Medicare is a federally funded health insurance program. Every U.S. citizen aged 65 and over is eligible for this guaranteed medical coverage. Additionally, many individuals under the age of 65 who are disabled are covered by Medicare. While individuals eligible for Medicare are able to purchase supplemental insurance policies, Medicare is the primary medical coverage provider for most disabled and over-65 Americans.
Individuals who have (or have a spouse who has) worked for at least 10 years and paid into the Medicare program via payroll taxes qualify for premium-free Medicare Part A (which covers inpatient hospital or nursing care). Individuals covered by Medicare Part B (which overs doctor visits and outpatient care) pay a premium for this coverage. Medicare Part D (a prescription drug plan) and Medicare Advantage are additional coverages individuals may opt to purchase from private insurers approved by Medicare.
Medicaid is a program funded by states and the U.S. government. Unlike Medicare, Medicaid is not age-based but income-based. Essentially, Medicaid is a public health- insurance program that provide free or low-cost healthcare for low-income individuals who otherwise would not be able to afford medical care (some disabled and elderly individuals also qualify for Medicaid.)
Each state runs its own Medicaid and determines what, if anything, beyond the mandatory benefits are covered by the plan. Additionally, states have the authority to extend Medicaid coverage to individuals whose incomes exceed the federal income eligibility cutoff, which varies according to family size and adjusted gross income.
- At minimum, Medicaid covers:
- Inpatient and outpatient hospital services,
- Screening, diagnostic, and treatment services for children
- Nursing facility services
- Home health services
- Physician services
- Rural health-clinic services
- X-rays and laboratory work
- Family planning
- Freestanding birth-center services
- Certified pediatric and family nurse practitioner services
- Tobacco cessation counseling for pregnant women
More than 73 million people are on Medicaid (roughly one out of five Americans), making it the single-larges health insurance program in the United States. Many Americans are eligible for both Medicare and Medicaid; typically Medicare pays first and Medicaid covers additional coinsurances and copayments.