Medicare vs. Medicaid

Vladimir Pustovit

According to the Social Security Administration, studies show that a 20-year-old worker has a 1-in-4 chance of becoming disabled before reaching full retirement age (65). In other words, we all have a significant chance of being forced to stop working before we plan to. For this reason, the government has set up a plan that provides a safety net for each of us in the event that an accident or illness does occur so that we can continue to receive the care we need at a subsidized, affordable cost.

Medicare was originally created in 1965 to help retirees pay for medical bills. Since that time, the program has grown to include those who become disabled before they are able to retire. Social Security Disability Insurance (SSDI) benefits recipients are eligible to receive Medicare (after two years). The program is administered by the Centers for Medicare and Medicaid Services (CMS), which is part of the federal government’s Department of Heath and Human Services.

What does Medicare cover?

Medicare does not cover all medical expenses, nor does it cover most long-term care cases. It consists of four main parts:

  • Hospital insurance—provides financial assistance to cover in-patient care
  • Medical insurance—helps pay for health care provider services and outpatient care
  • Medicare Advantage—separate coverage plans that can be incorporated into Medicare. There are several different options to choose from that will require extra payments for extended coverage.
  • Prescription drug coverage

Who is eligible?

  • Generally, people over the age of 65 who have been legal residents of the U.S. for five years or longer
  • Disabled individuals who have been receiving SSDI benefits
  • Specific medical conditions that are not necessarily “disabling” as defined by the SSA (i.e. permanent kidney failure)

 What is the difference between Medicare and Medicaid?

Medicare and Medicaid, though overseen by the same center, are different programs.

  • Medicaid, a social welfare program, is state-run. It was created specifically for low-income individuals. Medicare, meanwhile, is an insurance program that is paid for by Social Security taxes.
  • Medicare recipients still need to pay monthly premiums once they are eligible, while Medicaid recipients most likely do not.
  • Although it is possible to qualify for both Medicare and Medicaid, the eligibility requirements for Medicaid differ from state to state.

Medicaid in Utah

In order to receive Medicaid in Utah, you must meet certain criteria as outlined on their website. Generally, you must be a legal resident of the state and meet certain citizenship and income requirements. An assessment is made each month to determine whether you are eligible for continued coverage. There are many types of Medicaid programs to accommodate the wide variety of circumstances. For payment purposes, the state has divided cases up into categories. The monthly benefits you receive range somewhere between 55% and 133% of the Federal Poverty Level, depending on which category you belong to. 

For More Information

You can learn more about what benefits Medicare provides here in this online booklet.

Learn more about Medicaid here.

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Photo Courtesy of: Vladimir Pustovit