Medicare & Medicaid Regulations

Medicare and Medicaid seem very similar on the surface. They are both national health insurance programs in the United States. They were both introduced by President Lyndon B. Johnson as part of his Great Society reforms through the Social Security Act of 1965. Both offer benefits for health services and both are available across the country. In many ways, however, Medicare and Medicaid are quite different.

Administration

• Original Medicare, Parts A and B, are administered and funded by the federal government. Original Medicare benefits are standardized and are the same no matter where you live. The Centers for Medicare and Medicaid Services (CMS) oversees the program, and enrollment is handled by the Social Security Administration. Parts C and D, however, are sold by private insurance companies approved by the CMS, and may vary in their benefits and regulations. Medicaid is funded jointly by the federal government and the states, and the states manage Medicaid and set many of their own regulations regarding who is eligible and what services are offered through it.

Eligibility

• Medicare is open to any U.S. citizen who has reached the age of 65. People under 65 may also be eligible if they are receiving Social Security benefits for disabilities and certain health conditions. Medicaid is usually only available to certain members of the population, and even then only if they meet income and asset guidelines. However, the exact eligibility requirements for Medicaid depend on the state. New York's guidelines require only that you have high medical bills, receive Supplemental Security benefits and meet financial standards to be eligible. Other states like Georgia and Ohio, however, regulate that only minor children, pregnant women, the disabled, the blind, the elderly, people in nursing homes and women with breast or cervical cancer may receive Medicaid.

Ineligibility

• Once you have signed up for Medicare, you can keep it as long as you pay for it. You may not be eligible for Medicaid for as long as you like, however. Since Medicaid is generally used only by minor children and people who meet specific income guidelines, you will lose your Medicaid membership whenever you cease to meet these standards. If you received Medicaid as a child, you may lose benefits once you reach 19 years of age, and pregnant women or other adults receiving benefits will have them cease once they surpass their state's maximum income levels.

Costs

• Medicare comes with a number of different costs, which can be difficult to meet. Part A Medicare is often premium-free, but Parts B, C and D require monthly payments. Services usually come with co-payments for which users are responsible, and each part also has its own annual deductible. Medicaid usually does not have monthly premiums, especially for children, and the co-payments, when they even exist, are low. Monthly premiums are allowed for families on Medicaid who make more than 150 percent of the federal poverty level, however.