Breakdown of Medicare and Medicaid

For elderly citizens struggling to pay for prolonged medical care, there are government istock_23528216_largeprograms in place that can provide assistance. Medicaid and Medicare help alleviate medical expenses for those who qualify.

What’s the Difference?

Simply put, Medicare is a federally run insurance program reserved for the elderly (over age 65), for those with severe disabilities, and dialysis patients. Beneficiaries often pay into the program.

Medicaid, on the other hand, is a federal/state program designed for those with low income, regardless of age. Each state determines who qualifies for Medicaid and what services are provided, though this is done within certain federal guidelines.


So broken down, Medicare functions as an insurance program. It has four parts, listed from A to D, and each of those provides for certain aspects of medical care. These include:

• Part A: This part covers hospital stays, including meals, supplies, a semi-private room, certain therapies, and care in a skilled nursing facility. This part does not generally require a premium.
• Part B: Part B provides Supplementary Medical Insurance (SMI) to cover certain physician visits and medical procedures. SMI requires a monthly premium.
• Part C: This part of Medicare provides customized coverage based on the patient. The coverage plans created under Part C are called Medicare Advantage Plans.
• Part D: This is designed to help cover prescription drug costs, and it’s administered by private insurance companies.

Services not covered by Medicare are often covered by MediGap plans.


Medicaid covers certain federally mandatory medical costs as well as others approved by the state. Federally mandated coverage includes vaccines for children, inpatient and outpatient hospital services, physician services, prenatal care, home healthcare for certain individuals, lab and x-ray, and so forth.

State coverage may include clinic and diagnostic services, prescribed drugs, prosthetics, transportation, nursing for children under 21, rehabilitation, physical therapy, etc.

Medicaid is reserved for those who are around poverty level and have certain needs, though specific qualifications vary by state.

For more information on how Medicare and Medicaid can help pay for skilled nursing care, contact us at Senior Care Centers for more information.

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