Medicare vs. Medicaid | Health Tennessee

Medicare vs Medicaid – What is the Difference?

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Medicare Versus Medicaid: What’s the Difference?

It is easy to confuse these two terms, and while they may share many similarities, there are also some fundamental differences between the two.

Medicare is a federal government-sponsored healthcare plan that is available to all Tennessee residents and United States citizens 65 years or older who have been a legal resident of the country for at least five years and have worked in the U.S. for at least 10 years.

The Parts of Medicare

Medicare is split into four distinct plans, with each providing different amounts and aspects of coverage.

Part A, also known as hospital insurance, pays for overnight hospitalization and most other fees that may be incurred during the course of treatment. Part A often comes into play when a patient requires surgery or must be admitted to the hospital following an accident or serious illness. Part A is provided at no extra cost to anyone who is eligible for Medicare.

Part B, also known as medical insurance, is an optional form of coverage that pays for routine outpatient treatment, such as x-rays, laboratory work, immunizations, and emergency care. Part B also provides coverage for medical equipment that patients might require, including wheelchairs, oxygen tanks, and prosthetics. Patients who enroll in Part B will be required to pay a separate monthly premium to receive benefits.

Part C is known as Medicare Advantage and is a combination of Parts A and B. It also has the flexibility to allow patients to enroll in Part D as well. Medicare Advantage has a lower monthly premium than other plans, but co-payments after receiving treatment are typically higher.

Part D is known as the prescription drug plan. It was added to Medicare in 2006 and covers a wide variety of prescription drugs. It requires a separate monthly premium and is available to anyone who is covered by Parts A or B. However, like all plans it does come with certain restrictions and will only cover drugs that have been approved by the FDA. Part D also excludes some types of drugs including barbiturates, weight loss drugs, and any drug designed for cosmetic use.

On the other side of the coin, is Medicaid.

Medicaid Coverage and Eligibility

Medicaid is also a government-sponsored healthcare program that provides inpatient and outpatient services to patients, but unlike Medicare, it is also run on the state level. Residents of Tennessee may recognize it as TennCare.

Medicaid is issued to residents of each individual state on a needs basis. If a person meets a certain income level and overall asset value, they may be eligible to receive Medicaid. Being a recipient of Medicare does not prevent a person from receiving Medicaid benefits and vice versa, and many people are eligible to receive both.

Unlike Medicare, Medicaid is very broad in its coverage of health-related expenses. Doctor and hospital visits are mostly paid for by Medicaid, leaving the patient responsible for a small co-payment. Many prescription drugs are also included in Medicaid’s coverage as well.

Having both Medicare and Medicaid (TennCare)

If you meet the income eligibility requirements for TennCare and are also over the age of 65 or diagnosed with either ALS or ESRD, you can have both Medicare and Medicaid. This means that you can qualify for a dual-eligible Medicare Advantage plan and make the most of your available benefits. To get help selecting a dual eligible plan, contact our partners at Medicare Plan Finder. They can send a licensed agent to your home to help you select a plan from the hundreds of options available in Tennessee, with no bias and no purchase required.

 

*This post was originally published on December 5, 2013, by Ashley McNurlan, and updated on November 21, 2018, by Anastasia Iliou. 

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