Medicare vs Medicaid, differences, coverage and pricing

Medical coverage is essential for a dignified life and in the United States, in addition to private health insurance, there are different programs to help low-income families or patients with certain chronic diseases.

This is the case of Medicare and Medicaid and in this article we explain the differences between the two, their coverage and prices.

What is Medicaid

It corresponds to a health plan that combines state and federal government efforts to help low-income households have health care assistance. Among the costs you can cover are routine care, treatment for a serious condition and major hospitalizations.

It is a program that provides health care to anyone, including children, youth, adults and people with disabilities. By October 2022, more than 84 million people were enrolled in Medicaid and almost 7 million infants were part of CHIP (Children's Health Insurance Program).

What is Medicare

This program represents a government policy designed to enable adults over the age of 65 to cover their medical expenses. Its purpose is to support U.S. citizens/residents and their families in receiving financial assistance.

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If you are under 65 or have a disability, you may be eligible for this benefit. This also applies to those who have kidney disorders and are terminally ill. Each case has a particular evaluation based on Medicare and its eligibility criteria.

When it comes to choosing an option with this program, there are 2:

Original Medicare (Part A and B).

It consists of a government insurance for medical expenses that many seniors have as their main insurance. In terms of coverage, it offers you:

• Inpatient hospital services (Part A). These benefits cover health center visits, home health care, hospice/nursing home care, and limited nursing care.
• Outpatient hospital services (Part B). This is outpatient coverage for preventive, diagnostic and treatment purposes.

Medicare Advantage (Part C)

Also known as Part C, this is insurance that includes a few more things than Original Medicare. These are also programs offered through private insurers. Most of these alternatives have dental, hearing, vision and prescription drug coverage.

Requirements to enroll in Medicare

In most cases, Medicare requires you to be over 65 and have citizenship or permanent residency. Specific plans and premiums are subject to annual tax contributions to the program. The only exception to the age range are those with a verified disability.

Often, those enrolled in Medicare also receive another kind of Social Security benefit. This plan may include:

• The children of a person who has worked for the government for a certain amount of time and paid Medicare taxes.
• People who are eligible for the Social Security disability program and are widowed/widowed over age 50.

Medicaid enrollment requirements

Medicaid eligibility depends primarily on income and family size. For those under age 65, the money they earn must be 133% less than the federal poverty level. According to HHS, in 2023 this means earning less than $14,580 (individually), $30,000 (4 people) or $50,560 (8 people).

This varies for the youngest members of the household, who may show higher incomes to be enrolled in both CHIP and Medicaid and depending on state standards for each individual.

There are also special extended coverage programs for pregnant women and people requiring urgent medical care.

Medicaid vs. Medicare coverage

With Medicaid, the services covered vary from state to state. Still, there are benefits that are common to each plan:

• X-rays and lab
• Dental surgery for adults
• Adult nursing care
• Inpatient and outpatient hospital care
• Health screenings and applicable treatments for children
• Family planning, such as midwifery and birth control

Medicare coverage is divided into 4 parts. We have already discussed Parts A, B and C, leaving Part D, which deals with programs that follow government guidelines to facilitate payment and prescription drugs.

Medicare and Medicaid costs

If you want Medicare, you have to pay small monthly premiums. For each option, the costs look like this:

With Medicaid, you rarely have to pay for coverage, but there may be co-payments. Each state charges an enrollment fee and a premium, which apply to:

• People who need medical care.
• Disabled and FOA-eligible children.
• Pregnant women and children with a family income 150% above the LPF.
• Workers disabled and eligible under the Ticket to Work program and WIIA.
• Working individuals with a disability and income 150% above the LPF.

Español: Diferencias entre Medicare y Medicaid, coberturas y precios