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Medicaid Vs Medicare Individual Health Insurance What Are the Differences?

It doesn’t surprise that many US citizens confused Medicaid and Medicare individual health insurance as the same thing. However, both of these are entirely different programs, and while both of these programs are meant to ensure medical care for Americans, they are targeted towards two different demographics.

Medicare offers affordable health insurance to older individuals

The US government funds Medicare, and as mentioned above, it is an affordable health insurance program. If you are a US citizen over 65 years of age, you are eligible for Medicare health insurance, and Medicare guarantees medical coverage for you. However, even if you are eligible for Medicare, you can still buy supplemental insurance plans from health care organizations or agencies such as The Benefit Link. With that being said, Medicare serves as the primary health care coverage provider for individuals over 65 and individuals with disabilities.

If you or your spouse has worked a total of 10 years and paid into the Medicare program through payroll taxes, you qualify for Medicare Plan A without paying premium payments. Under Plan A, you get coverage for inpatient hospital costs and nursing care as well. If you have Medicare Plan B, you have to pay the premium for this Plan, and Medicare Plan B covers doctor visits and outpatient care. In addition to original Medicare plans A and B, you can also choose Medicare plan D from a private insurance company covering your prescription drug cost.


Medicaid offers free or low-cost insurance for low-income individuals

The US government also funds Medicaid, but it also gets funding from the states. However, while Medicare only includes individuals over the age of 65 or with disabilities, Medicaid is focused on offering free or low-cost insurance to low-income individuals. These individuals would not be able to afford healthcare without Medicaid because of their low income, so Medicaid steps in to help these individuals out. Since there is no age restriction for Medicaid, anyone with a low income regardless of age or disability can apply.

As mentioned above, Medicaid is also funded by state governments and each state has the liberty to decide if they want to offer additional benefits to the citizens of their state on top of the primary Medicaid benefits. The state government also can offer Medicaid to those citizens whose income exceeds the Medicaid cut off-limit. The income cut-off limit also varies depending upon the number of family members and adjusted total income.

Medicaid covers the following health care expenses:

  • Inpatient medical care and outpatient hospital service charges.
  • Medical screening fee, diagnostic, and treatment cost of diseases for children.
  • The cost for the nursing facility stays if you have to stay in one.
  • Home health care service cost
  • Fees for visits or medical consultation with your physicians.
  • Costs for health care services availed from rural health clinics.
  • Cost for x rays and other laboratory work such as blood tests or urine tests.
  • Cost for family planning consultations.
  • Cost for hiring midwives.
  • A fee of freestanding birth centers in case of childbirth.
  • Authorized pediatric services cost along with family nurse practitioner services cost.
  • Tobacco cessation therapy cost for pregnant women with tobacco addiction.

It is estimated that upwards of 73 million US citizens have Medicaid. This makes Medicaid one of the most extensive health insurance plans in the US. However, when many individuals are eligible for both Medicaid and Medicare simultaneously in such cases, Medicare becomes the primary insurance and Medicaid becomes the secondary insurance.

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