Medicare & Medicaid, What’s the Difference?

Medicare? Medicaid? What’s the Difference?

By Cheryl Theriault

Many people are confused about Medicare and Medicaid. They sound a lot alike but are extremely different forms of medical insurance coverage.

Medicare is a Federal government program that is available to people who:

  • are age 65 or older
  • have a disability, but are under age 65
  • people with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

It consists of 4 parts:

  • Medicare Part A is hospital insurance and most people do not have to pay for it.
  • Medicare Part B is medical insurance and most people pay a monthly premium for it. For details visit www.medicare.gov.
  • Medicare Part C are Medicare Advantage plans like PPOs and HMOs.
  • Medicare Part D is Prescription Drug Coverage

Medicaid is a state run program and is based on being eligible due to age, blindness, disability, having dependent children (categorical requirements). Its eligibility criteria vary greatly from state to state.

In addition to having to meet categorical requirements, Medicaid looks at assets and income to determine eligibility. The eligibility rules vary depending on whether you are applying for assistance while living independently in the community, applying for State/County Special Assistance for help paying for assisted living, or Medicaid for nursing homes.

For details in Wake County, visit www.wakegov.com.
For help sorting out Medicare and insurances, you can contact the NC SHIIP office – Senior Health Insurance Information Program through the NC Department of Insurance , visit.

MEDICAID

MEDICARE

An assistance program for low-income people. An insurance program for people over age 65 and some disabled people under age 65.
Is based on income. Some programs require that you be responsible for part of your medical bills before you can get a Medicaid card. This is known as “meeting” a deductible. Most people receive Medicare because they receive some type of Social Security Benefits.
A person who receives a Medicaid card pays no part of the medical costs other than a small co-payment to the doctor or pharmacist. You must pay a deductible for hospital visits. You must also pay an annual deductible for doctor visits and other medical services.
Medicaid will pay the Medicare premiums for most people. It also pays the Medicare deductibles and coinsurance for services which are covered by Medicare and Medicaid. You pay coinsurance(a portion of the total bill) for medical services. You also pay a monthly premium for coverage of medical expenses.
Most Medicaid programs pay for prescription drugs. Medicare Part D is prescription coverage.You must choose a plan
Is run by the State Government, but has Federal guidelines. Medicaid varies from State to State. Is run by the Federal Government and it is the same everywhere in the U.S.
The money for Medicaid costs comes from Federal, State, and County funds. The money for Medicare comes from Federal funds.
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