Questions About Medicare & Medicaid

Medicare and Medicaid are both health programs offered by the United States federal government. Both are managed by the Centers for Medicare and Medicaid Services, or CMS, and individuals states have some say in how the programs are offered. With Medicare, this means each state can choose which standard Medicare supplement plans is available in their area. States have much more control over Medicaid, which they help fund. Each state passes its own regulations regarding who qualifies for the program and exactly what services Medicaid covers.

Who Qualifies for Medicare and Medicaid?

• Medicare is health insurance for people ages 65 years or older, people under 65 who have certain disabilities, and citizens of any age who have end-stage renal disease, which is permanent kidney failure that requires a transplant or dialysis. Medicare is offered in four parts; if you qualify for Part A and B, you also qualify for C and D. Medicaid is a program for low-income families and individuals of any age, as well as people with certain disabilities. Medicare is meant primarily for senior citizens and is funded by the federal government, while the states help pay for Medicaid. Each state has its own requirements for Medicaid, generally based on the amount of monthly resources a person or family has. In New York, for example, you may qualify for Medicaid if you're a single person whose monthly income is less than $707, as of November 2010. If you're part of a family of four, the income level to qualify is $1,285 per month. There are different income levels for the disabled, the blind and people ages 65 or older.

How Much Is Medicare and Medicaid?

• Medicaid services are usually offered for free. Medicare Part A, which generally covers hospital in-patient services, home health and hospice care, may be offered without a monthly premium for certain people. If you're 65 or older and don't qualify for premium-free Part A, you may still participate if you pay a monthly charge. Medicare Part C is called Medicare Advantage, which is offered through private companies for a monthly premium but combines Parts A and B Medicare with other services such as vision and dental. Medicare Part D handles prescription drugs and also requires an extra charge. You may also choose to join a Medicare supplement plan, offered through private companies. Medicare supplemental policies necessitate paying deductibles, copays and coinsurance charges.

What Benefits Do Medicare and Medicaid Offer?

• Medicare Part A, often called original or standard Medicare, primarily covers in-patient hospital services. Part B adds preventive services, doctor's visits and outpatient hospital care. The benefits for Part C, Medicare Advantage, depend on which company you choose to go through but may include foreign travel emergency coverage, prescription drugs and eye care. Medicare Advantage plans are also often offered as HMO plans, PPO plans or private fee-for-service plans. What services Medicaid covers depend on the state. These may include in-patient and out-patient hospital care, dental services, vision services, mental health care and drug rehabilitation.