Comparison between Medicare and Medicaid
other. It is important to understand the differences between them. Medicare is a federal
medical insurance program primarily for persons over 65. Medicaid is a federal-state
medical assistance program for low-income recipients of public benefit programs.
Medicare provides only partial coverage, and requires beneficiaries to pay premiums,
deductibles, and co-payments. Medicaid provides more complete coverage, without
significant payments from the beneficiaries. All persons over 65 (as well as younger
individuals disabled for at least two years) who paid into Social Security are eligible for
Medicare, but only low-income persons who are elderly, blind, disabled or are low-
income families can receive Medicaid. It wont be wrong to say that Medicare is geared
more toward the elderly, while Medicaid is for women and children.
Medicare
Medicare is a Federal health insurance program for Americans above the age of 65 and
for certain disabled Americans. If a person is eligible for Social Security or Railroad
Retirement benefits and is above the age of 65, the person and their spouse automatically
qualify for Medicare. Medicare has two segments
Part A- hospital insurance which included inpatient hospital stays (at least overnight),
including semiprivate room, food, tests, and doctors fees. The maximum time of stay that
Medicare Part A covers in a skilled nursing facility per ailment is 100 days. The first 20
days is paid for in full by Medicare with the remaining 80 days requiring a co-payment.
Part B- supplementary medical insurance, which provides payments for doctors and
related services and supplies ordered by the doctor such as nursing services, x-rays,
laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood
transfusions, renal dialysis, outpatient hospital procedures, limited ambulance
transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy,
hormonal treatments and other outpatient medical treatments administered in a doctors
office.. Members who come in the part a category need not pay anything but the part b
category candidates need to pay a premium amount. Medicare pays for many health care
expenses, but not all of them. Medicare does not cover nursing home care, long-term care
services in the home or prescription drugs .There are also special rules on when Medicare
pays the bills of the members. The rules also are applied differently weather the
employment holder is the member or their spouse. Medicare provides services for a fee.
the better the fees the better the service. HMOs and similar forms of prepaid health care
plans are available to Medicare enrollees in some of the locations. People who are
covered by Medicare often buy private insurance, called Medigap policies, to pay the
medical bills that are not covered by Medicare. However, the categories of Part A nor
Part B do not pay for all of a covered persons medical costs. This program contains
premiums, deductibles and coinsurance, which the covered individual must pay out-of-
pocket. A study by the Kaiser family foundation in September 2008, found that the Fee-
for-Service Medicare benefit package was less generous than the Federal Employees
Health Benefits Program Standard Option.
Medicaid
Medicaid was created as an additional health benefit to two welfare programs
Supplemental Security Income (SSI) and Aid for Dependant Children (AFDC). AFDC
was replaced by the Temporary Assistance to Needy Families (TANF) program. People
who continue to receive those benefits except for earned income or cost of living
increases often continue to receive Medicaid. Women with breast or cervical cancer may
also qualify if they lack health insurance.
Medicaid provides health care coverage to the lower-income class people who generally
cannot afford a health or life insurance it. This includes people who aged blind, or
disabled or certain people in families with dependent children. Medicaid is operated by
the States and is a Federal program. The terms and conditions are different for every
state. Each State decides the eligibility and the range of health services offered. A limited
income is one of the primary requirements for Medicaid eligibility, but being poor does
not qualify a person to receive Medicaid benefits unless they also fall into one of the
defined eligibility categories. According to the CMS (Centers for Medicare and Medicaid
Services ) website, Medicaid does not provide medical assistance for all poor persons.
Even under the broadest provisions of the Federal statute (except for emergency services
for certain persons), the Medicaid program does not provide health care services, even for
very poor persons, unless they are in one of the designated eligibility groups There are
many number of Medicaid eligibility categories within each category there are
requirements other than income that must be met. These requirements include, but are not
limited to, age, pregnancy, disability, blindness, income and resources, and ones status as
a U.S. citizen or a lawfully admitted immigrant Medicaid - Examples of several of these categories include Children and Pregnant Women - pregnant women with low income and children through
the age of 18 may be eligible for Medicaid. Children between the ages of 6 to 18 are
eligible if their family income doe not exceed 100 of the federal poverty guideline.
Parents - Low income parentscaretakersguides of children may qualify for Medicaid.
People with Disabilities- People receiving a steady SSI because of disability or because
of being senior citizens, are automatically eligible for Medicaid in thirty-nine states.
Eleven states, Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New
Hampshire, Oklahoma, and Virginia, are known as 209(b) states and each state sets its
own eligibility criteria for Medicaid that is different than the SSI criteria. In certain cases
like if the individual, who meets the level of care requirement for nursing home care and
whose income does not exceed 300 of the SSI benefit amount is also considered to be
eligible for Medicaid nursing home services or Home and Community-Based Waiver
Services.
Children in Foster Care and orphanages - Children in foster care or in orphanages under
Title IV-E of the Social Security Act are eligible for Medicaid.
In comparison to Medicaid which is viewed as a comprehension program for low income
groups, Medicare has certainly outperformed Medicaid in many ways. In the year1998,
when 88 percent of older people were covered by Medicare, 73 percent of low income
groups did lacked proper insurance. This means that around 44 million people were left
uninsured. Even employer-based insurance programs have not been able to perform better
than Medicare. However after all the differences, the CMS website gives an overview
that in 2001, about 6.5 million Americans were enrolled in both Medicare and Medicaid.