Living with Chronic Pain

Medicare vs. Medicaid

Source: Healthline

Medicare and Medicaid are U.S. government-run healthcare programs regulated by federal laws and policies. Medicaid is based on income; Medicare covers U.S. citizens age 65 and older and citizens of any age with a disability. Medicare guidelines are universal in the United States; however, Medicaid guidelines vary from state to state.


Medicare insurance is designed to provide medical financial aid for individuals age 65 or older and those who have a disability, regardless of income. Individuals pay monthly premiums, depending on the number of years that they contributed to the Medicare program. However, for individuals under 65 with a documented disability, an exception can be made to the required premium. Although Medicare benefits are normally associated with those receiving Social Security or disability benefits, individuals in the final stages of kidney disease and/or dialysis may also be eligible. Cases are individually evaluated when determining eligibility. There are two parts of Medicare: Medicare Part A insurance covers hospital, hospice and home health or skilled nursing care insurance; Medicare Part B insurance covers doctor visits and outpatient care. Part A may be premium free, or individuals may have to pay a monthly premium. The Social Security Administration determines the premium amount based on income.


Medicaid insurance eligibility is determined solely on income. Low-income guidelines are determined by the federal poverty level (FPL). To qualify, an individual’s or family’s income must be at 133 percent or below the FPL. Individuals eligible for Medicaid insurance do not have to pay a monthly premium. Medicaid guidelines vary from state to state and are controlled by state and local governments. Assistance with healthcare expenses, including routine medical care and hospitalizations, is included in this government-funded healthcare program. Medicaid may also cover the expenses involved with emergency medical care and pregnancy health care.

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