If you’re trying to decide whether Medicare or Medicaid is right for you, we can help you better distinguish between these two U.S. government programs. While they do offer some overlapping benefits, Medicare and Medicaid are completely separate programs with significant differences.
In this helpful guide, Dr. Peramsetty explains what each program is and breaks down the differences between Medicare and Medicaid to help you determine which is right for you.
Medicare vs. Medicaid: Key Similarities
There are a few similarities between Medicare and Medicaid. These include:
Both are U.S. government-run healthcare programs established after an amendment to the Social Security Act in 1965. They are designed to help certain individuals get access to healthcare coverage.
Medicare and Medicaid are both run by the Centers for Medicare and Medicaid Services (CMS).
Both provide general health insurance benefits, though there are stark differences in eligibility and coverage.
What is Medicare?
Medicare is designed to provide primary coverage for U.S. citizens over the age of 65 who have difficulty covering expenses related to healthcare. In some cases, individuals under the age of 65 are eligible to enroll in Medicare if they have certain health concerns.
Medicare Basics
Medicare Plans
There are several different types of Medicare plans. These include Medicare Advantage Plans, Medicare Medical Savings Account (MSA) Plans, and other Medicare health plans (Medicare Cost Plans, pilot programs).
Each plan offers different levels of coverage. Learn more about the different plans here.
Parts A, B, C, and D
Currently, Medicare is further broken down into different parts— Plan A, B, C, and D—to distinguish the type of healthcare coverage an individual receives.
Medicare Part A — Covers inpatient hospital services, such as hospital visits, hospice care, limited skilled nursing facility care, and at-home healthcare.
Medicare Part B — Covers outpatient hospital services, such as preventive, diagnostic, and treatment services for health conditions.
Medicare Part C — Also known as Medicare Advantage Plan, this includes both Part A and Part B for more coverage choices.
Medicare Part D — Includes drug coverage, such as prescription medication and vaccinations.
Medicare Eligibility
Generally, Medicare eligibility is based on the age of the applicant. A person must be a citizen or permanent resident of the United States and 65 years old or older to qualify. The exception to this is people younger than age 65 who have certain documented disabilities.
What is Medicaid?
Medicaid is a government-run health program designed to help low-income households or individuals with certain disabilities cover medical expenses. Medicaid is run jointly by state and federal governments, with the program primarily managed by each state, so the eligibility requirements can change depending on where you live.
Medicaid Basics
Medicaid Coverage
The extent of healthcare coverage varies by state, but there are some key benefits included in every Medicaid program, such as:
Lab and X-ray services
Inpatient and outpatient hospital services
Family planning services (e.g. birth control)
Health screenings and applicable medical treatments for children
Nursing facility services for adults
Surgical dental services for adults
Preventive care (e.g. immunizations)
To learn more about your specific coverage with Medicaid, we recommend you reach out to your State Medical Assistance (Medicaid) office.
Medicaid Eligibility
Eligibility for Medicaid is based primarily on income. Whether or not someone qualifies depends on income level and family size. To find out if you qualify for assistance in your state, visit www.Healthcare.gov.
Furthermore, there are also certain programs within Medicaid that extend coverage to groups in need of immediate assistance, such as pregnant women and those with urgent medical needs.
Primary and Urgent Care Services in Tuscaloosa, AL
We accept all major insurance, including Medicare and Medicaid. If you need primary or urgent care services in Tuscaloosa, Alabama, get in touch with the friendly team at Crimson Care.
Learn more about urgent care and primary care, or schedule an appointment online.