Medicare and Medicaid: Everything you Need to Know


Medicare[1] is a national health insurance program in the united states of america which began in the year 1966 under the social security administration and now administered by the centres for medicare and medicaid services (cms). This program provides health insurance for americans aged 65 and above. It also provides health insurance to young people with some disability as reported by the social security administration or people with end stage renal disease and amyotrophic lateral sclerosis.

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All You Need to Know About Medicare and Medicaid

medicare and medicaid


Emergence of medicare

The name medicare was initially given to a program providing medical care for families of people serving in the military, as a part of the dependent’s medical care act passed in 1956. Former president harry s truman and his wife mrs bess truman were the first recipients of the program. Since 1965, the program’s provisions have expanded to include benefits for speech, physical and chiropractic therapy in 1972.

Medicare is divider into four parts. The first part or part a covers or administers hospital insurance, skilled nursing and other services. Part b deals with outpatient and inpatient services, part c covers health plans and lastly part d looks after the self administered prescription drugs. [2]

Eligibility for medicare

All persons of 65 years of age or older who have been legal residents of the united states for a minimum of 5 years are eligible for medicare. People with disabilities and below 65 years of age will also be eligible only if they receive social security disability insurance (ssdi) benefits. Some of the circumstances include:

  • Person of 65years of age or older, a us citizen or permanent legal residents for five continuous years and they or their spouse has paid medicare taxes for at least ten years.
  • Person under 65years of age, disabled and has been receiving either social security ssdi benefits or railroad retirement board disability benefits. They must receive one of these benefits for at least twenty four months from the date of entitlement before becoming eligible to enrol in medicare.
  • They receive continuing dialysis for end stage renal disease or need a kidney transplant.

Medicare and hearing aid

In general, original medicare plans don’t cover hearing aids. If the doctor orders a diagnostic hearing test then one has to pay 20% of the amount approved by medicare and the medicare part b deductible. Part b covers diagnostic hearing tests. Some medicare advantage plans (part c) cover hearing exams and aids

Medicare differs from private insurance as it is a social insurance program. Medicare is a mechanism by which the state takes a portion if the citizen’s resources to provide health and financial security to them in old age or in case of disability. It differs from private insurance which must decide whom to cover and what benefits to offer ensuring that their costs don’t exceed premiums.


What is medicaid?

Medicaid is a joint federal and state program in the united states of america that helps with medical costs for some people with limited income and resources. The health insurance association of america describes medicaid as “a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care. “

Eligibility for medicaid

It is a program intended for those having low income but there are certain other requirements needed to be fulfilled. To enrol, one must be a member of a category defined by statute; some of them include low income children below a certain wage, pregnant women, parents of medicaid eligible children who meet certain income requirements, low income disabled people who receive supplemental security income (ssi) or social security disabled income (ssdi), low income senior citizens (65 and older).

Medicaid and dental services

Dental services are included in the social security program of medicaid. These services are optional for adults of age 21 years and above. However this service is a requirement for those eligible for medicaid and below the age of 21 years. Services include pain relief, restoration of teeth, and maintenance of dental health. Early and periodic screening diagnostic and treatment (epsdt) is mandatory for children, aiming to focus on prevention, early diagnosis and treatment of medical conditions.

Difference between medicare and medicaid

Medicare is and social insurance program funded at the federal level and focuses primarily on the older population whereas medicaid is a program which is not solely funded at the federal level, states provide up to half of the funding for the medicaid program. The main criteria for the eligibility for medicaid is limited income and financial resources, a criterion absent in case of medicare. However medicaid covers wider range of health care services than medicare. The citizens eligible for both medicare and medicaid are known as medicare dual eligible or medi-medi’s.


Income requirements for medicaid

As per the records of 2918, for children, a household’s monthly income range should be from $2,500 to $6,300. Adult coverage range is from $1,800 to $4,500 if pregnant and $290 to $750 for parents. The elderly and disabled are eligible up to $1,145 a month.