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Medicare, Medicaid, & VA Military Benefits Differences

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Medicare, Medicaid, & VA Military Benefits Differences

Tuesday, July 11, 2017 2:44 PM

There are three major government programs that offer healthcare benefits: Medicare, Medicaid, and the U.S. Department of Veterans Affairs (VA, formerly the Veterans Administration). Eligibility is different for each program and will depend on things like income level, age, veteran status, and other requirements.

In general, Medicare is a federal health insurance program that primarily assists individuals of any income level who are 65 or older. However, if you are disabled or have kidney disease, you may be eligible for Medicare coverage, even if you’re under the age of 65. Medicaid is a health insurance program that is jointly administered by state and federal governments.It serves low-income and needy individuals who are also over 65, disabled, blind, or parents of minor children. Active military service members and veterans are eligible for health care through the U.S. Department of Veterans Affairs (VA).


What does Medicare cover?

Currently, Medicare consists of four parts: Part A, Part B, Part C, and Part D. Medicare Part A, which is also known as "hospital insurance," covers services associated with inpatient care in a hospital, skilled nursing facility, or psychiatric hospital. Medicare Part B, which is also referred to as "medical insurance," covers other medical care such as ambulance service, lab tests, and physical therapy. Medicare Part C permits Medicare beneficiaries to receive healthcare through managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and others. Medicare Part D helps cover the costs of prescription drugs.

Who is eligible for Medicare?

Medicare provides health insurance for individuals 65 years of age or older, individuals under 65 with certain disabilities, and individuals with End Stage Renal Disease (ESRD), regardless of any pre-existing medical conditions.


What does Medicaid cover?

Each state administers its own Medicaid program, within federal guidelines. Thus, the states determine the amount, duration, and types of benefits Medicaid will provide. Typical Medicaid programs cover inpatient and outpatient hospital services, physician and surgical services, lab tests and X-rays, family planning services, and prenatal and delivery services for pregnant women. There are also numerous optional benefits that states may choose to provide for Medicaid recipients.

Who is eligible for Medicaid?

In accordance with federal law, states are required to cover certain individuals, including, but not limited to low income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). Individuals may be eligible for Medicaid based on blindness, disability, or age. Although some individuals are exempt from this, some financial eligibility is based on MAGI, or Modified Adjusted Gross Income. To be eligible for Medicaid, individuals must also meet non-financial criteria, including being a resident of the state you receive Medicaid in, and either be a United States citizen or qualified non-citizen.

Military benefits (VA)

What military health care benefits are available?

Disability benefits, health care benefits, and long term care benefits are available through various military programs sponsored by the U.S. Department of Defense (DOD) and the U.S. Department of Veterans Affairs (VA). Health care for veterans is typically available at VA hospitals and health-care facilities.

Who is eligible for military health-care benefits?

In general, active service members, retirees, and veterans, other than those who were dishonorably discharged, are eligible for military benefits. Survivors of service members and veterans are also eligible for some of the same benefits. However, the rules surrounding these benefits can be complex and may change. Check with your military personnel office or local VA office if you have questions about any of these benefits.

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Last Revised 11/15/2017