|  | Healthcare Industry | Medicare

Medicare Vs. Medicaid Coverage

Medicare and Medicaid are two American health insurance programs that are often confused with each other. Medicare is the federally administered program for the elderly and disabled, and Medicaid is the state and federal administered health program for low-income individuals. The two are very different in how they are funded and implemented.

  1. Populations

    • In order to qualify for Medicare, you either must be 65 years of age or older, receiving Social Security Disability Insurance for at least 24 months, or have end stage renal disease. In comparison, Medicaid covers more varied populations than Medicare. While some states opt to cover more, federal law mandates that states must cover pregnant women, the disabled, the blind, the aged (65+) and children.

    Eligibility Requirements

    • Medicaid applicants are subject to strict income and asset guidelines that are determined by state-specific federal poverty limits. Medicare, on the other hand, does not have any requirements specific to income or assets.

    Funding

    • Medicare is funded completely by the federal government. Medicaid is funded by both federal and state governments. The federal government pays each state based on a federal matching formula called the Federal Medical Assistance Percentages. Wealthier states receive close to 50 percent, and the less wealthy states receive a higher percentage.

    Implementation

    • Both programs are overseen by the Centers for Medicare and Medicaid (CMS). However, CMS completely controls Medicare, while CMS simply oversees the states' implementation of the Medicaid program. Each state has the right to set its own guidelines, and the process for applying to Medicaid is different everywhere. The process to apply for Medicare, however, is the same no matter where you live in the United States.

    Services

    • Generally, both Medicaid and Medicare are comprehensive health care programs. There are a few differences in services covered. Dental benefits are one of the biggest differences. Medicaid offers the mandatory-coverage populations full dental coverage, including preventive screenings and cleanings. Medicare, however, only covers dental services if the services are medically necessary. Another notable difference is that many Medicaid programs will cover some classes of drugs that Medicare cannot cover by law. These drugs include benzodiazepines, barbiturates and over-the-counter drugs. Medicaid coverage varies by state.

Medicare - Related Articles