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Medicare vs. Medicaid

The federal government is a massive entity, the true size of which is up for debate. Depending on the source, the number of federal agencies has been reported to be as few as 60 and as many as 430. One agency whose existence is not in question is the Centers for Medicare and Medicaid Services (CMS), which, among other responsibilities, oversees Medicare and works with state governments to manage Medicaid. These two similar-sounding public insurance programs are very different, but they have the same goal of providing medical and health-related services to certain groups of disadvantaged people.

Medicaid delivers healthcare coverage to low-income families and individuals, including seniors, parents, children, pregnant women, and people with disabilities. It is jointly funded by the cooperation of the state and federal governments, and it is tied to individual need. Medicare, on the other hand, delivers healthcare coverage to people over age 65 and certain disabled individuals. Medicare is strictly a federal program that uses private insurance companies to assist with the high medical costs faced by older Americans who often are also dealing with a reduction in their ability to earn a living wage. In contrast to Medicaid, Medicare is not a means-tested program. Instead, it is an entitlement program that people are eligible for because they paid into it through their Social Security taxes.

It is estimated that Medicaid and the Children’s Health Insurance Program (designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid) provides health coverage to more than 31 million children, including half of all low-income children. Further, Medicaid finances about 40 percent of all U.S. births and provides health coverage to 11 million non-disabled adults, over 8.8 million individuals with disabilities, 4.6 million low-income seniors, and 3.7 million people with disabilities who are also enrolled in Medicare. Approximately 79 million U.S. citizens are expected to be enrolled in Medicaid in the year 2023. Medicare provides health coverage to more than 49 million Americans, with enrollment expected to increase to 80 million by 2030.

The programs do overlap, but qualifying for one does not mean someone will qualify for the other. There are separate eligibility requirements for each, but there is no prohibition against being on them at the same time. Medicare is designed to cover only a portion of healthcare costs, so dual-eligible recipients can get Medicaid assistance with some of the premiums, deductibles, and copayments that Medicare charges, and Medicaid can fill in other gaps that Medicare won’t cover.

The amount of Medicaid coverage varies from state to state, but, in general, Medicaid provides inpatient and outpatient health care coverage, including coverage for prescription drugs, diagnostic and preventive care, and eyeglasses.  Medicare coverage is the same in each state and is divided into parts. Medicare hospital insurance (Part A) provides basic coverage for hospital stays and post-hospital nursing facility and home health care. Medicare medical insurance (Part B) pays most basic doctor and laboratory costs, and some outpatient medical services, including medical equipment and supplies, home health care, and physical therapy. Medicare prescription drug coverage (Part D) pays some of the costs of prescription medications.

Medicaid and Medicare are complicated programs. If you have any questions about this topic, including eligibility and computation of benefits, you can find out more by discussing it with one of the attorneys at Church, Langdon, Lopp, Banet Law. We have years of experience helping people, and we can help you. Based in New Albany, Indiana, we proudly serve communities throughout Kentuckiana including, but not limited to, Floyd County, IN, Harrison County, IN, Clark County, IN and Jefferson County, KY. Contact us by calling (812) 725-8224 or through our online form.

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