A Closer Look at Medicare and Medicaid How They Are Different in Terms of How the Programs are Run, Who Can Be Eligible for Benefits and the Limits on Those Benefits
DEBORAH SEXTON
ARKANSAS ESTATE PLANNING ATTORNEY
Medicaid and Medicare are two important healthcare programs available to citizens of the United States. They were created when the Social Security Act was amended in 1965 and are managed by the Centers for Medicare and Medicaid Services. These programs effectively extended healthcare coverage to almost all Americans age 65 or older and healthcare services to low-income children without parental support and the relatives who take care of them, the elderly, the blind and individuals with disabilities. Though these programs have similar purposes, they are very different in terms of how the programs are run, who can be eligible for benefits and the limits on those benefits.
MEDICARE
Medicare is essentially an insurance program available to people over the age of 65 regardless of income level, younger people who are
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disabled and patients with End-Stage Renal Disease requiring dialysis. Through this program, patients pay a portion of the costs for medical treatment through deductibles and monthly premiums required for non-hospital coverage. Medicare benefits are usually provided by private companies that contract with Medicare to provide those benefits. Because Medicare is a federal program, it is basically the same everywhere in the United States. Medicare has several different parts that cover specific kinds of services:
Medicare Part A (Hospital Insurance), helps pay for care in a hospital and skilled nursing facility, home health care and hospice care. Most people don't have to pay for Medicare Part A because Medicare provides the coverage. You have a choice of any doctor, hospital or other healthcare provider that accepts Medicare. You or your supplement insurance coverage would be responsible for deductibles and coinsurance (or copays).
Medicare Part B (Medical Insurance), which helps pay for doctors, outpatient hospital care and other preventive medical services. Most people do pay for Medicare Part B. With Part B, you can also choose any doctor, hospital or other healthcare provider that accepts Medicare. You or your supplement insurance coverage would be responsible for deductibles and coinsurance (or copays).
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Medicare Part C (Medicare Advantage Plans) are offered by a private company that contracts with Medicare to provide Part A and Part B benefits. Medicare Advantage Plans include the following:
Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans
Coverage is provided by the private insurance companies that are approved by Medicare. You are required with most plans to use doctors, hospitals and other providers who are within the plan. You are required to pay monthly premiums in addition to any Part B premium that you pay, along with deductibles and copays.
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Medicare Parts A and B, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans. If you want this coverage, you should join a Medicare Prescription Drug Plan and pay the monthly premium. These plans are run by Medicare-approved companies. Some Medicare Advantage Plans offer prescription drug coverage. If they do not, you can join a Medicare Prescription Drug Plan.
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MEDICAID
Medicaid is an assistance program, as opposed to an insurance program, that serves low-income people regardless of age. Medical bills are paid from federal, state and local tax funds and the patients usually do not pay any of the costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program, meaning that it is run by state and local governments within
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federal guidelines. Therefore, the specifics of the program vary from state to state including the rules for Medicaid eligibility.
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Proof of your age such as a birth certificate, driver's license or a birth record from the hospital Paycheck stubs for everyone in your household who has a job Social Security card Letters or forms from Social Security, SSI, Veteran's Administration, or other sources that show the amount of your income Insurance policies, including other health insurance policies Bank books or other papers that show the amount of money or property you own
Arkansas has several Medicaid Programs: ARKids First, ConnectCare, ElderChoices, Alternative, DDS Waiver and TEFRA. For more information visit the Arkansas Medicaid website. https://www.medicaid.state.ar.us/
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