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Medicare vs Medicaid
Medicare and Medicaid are two very important programs in the United States, providing health care coverage to millions of Americans. While similar in name and purpose, there are distinct differences between the two programs. Medicare is a federal program that provides health insurance for individuals over 65 and younger people with certain disabilities or diseases. Medicaid is a government-funded health insurance program to provide medical services to those with low income and limited resources.
What is Medicare?
In the United States, Medicare is a national health insurance programme started in 1965. Previously administered by the Social Security Administration, it is overseen by the federal agency Centers for Medicare and Medicaid Services. When it comes to assisting those with disabilities, Medicare is essential. For 60 million elderly Americans living in the United States, Medicare also offers financial and health security. It covers various fundamental medical services, including hospital admission, doctor visits, and prescription medications.
The Medicare umbrella gives rise to two subbranches.
Many senior citizens in America use Original Medicare, a government-funded health insurance programme.
For those who want Original Medicare with more coverage options, there is a product called Medicare Advantage.
Who can receive Medicare?
Most of the population will be over 65, and trust funds are used to pay for their medical expenses regardless of their income. It also provides care for people under 65 who are disabled, receiving Social Security Disability Insurance (SSDI) for a specific period, or who have End-Stage Renal Disease (ESRD) and have undergone or are undergoing dialysis.
What is Medicaid?
Medicaid is a joint federal and state-run public health insurance and assistance programme in the United States. It offers low-income people of all ages effective health coverage. Only families who meet the low-income requirements, which vary from state to state, are eligible for Medicaid.
Who can receive Medicaid?
Legal immigrants, permanent residents, and U.S. citizens are all eligible for Medicaid. Almost 77 million people had Medicaid coverage as of January 2024.
Medicaid offers medical insurance to:
Children, pregnant women, seniors, people with disabilities, and those with low incomes and resources
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Finding the right Medicare plan for you can be confusing and overwhelming. That’s why we’re here to help!
What is covered
What is covered by Medicare?
The Medicare programme is divided into several components that provide coverage for various facets of healthcare. Details can be found in this link.
What is covered by Medicaid?
The benefits of Medicaid programmes vary from state to state, but a few are common to all programmes, as listed below:
- Services for lab and X-rays.
- Hospital services for inpatients and outpatients.
- Birth control, nurse, and midwife services are examples of family planning services.
- Health examinations and appropriate paediatric medical care.
- Adult nursing facility services.
- Adult surgical and dental services.
It is always advisable to speak with a caseworker in each state to learn about the applicable coverage since Medicaid varies from state to state.
How Can I Enroll ?
How Can I Get Medicare?
Obtaining a Medicare plan could be a significant accomplishment. To get you started on that journey, here is a warning.
Some people who are 65 or nearly 65 and not receiving Social Security will need to sign up for Medicare; others who receive Medicare automatically.
One can sign up or alter how they receive coverage at specific times of the year.
It will be simpler to avoid penalties in the future if you enrol in Medicare Part B when you are first eligible.
It is not necessary to enrol in Medicare every year; rather, there will be an opportunity to review coverage and possibly change plans each year.
How can I get Medicaid?
There are two methods for requesting Medicaid:
- Call the Medicaid Agency for your State. It demands that the applicant be a citizen of that state.
- Submitting a form via the Health Insurance Marketplace.
Benefits & Drawbacks
Benefits of Medicare
Medicare offers protection to those who otherwise wouldn’t have it because they couldn’t afford it.
- There are very few monthly out-of-pocket expenses.
- The Medicare Advantage plans provide older Americans who would otherwise be without coverage with extra benefits.
- Medicare has sparked advancements in the pharmaceutical industry by giving businesses more opportunities to create prescription drugs.
- Medical standards have significantly increased thanks to Medicare.
The drawbacks of Medicare
Medicare administration costs for the healthcare system are extremely high.
- Out-of-pocket expenses were twice as high for those with poor or worse health than those with better health.
- People with treatable conditions incur gradually higher hospital costs, which puts more strain on hospitals.
- Fraud among doctors and an increase in opioid-related crimes. The New York Times reported that these doctors submitted Medicare claims for medicines they had never purchased.
- The cost of Medicare is enormous for the taxpayer.
Benefits of Medicaid
- Approximately two-thirds of medical aid spending in America is known to go towards seniors and people with disabilities.
- While some procedures do not require a copay, the costs are significantly more reasonable and lower.
- Since Medicaid ensures financial protection, people with financial constraints won’t be hit with hefty hospital bills.
- People who Medicaid covers can also easily access private care plans.
The Drawbacks of Medicaid
Since Medicaid varies from state to state, not all low-income people will qualify for benefits.
- In the worst-case scenarios, when people need an emergency procedure, they might be forced to receive subpar treatment simply because they have Medicaid coverage.
- People covered by Medicaid plans are vulnerable to discrimination.
- Few procedures are excluded from Medicare coverage, which makes it difficult for those who require such procedures but couldn’t afford to have them done in the first place.
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Finding the right Medicare plan for you can be confusing and overwhelming. That’s why we’re here to help!
