Comparison of Medicaid and Medicare

It is not uncommon to be confused about the difference between Medicare and Medicaid.  Although these two programs have similar sounding names, and are administered by the same federal agency, these programs are very different.  One major difference between Medicare and Medicaid is that Medicare does not have a financial eligibility test; individuals who are disabled or reach retirement age, qualify for Medicare based on work history.  In contrast, all Medicaid recipients must be financially eligible.  Another key difference between these programs is the scope of benefits offered.  Generally, Medicare does not pay for long term care services, such as nursing home care requiring assistance with activities of daily living.  The table below provides an at-a-glance comparison of Medicare and Medicaid.

 

Medicaid

Medicare
Program: Health Care Health Insurance
Administered by: States with federal oversight Federal
Eligibility: Must Qualify Entitlement – if paid into the system
Qualifications: Financial & Disability Age or Disability
Covers: Hospitalization;Doctor Visits;Outpatient Testing;

Skilled Nursing Care;

Long Term Care including Custodial Care;

Several In-Home Care Programs including Custodial Care;

Psychiatric services including case management;

Prescriptions

Hospitalization;Doctors Visits;Outpatient Testing;

Skilled Nursing Care – 100 days maximum per spell of illness;

Home Care with Skilled Care Need;  

Psychiatric Services (no case management); 

Prescriptions

Contribution: Reimbursement may be required Premiums and co-pay
Estate Recovery:

Yes (with certain exceptions)

No

 

 

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