Medicare
=
Medical Care
Medicaid
=
Financial Aid to
pay for care
While
the example above might be stretching things a little, it's been helpful to quite a few people who were confused. And most
Americans are confused about the difference between
Medicare and Medicaid. Here's a brief synopsis:
Both
programs are part of the Social Security Act. There are major
differences, however.
Medicare
is the
federally funded health insurance program. It provides health
benefits to older Americans, to disabled individuals who have
met specific disability guidelines, and to people with
irreversible kidney failure or Lou Gehrig's Disease (ALS).
Traditional
Part
A covers
inpatient hospital care, inpatient rehabilitation after a
hospital stay, medical home health care, and hospice care. Just
like other health insurance policies, there are deductibles and
co-payments that must be satisfied.
Individuals
who have reached the full Social Security retirement age (65 at
this writing) receive Medicare Part A along with their Social
Security benefits. There is no additional cost for Medicare Part
A because they contributed to Medicare during their working
years.
Traditional
Part
B covers
doctor visits and services, and outpatient services such as
therapy and rehabilitation, diagnostic tests, outpatient
hospital services, ambulances, durable medical equipment, and
some supplies.
After
an annual deductible is met, Medicare Part B pays 80% of
approved charges.
Enrollment
in Medicare Part B is optional and voluntary. Participants pay a
monthly premium, which is automatically deducted from Social
Security retirement (or disability) benefits.
Because
Medicare is a federal program, Parts A and B are generally
uniform from state to state across the country.
Medicare
HMO (Medicare + Choice)
Individuals
who are eligible for Medicare insurance have the option of
enrolling in a managed care program. Medicare + Choice
programs are administered by private health insurance companies
that contract with the federal government. Coverage varies by
company and by geography, but all Medicare + Choice policies are
required to offer the same basic coverage.
There
is no income test required to qualify for any Medicare
benefits.
Medicaid
is an
assistance program funded jointly by the federal government and
the individual states. It is designed to assist low income
individuals of all ages with medical costs. Because programs are
administered by the individual states, eligibility requirements
vary.
Many
people who have Medicare coverage also qualify for Medicaid
because of their low income status. In this case, Medicaid will
often cover deductibles and co-payments (as well as some
medications) that would otherwise have to be privately paid.
Medicaid
is the primary government funding source for frail older people
who need long-term custodial care in a nursing home. Medicare
does not cover any kind of custodial care.
For
additional, more specific information, you can access several
helpful brochures about Medicare at
http://www.medicare.gov.
For
information about Medicaid, contact
your state Medicaid office.
 
|
