What is the difference between Medicare and Medicaid?

Many people are confused about the difference between Medicare and Medicaid. Both are health insurance programs that provide services to nearly 100 million Americans and are managed by the U.S. Department of Health and Human Services. In fact, an estimated 47 million Americans are served by Medicaid, many of them children, low income, or disabled. Another 37 million elderly or disabled Americans are served by Medicare.

Medicaid is a primarily means-tested individual health insurance program. Eligibility is largely based on income, but people may also qualify based on their age, disability or pregnancy status, or citizenship status. Although states can set their own requirements for those receiving Medicaid, they are required to provide services to those who qualify according to federal guidelines as well.

The program is overseen by the federal government, but each state determines eligibility and administers the program. Although each state has some degree of autonomy when it comes to determining the scope of health care services, some are required under federal law, including:

• Inpatient and outpatient hospital services
• Laboratory and X-ray services
• Physicians services
• Vaccinations
• Family planning services and prenatal care
• Nurse midwife services
• Home health care and skilled nursing facility services
• Rural health clinic services
• Ambulatory services
• Pediatrician services

Medicare, on the other hand, is a federal program that provides health coverage to elderly Americans and some Americans with certain types of disabilities. Four types of Medicare exist: parts A, B, C, and D.

Medicare Part A provides coverage for hospital stays, home health care, and skilled nursing care, among other things. Medicare Part B pays for physician services, outpatient or home health care, and prosthetics or eyeglasses, and premiums are required. Medicare Part C provides a customized plan based on the needs of the individual and is often similar in design to an HMO. Medicare Part D provides drug coverage.

Medicare is not a family health insurance plan. Individuals who are disabled, suffering from end-stage renal disease, or who are over the age of 65 are eligible for Medicare. They must also be U.S. citizens or permanent legal residents who are eligible to collect Social Security benefits.

Source: Los Angeles Health Care

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