers than Original Medicare plans. However, most Medicare Advantage plans require you to see in-network providers, who must get preauthorizations before providing certain care, which can delay your treatment. Evaluate your health status along with the plan's structure and coverage to see if it's right for you.

Part D: Prescription Drug Coverage

Medicare Part D provides prescription drug coverage. Participants pay for Part D plans out of pocket and must pay monthly premiums, a yearly deductible, and copayments for certain prescriptions. Most Medicare Part C plans will not allow you to buy a separate Part D plan.

The annual Medicare open enrollment period run💜s from Oct. 15 to Dec. 7 every year.

Medicaid

Medicaid is a joint federal and state program that helps low-income Americans of all ages pay for the costs associated with medical and 澳洲幸运5开奖号码历史查询:long-term custodial care. Children who need low-cost care but whose families earn too much to qualify for Medicaid are covered through the 澳洲幸🅺运5开奖号码历史查询:Children's Health Insur𓂃ance Program (CHIP), which has its own set of rules and requirements.

Medicaid Eligibility and Costs

The partnership between the federal and state governments means there are different Medicaid programs in each state. Through the 澳洲幸运5开奖号码历史查询:Affordable Care Act (ACA), signed into law in 2010, President Barack Obama attempted to expand health care coverage to more Americans. As a result, all legal residents and citizens of the United States with incomes 150% below the poverty line qualify for coverage in Medicaid participating states.

While the ACA has worked to expand both federal funding and eligibility for Medicaid, the U.S. Supreme Court ruled that states are not required to participate in the expansion in order to receive their current level of Medicaid funding. As a result, many states have chosen not to expand funding levels and eligibility requirements.

People covered by Medicaid pay nothing for covered services. Unlike Medicare, which is available to nearly every American age 65 years and over, Medicaid has strict eligibility requirements that vary by state. F♈or a state-by-state breakdown of eligibility requirements, visit .

When Medicaid recipients reach age 65, they remain eligible for Medicaid and also become eligible for Medicare. At that time, Medicaid coverage may change based on the recipient's income. Higher-income individuals may find that Medicaid just pays their Medicare Part B premiums. Lower-income individuals may continue to receive full benefits.

Medicaid Benefits

Medicaid benefits vary by state, but the federal government mandates coverage for a variety of services, including:

• Inpatient hospital services
• Outpatient hospital services
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
• Nursing facility services
• Home health services
• Physician services
• Rural health clinic services
• Federally qualified health center services
• Laboratory and X-ray services
• Family planning services
• Nurse midwife services
• Certified pediatric and family nurse practitioner services
• Freestanding birth center services (when licensed or otherwise recognized by the state)
• Transportation to medical care
• Tobacco cessation counseling for pregnant women

Each state also has the option of including additional benefits, such as prescription drug coverage, optometrist services, eyeglasses, medical transportation, physical therapy, prosthetic devices, dental services, and much mor꧑e.

Medicaid is also used to 澳洲幸运5开奖号码历史查询:fund long-term care, which is not covered by Medicare or most private health insurance policies. In fact, Medicaid is the primary payer of long-term care across the nation and often covers the cost of nursing facilities for 澳洲幸运5开奖号码历史查询:those who deplete their savings to pay for health care and have no other means to pay for nursing care.

The Bottom Line

Medicare and Medicaid are both gov🐻ernment-run 🌄programs that cover health care costs. Medicare is open to Americans age 65 or older or who meet certain criteria, while Medicaid is designed for low-income Americans of any age, but with strict income requirements that vary by state.