Friday, May 2, 2014

Medicare. Medicaid. Do you know the difference?

Their names sound similar. They’re both government-run health care programs. But, there are a number of important differences between Medicare and Medicaid that you should be aware of.

What is it?

Medicare is a federal health insurance program generally for U.S. citizens and legal residents who are 65 or older or under 65 with certain disabilities, end-stage renal disease, ALS or complications from chemical exposure from a war. Most people become eligible for Medicare because they have contributed to the Medicare trust fund while working. The trust fund covers the cost of Medicare expenses.

Medicaid is a jointly funded state and federal program that helps pay health care costs for people with limited income and resources. Medical bills are paid from a federal, state and local tax fund. The federal government also pays the states for a percentage of their program expenses.

Who runs it?

Medicare is a federal program run by the Center for Medicare and Medicaid Services. The rules for Medicare are basically the same throughout the United States.

Medicaid is run by individual state and local governments who operate within federal guidelines. Unlike Medicare, the administration and rules for Medicaid vary from state to state.

What does it cover?

Medicare coverage includes care and services in a hospital or skilled nursing facility (part A), doctor visits, care and services received as an outpatient and some preventive care (part B), prescription drug coverage (Part D).  Medicare Advantage Plans combine Part A and B coverage and often include Part D coverage in one plan.

Medicaid programs are created by the individual states and may offer some benefits not normally covered by Medicare, including nursing home care and personal care services. Mandatory benefits include care and service received in a hospital or skilled nursing facility; care and service received in a federally qualified health center, rural health center or a free-standing state recognized birth clinic; doctor, nurse, midwife and certified pediatric and family nurse practitioner services. Prescriptions and other services may also be covered.

Some people qualify for both Medicare and Medicaid and the two programs can work together to cover most of their health care costs.

To learn more or find out if you qualify for Medicaid, please visit Ohio’s Medicaid website at  For Medicare information, please visit

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