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Medicare & Medicaid Plans

The U.S. government teamed up with state governments to offer the Medicaid and Medicare insurance programs. Medicaid is an insurance program available to low-income households that cannot afford to buy medical insurance. Medicaid offers basic medical services but states have the option to include additional services in their Medicaid programs. Medicare is available to seniors age 65 and older, certain disabled persons, and people with end-stage renal disease (ESRD).

  1. Medicaid Program Details

    • Medicaid is federally and state funded and is administered by the states. Medicaid sends money directly to its participants' healthcare service providers. Some states require Medicaid participants to pay a small co-payment for certain medical services. States determine the exact services offered under their Medicaid programs. Mandatory services provided by all states include inpatient and outpatient care, physician services, nurse-midwife services, pediatric and family-nurse practitioner services, laboratory and x-ray services, prenatal care, family planning services, early prescreening services, and vaccines for children.

    Medicaid Eligibility

    • Medicaid eligibility is based on a household's income and citizenship. Medicaid has established mandatory eligibility groups that include families with children receiving Temporary Assistance for Needy Families, individuals receiving Supplemental Security Income (SSI), children born to parents on Medicaid, children under age 6, pregnant women whose families are at or below 133 percent of the national poverty level, individuals involved in adoption or foster care, and certain Medicare recipients.

    Medicare Parts A and B

    • Medicare has four parts. Medicare Part A covers hospital insurance and is used for inpatient hospital care, services at a skilled-nursing facility, hospice care and home health care. Medicare Part A is free for most people because they already paid for it while working and paying Medicare taxes. People who are not entitled to free Medicare Part A may purchase it if they are 65 or older, or if they are under 65 and disabled or no longer receiving free coverage because they have returned to work. Medicare Part B is medical insurance that covers outpatient care, home health services and preventive care. People must pay a premium to participate in Medicare Part B.

    Medicare Parts C and D

    • Medicare Part C is the Medicare Advantage Plan. Medicare Part C includes all the services provided in Part A and Part B, as well as additional services under vision, hearing, dental and wellness programs. Many Medicare Advantage Plans also include prescription services. Premiums for Medicare Advantage Plans vary per provider. Medicare Part D provides insurance for prescription drugs. The insurance is run by insurance companies or other private companies that are approved by Medicare. Premiums for Medicare Part D depend on the insurance company and the drugs covered by the plan.

    Medicare Eligibility

    • Individuals are eligible for Medicare if they or a spouse worked at least 10 years in a Medicare-covered job and are age 65 or older. U.S. citizenship or permanent-residence status is required to qualify for Medicare. People under age 65 may qualify if they have end-stage renal disease. Those age 65 and older may receive free Part A coverage if they receive Social Security or RailRoad retirement benefits, are eligible for these benefits but have yet to file, or if they or a spouse have Medicare-covered government employment.

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