What is Medicare?
Medicare is a U.S. federal health insurance program mainly for people 65 years and older, under 65 with certain disabilities, or people with End-Stage Renal Disease (ESRD) or ALS. It helps cover medical costs, though it doesn’t pay for everything.
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Parts of Medicare
Part A – Hospital Insurance
- Covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.
- Usually free if you (or your spouse) paid Medicare taxes while working.
Part B – Medical Insurance
- Covers doctor visits, outpatient care, preventive services, and some home health care.
- You pay a monthly premium.
Part C – Medicare Advantage (Private insurance alternative)
- Run by private companies approved by Medicare.
- Combines Part A + Part B, often includes prescription drug coverage (Part D) and extras like vision or dental.
- Usually has a provider network (like an HMO or PPO).
Part D – Prescription Drug Coverage
- Helps cover the cost of prescription medications.
- Offered through private plans approved by Medicare.
What Medicare Does Not Fully Cover
- Long-term care (nursing homes beyond skilled care)
- Most dental, vision, and hearing services
- Cosmetic surgery
- Routine foot care
(That’s why many people buy Medigap supplemental insurance to fill coverage gaps.)
In Summary
|
Medicare Part |
What It Covers |
Cost |
|
A |
Hospital, skilled nursing, hospice |
Usually free |
|
B |
Doctor visits, outpatient care, preventive services |
Monthly premium |
|
C |
Private plans (A + B + often D, extras) |
Varies |
|
D |
Prescription drugs |
Monthly premium |
In short: Medicare is government-run health insurance for seniors and certain disabled individuals. It has 4 parts (A, B, C, D), each covering different needs.
The Difference Between Medicare and Medicaid
Medicare
Who qualifies?
- Mostly people 65+
- Some younger people with disabilities or certain illnesses (like ESRD, ALS)
Who runs it?
- Federal government program (same rules in every state)
What it covers?
- Hospital care (Part A)
- Doctor visits & outpatient care (Part B)
- Prescription drugs (Part D)
- Private plan option (Part C: Medicare Advantage)
How it’s funded?
- Payroll taxes (paid during working years)
- Premiums (monthly payments for some parts)
Medicaid
Who qualifies?
- People with low income (varies by state)
- Children, pregnant women, elderly, and disabled individuals with limited resources
Who runs it?
- Joint federal and state program (rules and benefits differ by state)
What it covers?
- Hospital and doctor visits
- Long-term care (like nursing homes)
- Often includes dental, vision, and other services that Medicare does not cover
- How it’s funded?
- Federal government + state governments
- Free or very low-cost to enrollees
Comparison Table
|
Feature |
Medicare |
Medicaid |
|
Main Basis |
Age (65+) or disability |
Income/financial need |
|
Level of Program |
Federal (same nationwide) |
Federal + State (varies by state) |
|
Cost |
Premiums, deductibles, co-pays |
Usually free or very low cost |
|
Covers |
Hospital, doctors, drugs (limited) |
Broader: includes long-term care, dental, vision (in many states) |
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Medicare = age/disability-based health insurance for seniors and certain disabled people.
-
Medicaid = income-based health insurance for people with low income/limited resources.
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