Medicaid, Medicare : which is which?

MEDICAID
MEDICARE

outaicb

oohich \

larySand 21g44

July 1975

CAUTION >

>7his is

nof 01 rule book
for e^ifber program.

MEDICAID d&Wls are,
av/ailable from your

Welfare Office*.

medicare details are

available frc?n9 i4c?ur
Social Security Office.

bofh MEDICARE and MEDICAID
help pay medical bills.

bofh MEDICARE and MEDICAID
are pcrf of

fhe Social S&curihj Aof.

MEDICARE -TIfle 18
MEDICAID -TTfle \e

MEDICARE" and MEDICAID
oOork^ together.

> but MEDICARE"
and MEDICAID

are nof the same

ThTs book

tells the differences
beloOeeio

MEDICARE and MEDICAID.

-5-

MEDICARE

is for almost everybody
65 or older
rich or poor.

MEDICARE also protects
disabled people who have
been entitled to Social
Security disability
payments for at least two
consecutive years.

Some people
can have both

MEDICARE andMEOICAID.

6

MEDICAID

is for Gerfain kinds of
needy cmd lc?oO--mc<7me people :

. the aged (65 or older)

• +he- blind

• rhe disabled

• members of families uMfta

dependent children

• some olbe-r c-hi Idren

Some Stafes also include

(a! Qloife expense)
ofher

needy and \outi* income people.

-7-

is an insurance proqram.

Moneij from
frusf funds
pays medical bills
for insured people,.

-8-

MEDICAID

is a n assistance program

Monei^ from

Federal, Sfafe, and local faxes
pays medical bids
for eligi ble people .

MEDICAL

is a E&dzral proqram.

MEDICARE
is the same

all o\/er the Unifed Sfafes.

-10-

MEDICAID

is a P&d era I* 3 bate pariwrsb'ip.

Stafes design fheir <?u)n
MEDICAID proqrawQ
oo i f W i 10 Pederal qoidelmes.

MEDICAID

Varies

{■row Qtotfe 5fafe.

-11-

medicare

is ev/erijuoloere

in fbe, Unifed States.

-12-

is noud in SMes,
\\\e Disfricf of Co\omhiq l
G-uam, Puerto Rico, and

\he Virgm Islands.

Arizona does not
hove a medicatd
program.

are* I is led

on pages 26 and 27.

-13-

MEDICARE"
MOSPirAL INSURANCE"

provides basic profecfion
o*qjo»msf cosfs of

• inpotfiert bospifal care

• posl*haspifoil extended ocare

• post* hospital home health care

MEDICAL
AAEDICAL INSURANCE
provides supplement-oil protection
oigainsf costs of physicians'
serv/ices, medical services and
supplies, home health care-
services, oof pot ticnf hospifal
services and fherapy, ar?d
of her .serVi'ces.

-W-

Medicaid

pays fop at least
these services :

• inpatient hospital care

• outpatient hospital services

• other laboratory and X-ray services
' $k\[[ed nursing facility services

• physicians' services

• screening, diagnosis, and
treatment of children under 2/

• home health care services
- family planning services

In many states
MEDICAID pays for such
additional services as dental
care, prescribed drugs, eye
glasses, clinic services,
intermediate care facility services,
and other diagnostic, screening,
preventive, ana rehabilitative
services.

-15-

MEDICARE

pays pari - but not all - or
hospital and medical costs
for people cuho are insured.

HOSPITAL INSURANCE
pays inpatient hospital
bills exoe-pf for the first *92
in each benefit period.

MEDICAL INSURANCE

pays 14 out of each $5
of reasonable medical cosh
except for the f\rs\ $60
in each calendar year. It
does not paij any of the first £60.

-16

MEDICAID

cow pay

u)Vjoi} medicare does nofpay

for people- u)ho are-
eligible, for ho\h programs.

MEDICAID can pay

the $ 92 medicare does not pcy

in each benePif period
for eligible people.

MEDICAID can paj^
Hie f ir-st £60 per year of
medical care cosfs and oan
pajj cOlodf MEDICARE does oof pay
of the remaining reasonable charges
for eligible people.

-17-

MEDICARE"

HOSPITAL INSURANCE

is financed by
payroll contributions.

MEDICARE*

MEDICAL INSURANCE

is find need by

monthly premiums paid by

the Federal Government

and the insured person.

These monthly premiums noa) ar£

#6.70 or more from the

Federal Government for
eac-b insured person.

#6.70 from each insured person.

MEDICAID can pay f(?is
£6.70 for eligible people.

-18-

MfDfCAlD

is financed by
Federal and State-
governments.

The Federal Government
contributes from
50% ( to the richest States )
to 78% Cto the State ooith the

lotOesf per*capita \ncom&)
of medical care costs for
needi^ and lou) = income people
(Oho are acjed, blind, disofbled,
under l\, or members of families
u)ith dependent chi Id ren.

State-s pai4 the remainder,
often 101th help from
local governments.

-19-

MEDICARE

paid medical bills last year
for nearly 13 million people.

HOSPITAL INSURANCE

protected 23 million people.

Almost 23 million people
were also signed up for

MEDICAL INSURANCE.

This means that
about

11%

of all the people
in the United States
have the protection or

MEDICARE

-20-

MEDICAID

paid medical bills lasr i^ear
for more than
uofoo uuere aged, blind,
disabled, under 21, or
members of families u)ifh
depende-nf children.

Ir> oiddilion, some Stales pdid
medical bills for |ou) = income
people nofaged, blind,
disabled, under Zl, or
members of families cOif h

de-pendeml- cbilolrer).

-21-

MEDICARE-
IS run

by fhe federal Government.

The Bureau of tfeaHh Insurance

of Hi©

Social Security Adm mis traf ion
of fhe United Stafes Deparfroenf of
dealfh, £ducoi\'\or) t and Welfare
is responsible for

MEDICARE.

-22-

MEDICAID

is run

by QMe qotfernmente
uOiffoin Federal guidelines.

the Medical Services Administration
of the

Social and "Rehabilitation Service

I of f be United Stales Department of

deallh, E (location, omd Welfare
is responsi ble for

federal aspects of Ml

£3

bofh MEDICARE and MEDICAID

• insist on high standards

• support development of

needed facilities

• encourage innovation

in medical care delivery

• require review of care

and, in addition, MEDICAID

• requires that medical services

be available to all eligible
people in a State

• trains and employs

neighborhood people
as community
health workers

-24-

y that AAEDICARF
cinoi MEDICAIP

b(4 iry?pr<7\/iV?<3 the-
quality, the c^uanti'ty,
the efficiency, the

orvaitebility, and the
effectiveness op

J w the- United States.

-25

MEDICARE has been everywhere r

MEDICMD is now- July 1975- i

These 32 programs cover people wK ai
Children and Supplemerfal Security Income, aim

Arkansas Kentucky,

California Maine

* Connecticut Maruland
District of Columbia Massachusetts
Guam Michigan

* Hawaii * Minnesota

* Illinois Montana
Kansas * Nebraska

These 21 MEDICAID programs cover only |*

Dependent Children and Supplemental I

Alabama Georgia

Alaska Idaho .

* Colorado + Indiana

Delaware Iowa.

Florida Louisiana

* These States do not use national SSI
resources to determine Medicaid eligibility,
usual lu, stricter. 0£>

j|n the United States since 1966.

everywhere except Arizona.

_ eligible for Aid to Families with Dependent
tvell as some other low- income people.

* New Hampshire Tennessee
New YqHT * Utah .

* North Carolina Vermont
North Pakota Virgin Islands

* Oklahoma Virginia
Pennsylvania Washington
Puerto Rbo . West Virginia
Rhode Island Wisconsin

eople who ore eligible for Aid to Families with
ecurifc, Income. q

Mississippi OrSon

ma

W2y? c (2r^.i South Pakota

New Jersey Texas.

New Mexico Wyoming

standards for age, disability, income and
Instead, theu, use their ovun standards that are

-27-

Medical Services Ad m m is f ration
Social and Rehabilitation Service
Uioi+eoJ Stabs Departmenf of
dealtb, tdocak ion, and Welfare

DHEW Publication No (SRS) 75-2H902