At a Glance: US Government Health Programs
| Program Name | Medicare | Medicaid |
|---|---|---|
| Managed By | Federal Government (CMS) | State & Federal Government |
| Target Audience | Age 65+ or Disabilities | Low Income / Financial Need |
| Coverage | Standard across USA | Varies by State |
| Official Link | medicare.gov | medicaid.gov |
The healthcare system in the United States differs significantly from most other developed nations. There is no single universal health system. Instead, the government provides coverage mainly through two distinct programs: Medicare and Medicaid.
Understanding the difference between these two, and navigating the "Alphabet Soup" of Medicare Parts (A, B, C, D), is essential for ensuring you and your family are protected against high medical costs.
Medicare vs. Medicaid: What's the Difference?
This is the most common confusion for applicants. Here is the simplest way to remember:
Medicare (Care for the Elderly)
Think of "Care" for the elderly. This is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients.
Medicaid (Aid for the Poor)
Think of "Aid" for the needy. It is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. It is a federal-state program, so rules vary by state (e.g., Medi-Cal in California).
The 4 Parts of Medicare Explained
Medicare is termed "Original Medicare" (Parts A & B). Later, private companies introduced Part C and Part D. Here is the breakdown:
Part A (Hospital Insurance)
Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B (Medical Insurance)
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Part C (Medicare Advantage)
An "all-in-one" alternative to Original Medicare. Offered by private companies approved by Medicare.
Part D (Prescription Drugs)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Who is Eligible?
For Medicare (Age & Disability Based):
- Age: You are 65 or older.
- Disability: You are under 65 but have received Social Security Disability Insurance (SSDI) for 24 months.
- Specific Diseases: You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease).
- Citizenship: You must be a U.S. citizen or a permanent legal resident who has lived in the U.S. for at least 5 continuous years.
For Medicaid (Income Based):
Eligibility depends on your state's rules, but generally includes:
- Pregnant women.
- Children (CHIP program).
- Seniors with low income.
- Individuals with disabilities.
- In some states, all adults below a certain income level (due to ACA expansion).
Medicare Costs for (Estimated)
While Part A is often free, Medicare is not completely free healthcare. You must budget for premiums and deductibles.
| Component | Cost (Approx) | Notes |
|---|---|---|
| Part A Premium | $0 (Free) | If you paid taxes for 40 quarters (10 years). |
| Part A Deductible | $1,632 | Per benefit period (hospital stay). |
| Part B Premium | $174.70 / month | Standard amount. Higher for high income. |
| Part B Deductible | $240 / year | After this, you typically pay 20% of costs. |
Need to Find a Hospital?
Search for Medicare-approved hospitals and facilities in your state.
Search Hospital DirectoryHow to Apply for Medicare
You should apply 3 months before you turn 65. This is your "Initial Enrollment Period".
Method 1: Online (Fastest)
Visit the Social Security Administration (SSA) website. The application takes about 10 minutes.
Method 2: Phone
Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, from 7 a.m. to 7 p.m.
Method 3: In-Person
Visit your local Social Security office. (Appointments are recommended).
Warning: If you do not sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Part B.