Medicare and Medicaid: What Do They Do?

Medicaid and Medicare are federally funded health care coverage programs. People who are 65 or older or who are disabled and meet specific requirements are eligible for Medicare.

People who meet Medicaid's income guidelines receive financial assistance. These two programs heavily impact the government budget. If you want to know more, read on to see how every one of these initiatives is addressed.

What is Medicaid

Medicaid is the United States government-run health insurance program for low-income individuals and families. Each state and the national authorities contribute to the program.

Since it is managed on a state level, the scope of services and how they are administered differ significantly between jurisdictions. This program is restricted to households that meet specific income requirements.

People who get this aid are either U.S. citizens, lawful immigrants, or permanent residents. As of September, of that year (2020), Medicaid enrolled about 70.6% of the population.

Individuals cannot receive medical care via Medicaid. As an alternative, it pays for all their medical expenses, such as visits to the doctor, hospitalizations, custodial care, long-term medical care, and more.

Who is covered, what kind of coverage, and how providers and facilities are reimbursed are all matters left to the discretion of individual governments. That's because the Medicaid program is a matter for each particular state to govern and administer.

Depending on the state, there is a statutory baseline of 50% federal match and a peak of 83% federal matching. Participation in Medicaid is voluntary for the states, but all of them provide it.

What is Medicare?

Medical coverage is available through Medicare for anyone 65 or older or disabled and satisfies specific financial and health requirements according to this website. Typically, insurance companies are hesitant to insure anyone over 65.

This is because persons at this age are disproportionately affected by extremely costly medical diseases. In 1965, while Lyndon B. Johnson was president, the federal government started the Medicare program to address this issue.

Medicare was developed as part of the broader Social Security system. The Social Security program, which was established in 1935, offers an income in retirement to those who are 62 or older, as well as to those people with impairments. Medicare is an auxiliary service of the Social Security Administration.

Medicare is an elevated health insurance program that does not require applicants to undergo a medical or financial underwriting process. In general, Medicare does not charge a premium for its covered services. Those who meet the requirements can now participate in the program.

Eligibility to Medicare and Medicaid Programs

There are prerequisites for participating in each course.

Medicare eligibility

Their age determines a person's Medicare eligibility. Eligibility requirements include being at least 65 years old and a permanent resident or a U.S. citizen.

The number of years of Medicare taxation determines both premiums and plan eligibility. Disabled individuals under 65 who meet specified criteria are an exception to this rule.

Medicare recipients typically also obtain Social Security disability or retirement payments. Additionally, Medicare coverage may be expanded to:

  • A widow(er) above the age of 50 who is applying for benefits under the Disability Insurance program
  • Someone who pays Medicare taxes for a certain number of years while at a public service job

Medicaid eligibility

Medicaid qualification is generally income-based. Individuals may be eligible depending on their household income and composition.

Because the required income requirement is the same across the nation, the Affordable Care Act has expanded coverage to bridge healthcare shortages for individuals with the lowest wages.

Eligibility is determined by having an annual income of less than 133 percent of the national poverty line for most individuals under 65. The average cost for a four-person family in 2021 is estimated to be $26,500, while an individual would pay about $12,880 if using Healthcare.gov as a guide.

Medicaid and the Children's Health Insurance Program (CHIP) income limits for families with children vary by state.

Medicaid also has specialized programs that provide health insurance to vulnerable populations, like pregnant women and people with severe medical conditions, who otherwise would not qualify for the program.

Medicare and Medicaid coverage

Medicare coverage

Medicare covers various medical expenses through its many segments.

Inpatient treatment is covered by Medicare Part A, including hospitalization, hospice, skilled nursing, and home health aide services.

Subpart B of Medicare covers medical services received outside of a hospital setting. Outpatient hospital treatment, doctor visits, preventative care, and some medical equipment are only some of the things that are covered.

Medicare Part C or Medicare Advantage is a commercial insurance program that provides the same coverage as Original Medicare (Parts A or B) but is administered by private companies. Dentistry and vision care and insurance for medications may be available under these policies for an additional premium.

Prescription medication coverage is provided via Medicare Part D, administered by approved plans per government regulations.

Medicaid coverage

Medicaid's coverage varies by state, although all offer at least some of the same services.

These include:

  • X-ray and laboratory testing
  • Hospital care for both in- and outpatients
  • Contraception and other forms of family planning assistance (e.g., nurse-midwife care)
  • Nursing home care for seniors and preventative medicine for kids
  • Surgical, dental care is available for adults.

Since Medicaid laws vary from state to state, it's a good idea to speak with a counselor in your area to evaluate your eligibility and assist you with enrolling.

In the United States, Medicaid and Medicare are two government-run healthcare programs available. Medicaid's eligibility criteria mostly center on financial needs, while Medicare primarily covers senior adults and people with specific chronic diseases or disabilities.

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