I remember that the conversations happened. I even remember being vaguely aware of what they were about. But being only seven years old, healthcare for older Americans was not at the top of my list of things that interested me. How times have changed!
The year was 1972 and my grandparents had just retired to northern Wisconsin. Their new house was just a 10-minute walk through the woods from our home, so I had ample opportunities to overhear “adult” conversations. Since it would be many years in the future before I had to worry about stuff like that, I didn’t pay much attention.
Well…now the future is here and sometimes I wish I’d paid more attention to those long-ago conversations. There sure is a lot to know and learn. I’m going to share some of the many things I am still very much in the process of learning.
I’ll start with something easy, and maybe there are a couple things you can learn along with me. Let’s explore the similarities and differences between Medicare and Medicaid.
Both Medicare and Medicaid are government-funded healthcare programs, and both exist to provide medical coverage to specific groups of individuals. Each program serves different populations and has distinct eligibility requirements, coverage options, and funding sources. Understanding these programs — and how they compare and contrast — is crucial in navigating and planning for healthcare needs.
Medicare is a federal health insurance program primarily geared towards people aged 65 and older. There are four different types of coverage, commonly referred to as: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
Let me break that down a bit more. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services. Part C provides an alternative way to receive Medicare benefits through private insurance plans, while Part D offers prescription drug coverage. I’ll be covering the history of these individual parts in the future.
Medicaid, on the other hand, is a joint federal and state program providing health coverage for low-income individuals and families. While Medicare has a universal eligibility age, each state sets its own Medicaid eligibility requirements, based on income level and other specific criteria. And while the federal government sets certain requirements, individual states retain some flexibility to set eligibility guidelines and benefits. Medicaid covers a broad range of services, including doctor visits, hospital stays, preventive care, and long-term care.
Medicare and Medicaid also differ in their funding sources. Medicare is financed by the federal government via general revenues, payroll taxes, and beneficiary premiums. Medicaid, on the other hand, is funded jointly by the federal government and individual states. The federal government matches state Medicaid expenditures based on a predetermined federal medical assistance percentage (FMAP), with higher matching rates for states with lower per capita income.
The scope of coverage provided by Medicare and Medicaid also differs. Medicare generally provides coverage for acute care services like hospital stays, doctor visits, and outpatient care. In contrast, Medicaid covers a more comprehensive range of services, including long-term care for some eligible individuals.
Another significant difference is how the programs are administered. Medicare is administered solely by the federal government, with standardized rules and regulations across the country. Medicaid, however, is administered jointly by the federal government and individual states. This shared administration allows states to tailor their Medicaid programs to better meet the unique needs of their populations.
So there you have it. Medicare and Medicaid are both government-funded healthcare programs, but each serves different populations and each has distinct eligibility requirements, funding sources and administrative structures. Understanding these differences is critical as we navigate and plan for our own healthcare needs.
By Steven Roberts
