What is the difference between Medicare and Medicaid?

Medicaid differs from Medicare in that it is an assistance program funded by federal, state and local tax funds. The state administers the program and the federal government dictates program guidelines. The program targets low-income individuals of every age. Patients generally have no out-of-pocket costs. However, in some cases, patients may have a small co-pay. Unlike Medicare, Medicaid requirements vary from state to state.

Medicare is a federal program operated by the Centers for Medicare & Medicaid Services. It functions like an insurance program. Individuals pay into the program, and those funds cover the insured’s medical bills. Generally, people over 65 years of age qualify for coverage, regardless of their income. Disabled individuals and those receiving dialysis services also qualify. Out-of-pocket costs include a monthly premium for non-hospital coverage, hospital deductibles, prescriptions and other costs not covered by Medicare.

Medicare Advantage Plans offer an alternative to standard Medicare. The program is a Medicare-approved health plan offered through private insurance companies. Approved insurance companies contract with Medicare to provide all Part A (hospitalization) and Part B (medically necessary and preventative services) benefits. Many Medicare advantage plans also offer Medicare Part D (prescription) benefits. Patients can choose from a variety of plans types including

Health Maintenance Organizations Plans (HMO) have in-network doctors, hospitals and specialized providers that patients must use. Generally, a referral from a primary care physician is needed to use an out-of-network healthcare professional.
Preferred Provider Organization Plans (PPO) have in-network doctors, hospitals and specialized providers, but patients can choose an out-of-network health professional at a higher cost.
Private Fee-for-Service Plan (PFFS) have predetermined fees for doctors, hospitals, providers and patient co-pays. Patients can choose any Medicare-approved health professional or facility that participates in the PFFS program.
Special Needs Plans (SNPs) are limited to patients with specific diseases or symptoms. All SNPs provide prescription drug coverage.
HMO Point of Service Plans (HMOPOS) is an HMO plan that allows the patient to use an out-of-network hospital, doctor or other healthcare provider at a higher cost.
Medical Savings Account (MSA) plans links health plans with high deductibles with a checking or savings account. Medicare puts money into the patient’s account, and the money is used to pay for medical services throughout the year.

Contact Brindle Insurance Group  for help in choosing a plan that fits your healthcare needs.

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