What is the difference between Medicaid & Medicare?

As a Fiscal Intermediary for the Consumer Directed Personal Assistance Program, Burd Home Health helps guide families through the world of Medicaid which can often be confusing and even frustrating. The first place to start when qualifying a potential consumer for the program is to determine if they are on Medicaid, as it is a Medicaid only program. One of the more common confusions is the difference between Medicare and Medicaid and which program a potential consumer is enrolled in. The answer could be one or in fact both Medicare and Medicaid.

The Creation of Medicare and Medicaid

Created in 1965, Medicare and Medicaid were created in response to the inability of older and lower income Americans to buy private health insurance. Both programs were part of President Lyndon Johnson’s “Great Society” initiative which addressed various aspects of society in an effort to combat poverty and racial injustice. Medicare and Medicaid were a part of that vision as President Johnson wanted the country committed to helping everyone access affordable healthcare. (1)

To start, there are a few simple differences between the programs. Medicare is a federal program that provides health coverage is you are 65 or older, or under 65 and have a severe disability, regardless of income. (1) This means that everyone over the age of 65 immediately qualifies for Medicare. Medicaid on the other hand is a federal and state program that provides health coverage if you have a very low income. (1) If you are eligible for both you are what’s known as “dually eligible” and can enroll in both Medicare and Medicaid.

Medicare Explained

Focusing on Medicare, this service can be provided by either Original Medicare or a Medicare Advantage Plan. Original Medicare is the traditional fee-for-service program offered directly through the Federal government. Medicare Advantage Plans are offered through private insurance companies contracted with the Federal government to provide Medicare services. Original Medicare is more widely accepted by doctor’s offices and hospitals nationwide. Medicare Advantage Plans may have specific networks of doctor’s offices and hospitals that would restrict coverage to healthcare professionals within the network. However, Medicare Advantage Plans can offer additional benefits such as vision and dental coverage. (2) Medicare also comes in 4 different parts. Part A covers hospital care and the cost of being in a medical facility. Part B covers doctor’s appointments, medical testing and some procedures. Part C is the Medicare Advantage Plan which would cover procedures not covered by traditional Medicare such as vision and dental. Medicare Part D comprises prescription drug coverage. While the finances are different for each person, Medicare Part A usually comes at no cost while additional coverage of Part B and Part D may have monthly premiums. (4)

Medicaid

Medicaid differs from Medicare in several ways. Unlike Medicare’s qualifications based on age or disability, Medicaid is designed to provide health coverage for people with limited income and assets. Medicaid is also a jointly federal and state-run program. All states must have Medicaid programs for those of low income who need nursing home care, long-term care service

s, and home health care services. Some states also have other programs that do not fit into these categories. Each state uses financial eligibility guidelines to determine whether you are eligible for Medicaid coverage. Generally, your income and assets must be below a certain amount to qualify, but this amount varies from state to state. (3) In 2020, New York State’s Medicaid eligibility limits for an individual are a maximum $875 monthly income and a $15,750 asset limit. (5)

In the end...

The healthcare world can be a complex maze of coverage options and eligibility questions that can be confusing to the average American. The differences between Medicare and Medicaid are just one example of this. Burd Home Health believes that being able to recognize some of the primary differences between the programs can help those in need find the care they deserve.