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Medicare vs. Medicaid (Medi-Cal in California)

01/15/2023

medicaid vs medicare

Medicare and Medicaid are two government-funded health insurance programs that provide coverage to certain groups of people in the United States. While they are designed to help people pay for medical care, they serve different populations and have some key differences.

Here is a breakdown of the main differences between Medicare and Medicaid:

Eligibility:

  • Medicare is a federally funded health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). To be eligible for Medicare, you must be a U.S. citizen or permanent resident and have worked and paid Medicare taxes for at least 10 years.
  • Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families. Eligibility for Medicaid is based on income and resources and varies by state. In general, Medicaid is available to people with low income and few assets, including children, pregnant women, parents of dependent children, people with disabilities, and seniors.

Coverage:

  • Medicare is divided into four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. Medicare Part B covers medically necessary services like doctors’ visits, outpatient care, and preventive services. Medicare Part C, also known as Medicare Advantage, is an alternative to traditional Medicare offered by private insurance companies. It combines the benefits of Parts A and B and often includes additional benefits like prescription drug coverage and vision and dental coverage. Medicare Part D is a separate prescription drug plan that can be added to the original Medicare or Medicare Advantage plan.
  • Medicaid covers many medical services, including hospital stays, doctor’s visits, preventive care, prescription drugs, and long-term care. However, Medicaid benefits can vary from state to state, as states have some flexibility in determining which benefits to cover.

Cost:

  • Medicare premiums, deductibles, and copayments are generally based on your income and the type of coverage you choose. Most people eligible for Medicare are automatically enrolled in Part A and Part B, but they may have to pay premiums for Part B and Part D. Medicare beneficiaries may also be responsible for deductibles, copayments, and coinsurance for certain services.

In California, Medicaid is referred to as Medi-Cal.