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By John R. Merlino Jr. Esq.
Founding Attorney

Both Medicare and Medicaid are government-sponsored, taxpayer-funded programs that are intended to help Americans cover the costs associated with healthcare. Additionally, both programs were established back in 1965. With similar-sounding names and the fact that both are intended to cover healthcare costs, many people confuse the two. There are, however, important distinctive qualities between the two programs. Here, we discuss the differences between Medicare and Medicaid.

What Is the Difference Between Medicare and Medicaid?

It can be helpful to think of Medicare as an insurance program and Medicaid as an assistance program. Medicare is an insurance program that provides coverage primarily to those over 65 years of age, regardless of income level, and younger disabled individuals as well as dialysis patients. Eligibility for Medicare has nothing to do with income level. This sets it apart from Medicaid which is an assistance program designed to help out low-income individuals at every age.

In the Medicare program, qualifying individuals have medical bills paid from a fund that those covered individuals have paid into. Patients cover part of the costs of medical care through paying deductibles for hospital costs and other medical expenses. Additionally, there are relatively low monthly premiums required if a person wants non-hospital coverage.

In the alternative, Medicaid patients usually do not have to pay any part of the costs for medical expenses covered under the program. In fairly rare instances, a small co-pay is required. While Medicare is a federal program, Medicaid is a federal-state program. This means that some of the program specifics vary from state to state. The program is run by state and local governments, but must be administered in accordance with federal guidelines.

The Medicare program has four parts of coverage available. Part A covers hospitalization. Part B covers medically necessary services and equipment. Part C, supplemental insurance, provides qualifying individuals with coverage for vision, hearing, and dental. Part C is also known as “Medicare Advantage.” Part D provides prescription drug coverage.

Medicaid coverage is, again, subject to sometimes state-specific details. The federal government, however, mandates that state Medicaid programs provide minimum coverage, including coverage for:

  • Hospitalization
  • Doctor’s services
  • Family planning
  • Laboratory services
  • Midwife services
  • Nursing services
  • Pediatric nurse practitioner services
  • X-rays

In sum, Medicaid provides almost complete medical coverage as a last resort for individuals with limited resources. Medicare provides lower-cost insurance coverage primarily to individuals over the age of 65.

Estate Planning Attorney

Health care coverage can be complicated, but vitally important. This can be especially true as we age. The dedicated elder law and estate planning attorneys at Merlino & Gonzalez will provide you with sound legal counsel on your medical coverage options and talk to you about how this can come into play as you plan for the future and investigate long-term care plans. We are here to look out for what is best for you and your family. Contact us today.

About the Author
John is a fierce advocate and the office guru for problem-solving and brainstorming. He guides clients through every stage of a real estate transaction from offer to contract, navigating through nerve-shattering home inspection and title clearance concerns, maintaining constant contact with lenders, conducting the actual closing, and continuing to advise clients with regard to any post-closing concerns.  John brings a practical and fair-minded approach to the process which has earned him the respect of his clients and peers.