|
Medicare
& Medicaid Explained
by Nolo.com
From
the Nolo.com Retirement & Elder Care Center
A
comparison between Medicare and Medicaid and explanations of both types of coverage.
People are often confused
about the differences between Medicare and Medicaid. Medicare was created in
an attempt to address the fact that older citizens have medical bills significantly
higher than the rest of the population, while it is much more difficult for
most seniors to continue to earn enough money to cover those bills. Eligibility
for Medicare is not tied to individual need. Rather, it is an entitlement program;
you are entitled to it because you or your spouse paid for it through Social
Security taxes.
Medicaid, on the other hand,
is a federal program for low-income, financially needy people, set up by the
federal government and administered differently in each state. This program
is called Medi-Cal in California.
Although you may qualify
and receive coverage from both Medicare and Medicaid, there are separate eligibility
requirements for each program; being eligible for one program does not necessarily
mean you are eligible for the other. Also, Medicaid pays for some services for
which Medicare does not.
The following chart summarizes
the differences between the two programs.
| |
Medicare |
Medicaid |
| Who Is Eligible |
Medicare covers: almost
everyone 65 or older, certain people on Social Security disability, and
some people with permanent kidney failure. |
Medicaid covers low-income
and financially needy people, including those over 65 who are also on Medicare.
|
| Who Administers
the Program |
Medicare is a federal
program. Medicare rules are the same all over the country. Medicare information
is available at your Social Security office. |
Medicaid rules differ
in each state. Medicaid information is available at your local county social
services, welfare or Department of Human Services office. |
| Coverage Provided |
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 of basic doctor and laboratory costs, and some of other
outpatient medical services, including medical equipment and supplies,
home health care and physical therapy. It does not cover prescription
drugs.
|
In many states, Medicaid
covers services and costs Medicare does not cover, including prescription
drugs, diagnostic and preventive care and eyeglasses. |
| Costs to Consumer |
You must pay a yearly
deductible for both Medicare Part A and Part B. You must also pay hefty
co payments for extended hospital stays.
Under Part B, you
must pay 20% of doctors' bills and sometimes an additional 15%. Part B
also charges a monthly premium.
|
Medicaid can pay Medicare
deductibles and the 20% portion of charges not paid by Medicare. Medicaid
can also pay the Medicare premium.
In some states, Medicaid
charges consumers small amounts for certain services.
|
©
2001 Nolo.com.
|
Equal Housing Opportunity.