Differences Between Medicaid and Medicare

By: Kayla Orange

At Royal Care, we know the challenges a client faces when searching for home care services for either themselves or a loved one. We take the pain out of finding a home care provider by offering our directory of highly skilled caregivers. Our caregivers deliver specialized care for each client, assisting them with various household activities and helping them maintain their independence. Aside from helping you find the perfect caregiver, we also offer solutions to many of the financial challenges you may face, including Medicaid and Medicare to help clients and their families afford professional home care.

The Centers for Medicare And Medicaid Services (CMS) is a federal agency that administers the Medicare program and works with state governments to administer Medicaid. Medicare and Medicaid were created to provide more people with access to healthcare. Because these terms sound alike, they are frequently confused or used interchangeably, but they are actually very different programs. Understanding the differences between Medicare and Medicaid will make it easier to select for the client or family member’s needs.

What is Medicaid? 

Medicaid is a state and federal assistance program that serves individuals of any age by helping them with healthcare expenses. The program varies from state to state and is run by state and local governments within federal guidelines. Medicaid patients typically pay no part of costs for covered medical expenses. However, a small co-payment is sometimes required.

Qualifying for Medicaid depends on an individual or family’s income. Visit Healthcare.gov to see if you are eligible based on your current income of 2021. If you qualify for Medicaid, your coverage will vary depending on the state you live in, but there are some benefits included in every program:

·      Inpatient and outpatient hospital services

·      X-Rays and lab services

·      Family planning services, such as birth control and nurse-midwife services

·      Health screenings and relevant medical treatments for children

·      Nursing facility services for adults

·      Surgical dental services for adults

What is Medicare?

Medicare is a federally run insurance program that provides health coverage for people who are over 65, regardless of their income. The program is designed to support senior citizens and their families who need financial assistance for healthcare services, including home health aides and companion care. People under the age of 65 who live with specific disabilities may also be eligible for Medicare benefits. However, eligibility is evaluated on a case-by-case basis.

Because the federal government runs Medicare, it is basically the same everywhere in the United States. Medicare patients’ medical bills are paid from trust funds which those covered have already paid into. Patients pay a deductible for hospital costs and may have small monthly premiums for non-hospital coverage. Individual premiums and specific eligibility will depend on how many years of Medicare taxes they have paid. The only exception here is for people younger than 65 who have particular disabilities. Typically, coverage under Medicare includes both inpatient and outpatient services, such as:

·      Inpatient hospital visits

·      Hospice care

·      Nursing facility care

·      At-home healthcare

·      Preventative and diagnostic services

·      Treatment services for health conditions

Major Differences

There are several differences between Medicare and Medicaid. Here is an overview of the key features of each program:

 Qualifying for Both Medicaid and Medicare

Medicaid and Medicare are each regulated by their own set of laws and policies, and they’re usually designed for different types of people. However, some seniors can be eligible for both programs. These patients are called dual-eligible beneficiaries. In these cases, an elder can receive partial or full Medicaid benefits from the state, while Medicare remains the primary source of coverage and payment for healthcare services through the federal government. The programs will work together to help lower their costs and fill in any gaps in the coverage.

Medicaid and Medicare with Royal Care

Royal Care offers various home care and companion services available through both Medicaid and Medicare. If you’re worried you can’t afford professional home care, contact us today to learn more about our highly skilled home caregivers. Our team is committed to providing you with personalized care and support that fits your budget and provides peace of mind.

Service offerings through Royal Care include:

·      Personal Care Aid (PCA)

·      Home Health Aide (HHA)

·      CDPAP – Hire A Loved One As A Caregiver

·      Remote Patient Monitoring (Telehealth)

·      Medicaid Assistance

·      Housekeeping And Assistance With Daily Activities

·      Registered Nurses

·      Physical Therapists

For a full list of Royal Care service offerings, click here.

For more information about Medicare, visit http://www.medicare.gov. For more information on Medicaid, visit http://www.medicaid.gov.