The Basics on Medicaid and Medicare

Medicaid and Medicare are essential programs for practicing physicians, members of the American Medical Association, and the entire nation. The programs were developed in 1965 to assist certain categories of individuals with their medical costs. Today, Medicaid provides coverage to over 50 million Americans while Medicare aids over 45 million. These numbers make Medicaid and Medicare the largest source of medical funding in our nation.

Being curious about the programs, I completed some research on their general information. The basics are described in this article. After reading through each program description, you will see how different and important Medicaid and Medicare are.

Medicaid

Medicaid is a program designed to assist US individuals and families that fall into certain eligible categories. Although the main qualifying category is low income, it is not the defining factor. For instance, many poverty stricken individuals cannot receive Medicaid due to other qualifying aspects. The other eligibility requirements include measures like your age, pregnancy status, citizenship, and disability like blindness.

The Medicaid program is funded by both the state and federal government. The funding, program name, and process requirements can differ from state to state. The states administer their own program but receive a percentage of federal funds under the notion that they must adhere to the federal requirements regarding service, funding, quality, and eligibility. These requirements are monitored by the Centers for Medicare and Medicaid Services (CMS).

Those receiving Medicaid receive specific inpatient and outpatient coverage and they have the option of dental care and Prescription Drug Rebates. Depending on the category they fall under, they may be required to pay some out of pocket costs like co pays to doctors or providers. But, the out of pocket costs are generally much lower than higher income individuals that might receive medical insurance through their employer.

Medicare

Medicare, on the other hand, is a social insurance program in place providing health care coverage to those 65 years or older, those with certain disabilities, or those with permanent kidney failure. The federal government is the sole funder of the Medicare program. Although it is administered on a federal level, it is still monitored by the CMS.
There are four different elements to Medicare: Hospital Insurance (Medicare Part A), Medical Insurance (Medicare Part B), Medicare Advantage Plans (Medicare Part C), and Prescription Drug Plans (Medicare Part D).

• Part A covers inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. Members who have Part A coverage typically do not pay any monthly premiums because they already contributed through taxes taken while working. Individuals that have not completed the required tax contributions can still elect for Part A coverage but they will have to pay a premium.

• Part B covers doctor services, outpatient care, some physical and occupational therapy, and some home health care. Those that elect Part B will pay a monthly premium, similar to the premium paid when receiving medical coverage through your employer. This helps explain one of the reasons for having a premium attached with Part B. Many individuals do not elect Part B because they receive their medical insurance through their current or previous job.

• Part C is also referred to as Medicare Choice or Medicare Advantage. It is a means for individuals to receive Medicare coverage, but it is through private health insurance plans of their choice. The individuals pay their insurance provider a premium. Medicare also pays the provider a set amount for each Medicare member the company covers. Medicare Advantage allows those that can afford the premiums to benefit from prescription drug coverage, dental care, vision care, and a number of other items not covered by traditional Part A or Part B programs.

• Part D helps lower prescription drug costs for those that elect the coverage. It was added to the Medicare options in 2006. Like Part B, Medicare Part D requires a monthly premium from most. Anyone in Part A or B is eligible to enroll but they must also have a separate Prescription Drug Plan or Part C Coverage with prescription drug coverage.