Understanding the difference between Medicare and Medicaid is important for individuals who need healthcare coverage, designed especially for seniors but also for low-income and disabled residents. While both are government programs designed to help people access medical care, they serve different populations and have distinct eligibility rules, coverage options, and funding sources.
Origins of Medicare and Medicaid
Medicare and Medicaid were created in 1965 as part of the Social Security Act, but they were designed for different purposes. Medicare is a federal program that provides healthcare coverage to people aged 65 and older, as well as certain individuals under 65 who have disabilities or specific medical conditions. Medicaid, on the other hand, is a joint federal and state program that offers healthcare assistance to people with limited income and resources, regardless of age. Because Medicaid is managed at the state level, benefits and eligibility requirements can vary.
In Kentucky, Medicaid is administered by the Kentucky Department for Medicaid Services (DMS). The state has expanded Medicaid under the Affordable Care Act, allowing more people to qualify based on income.
Who Qualifies? Eligibility Differences in Kentucky
Eligibility requirements further highlight the difference between Medicare and Medicaid. Medicare is primarily based on age, with most people qualifying once they turn 65. Younger individuals may also qualify if they have certain disabilities.
Medicaid eligibility in Kentucky depends on income, household size, and other financial factors. Kentucky Medicaid covers low-income children, pregnant women, parents, seniors, and individuals with disabilities. The program also includes the Kentucky Children’s Health Insurance Program (KCHIP) for children in families who earn too much to qualify for Medicaid but still need assistance.
Comparing Coverage: What Each Program Provides
Medicare and Medicaid also provide different types of healthcare coverage.
Medicare is divided into several parts:
- Part A covers hospital stays
- Part B covers doctor visits and outpatient care
- Part C offers Medicare Advantage Plans that include additional benefits
- Part D provides prescription drug coverage
Medicaid typically covers essential healthcare services such as hospital and doctor visits, laboratory tests, x-rays, and long-term care. In Kentucky, Medicaid also provides dental, vision, and behavioral health services for eligible individuals. Additional benefits, including transportation to medical appointments, are also available.
How Are They Funded?
The way these programs are funded is another important difference between Medicare and Medicaid. Medicare is funded primarily through payroll taxes that employees and employers contribute under the Federal Insurance Contributions Act (FICA), along with premiums paid by beneficiaries.
However, Medicaid is funded jointly by the federal government and individual states. In Kentucky, the federal government covers a significant portion of Medicaid costs, while the state contributes the remaining amount. The state receives a higher federal match for individuals covered under the Medicaid expansion.
Who Qualifies? Eligibility Differences
Eligibility requirements further highlight the difference between Medicare and Medicaid. Medicare is primarily based on age, with most people qualifying once they turn 65. Younger individuals may also qualify if they have certain disabilities. Medicaid eligibility, however, depends on income, household size, and other financial factors. Each state sets its own guidelines within federal requirements, which means that qualifications for Medicaid can differ depending on where a person lives.
Why Understanding the Difference Matters
While both programs are essential in helping people access healthcare, they serve different groups and operate under separate rules. Understanding the difference between Medicare and Medicaid can help individuals determine which program may apply to their situation and what kind of benefits they can expect.
For Kentucky residents, Medicaid offers a vital safety net for those who meet income guidelines, while Medicare ensures seniors and individuals with disabilities receive necessary healthcare coverage.
Get Help Understanding Your Healthcare Benefits
If you need assistance in understanding how Medicare or Medicaid applies to your situation, Kentucky ElderLaw is here to help. Our team is dedicated to providing guidance on qualifying for benefits and ensuring you or your loved ones receive the coverage that best meets your needs. Contact us to learn more about how we can assist you.
