Medicare da Medicaid: Cikakken Jagora kan Bambanci, Cancanci & Rufewa

Bambancin da ke tsakanin Medicare da Medicaid yana bata wa miliyoyin Amurkawa rai a kowace shekara kuma sunayen ba sa taimakawa. Dukansu shirye-shiryen kiwon lafiya ne na tarayya. Dukansu sun fara da "Medi." Dukansu sun fara aiki a ranar ɗaya a 1965. Duk da haka suna aiki tare da mutane daban-daban gaba ɗaya, ba sa aiki iri ɗaya, kuma suna da wasu dokoki. Medicare shine inshorar lafiya wanda aka dogara da shekaru, watau galibi ga mutanen da ke da shekara 65 ko sama da haka. Rufin kiwon lafiya wanda aka dogara da kudin shiga ga mutanen da ke da karancin kudin shiga, ba tare da la'akari da shekarunsu ba, shine ma'anar Medicaid. Akwai waɗancan mutanen da suka cancanci duka biyun.

Wannan jagorar zai kawo muku abin da kowane shiri ke yi, wane ne ya cancanci, abin da yake kashewa, abin da yake rufewa da kuma yadda cancantar guda biyu ke aiki. Tushen bayanin shine CMS, Medicare.gov, Medicaid.gov, da KFF. 

Menene Medicare kuma menene Medicaid?

Medicare shiri ne na inshorar lafiya na tarayya tsakanin mutanen da ke da shekara 65 ko sama da haka, da kuma waɗanda ke ƙasa da 65 tare da wasu nakasa ko cutar koda ta ƙarshe. Yana da harajin albashi wanda ya fi yawanci ana samun sa daga harajin albashi da kuka biya tun lokacin da mafi yawa daga rayuwar aikin ku. Babu kuɗin shiga, ko wasu, buƙatun da ake buƙata don samun cancanci, kuma fa'idodin yawanci iri ɗaya ne a duk jihohin.

Medicaid shiri ne na tarayya-jiha, wanda ke ba da rufin kiwon lafiya ga masu karancin kudin shiga. Kowane jiha tana gudanar da bambancin ta, kuma gwamnatin tarayya tana samar da kuɗin sa kamar jihohin. Dokoki, cancanci da ayyukan da aka rufe suna bambanta sosai dangane da jiha. A cewar kididdigar CMS, kusan mutane miliyan 80 ne suka sami rufin shiri na inshorar lafiya mafi girma a Amurka, wanda shine Medicaid.

Gajeren sunan da yawancin masu ba da inshora ke amfani da shi: Medicare ga tsofaffi ne, Medicaid ga karancin kudin shiga ne. 

Medicare vs Medicaid: kwatancen gefe da gefe

Bambancin Medicare da Medicaid ya bayyana mafi girma a kallon gefe da gefe. Shirye-shiryen biyu suna rufe ziyarar likita, kwanciya a asibiti, da takardar sayan magani, amma cancanci da tsarin kuɗi sun bambanta sosai.

Medicare yana da sassa hudu (A, B, C, D), kowanne yana rufe ayyuka daban-daban. Medicaid yana da shiri ɗaya na farko a kowace jiha, tare da ƙarin zaɓi. Tsarin tsare-tsare sun bambanta sosai har yadda "Medicare vs Medicaid" ba shi da kyau a gaskiya ga mutane da yawa. Gaskiyar tambaya ita ce wanda kake cancanci, kuma ko za ka iya cancanci ga duka biyun.

Menene bambancin cancanci tsakanin Medicare da Medicaid?

Yaya Medicare da Medicaid suka bambanta a adadin mutanen da suka cancanci? Duk yana komawa ga shekaru da kuɗin shiga. 

Cancancin Medicare na buƙatar ko dai shekaru (65 ko sama da haka) ko nakasa. Medicare.gov ya ce mafi yawan mutane suna cancanci ta atomatik idan kawai sun ko iyalansu sun yi aiki aƙalla shekaru 10 (kwata 40) suna biyan harajin Medicare. Mutanen da ke ƙasa da 65 suna cancanci idan sun sami Taimakon Nakasa na Social Security (SSDI) na tsawon watanni 24, ko kuma suna da ALS ko cutar koda ta ƙarshe. 

Cancancin Medicaid ya bambanta gwargwadon kuɗin shiga, girman gida da dokokin jihohin ku. Akwai mafi ƙarancin ka'idoji daga gwamnatin tarayya, amma jihohin suna kafa iyakokinsu na kuɗin shiga. A jihohin da suka faɗaɗa Medicaid a ƙarƙashin ACA, masu tasowa suna cancanci har zuwa kashi 138 na Tsarin Talauci na Tarayya (kusan 20,800 a shekarar 2026). A jihohin da ba su faɗaɗa ba, iyakokin kuɗin shiga sun fi ƙasa sosai ko kuma ƙungiyoyi kaɗan ne kawai suka cancanci (mata masu ciki, iyaye, yara, masu nakasa). 

Kuna amfani da Hukumar Social Security don neman Medicare. Kuna yin rajista don Medicaid a jihar ku ta hukumar Medicaid ko healthcare.gov. Don samun shawarar da ta dace da jiha, misali yadda dokokin jihar ke aiki shine jagoranmu Medicaid Illinois.

Menene kowane shiri ke rufewa?

Shirye-shiryen biyu suna rufe yawancin manyan ayyukan likita, amma cikakkun bayanai sun bambanta.

Rufin Medicare:

• Sashi na A (asibiti): Shiga asibiti, kulawa a wurin jinya mai kulawa, hospice

• Sashi na B (likita): Ziyarar likita, kulawa a wajen asibiti, ayyukan rigakafi, kayan aikin likita na dindindin. Duba cikakken jagoranmu Medicare Sashi na B don cikakkun bayanai.

• Sashi na C (Medicare Advantage): Haɗa Sashi A + B (kuma sau da yawa D) ta masu samar da inshora masu zaman kansu

• Sashi na D (takardar sayan magani): Magungunan da ba sa bukatar shiga asibiti. Duba jagoranmu Medicare Sashi na D

Medicare ba ya rufe mafi yawan hakori, gani, ji, ko kulawa na dogon lokaci. Wannan shine mafi yawan mamaki ga sabbin masu amfana. Don ƙarin bayani game da gibin hakori, duba jagoranmu idan Medicare ke rufe hakori.

Rufin Medicaid: Dokar tarayya ta bukaci kowane shirin Medicaid na jiha ya rufe ayyukan asibiti da na likita, dakin gwaje-gwaje da X-ray, tsare-tsaren iyali, kulawa a wurin jinya, kulawa a gida ga mutanen da suka cancanci wurin jinya, sufuri zuwa ganawar likita, da EPSDT (kulawa ta rigakafi) ga yara 'yan ƙasa da 21. Jihohin na iya ƙara takardar sayan magani, hakori, gani, gyaran jiki, da sauran ayyuka a matsayin fa'idodin zaɓi. Duba jagoranmu Medicaid hakori ga manya daga jiha zuwa jiha don misali ɗaya na yadda wannan ke bambanta.

Medicaid ya fi Medicare karimci sosai kan kulawa na dogon lokaci. Yawancin kwanciya a gidajen jinya a Amurka ana biyan su ne ta Medicaid, ba Medicare ba.

Zaka iya samun duka Medicare da Medicaid?

Eh. Mutanen da suka cancanci duka ana kiransu "dual eligible," kuma kusan miliyan 12.5 na Amurkawa sun fada cikin wannan rukunin, a cewar binciken KFF. Mafi yawansu mutane ne 65+ tare da karancin kudin shiga.

Aikin rufin dual eligible Medicare Medicaid yana aiki kamar haka: Medicare shine babban mai biyan kuɗi don ayyukan likita da yake rufe, kuma Medicaid yana shiga don biyan kuɗin fito na Medicare, kuɗin da aka biya kafin samun sabis, da kuma abin da za a biya kafin samun sabis, da kuma ayyukan da Medicare ba ya rufe (kulawa na dogon lokaci, sau da yawa hakori da gani).

Rufin haɗin gwiwa shine ɗayan mafi cikakken tsarin inshorar lafiya da ake samu a Amurka. Mutanen da suka cancanci sau da yawa suna biyan $0 daga aljihu don kusan dukkanin kulawar likita, gami da takardar sayan magani ta Shirin Ajiye Kuɗin Medicare da Taimakon Ƙarin.

Don duba ko za ka iya cancanci ga duka, tuntuɓi Shirin Taimakon Inshorar Kiwon Lafiyar Jiha (SHIP) ko yi amfani ta ofishin Medicaid na jiha.

Tambayoyi Akai-akai

Shin Medicare ko Medicaid ya fi kyau?

Babu ɗayansu da ya fi kyau. Suna hidima ga mutane daban-daban. Medicare shine madaidaicin shiri idan kana 65+ ko kana da nakasar da ta cancanci. Medicaid shine madaidaicin shiri idan kana da karancin kudin shiga, ba tare da la'akari da shekaru ba. Kimanin 1 cikin 8 masu amfana da Medicare suma suna cancanci don Medicaid, wanda ke ba su cikakkiyar rufewa na kowane tsarin inshorar Amurka.

Ina buƙatar duka Medicare da Medicaid? 

Ba ka zaɓar ka sami duka biyun ba. Kana cancanci ga duka bisa ga shekaru da kuɗin shiga. Idan kana 65+ tare da karancin kudin shiga, neman duka biyun ya cancanci a yi la'akari da shi. Shirye-shiryen biyu tare suna biyan mafi yawan kuɗin kiwon lafiya, gami da kuɗin fito, kuɗin da aka biya kafin samun sabis, da ayyukan da Medicare ba ya rufe. Yi magana da mai ba da shawara na SHIP don taimakon kyauta.

Zan iya rasa Medicaid idan na sami Medicare? 

A'a. Idan ka cancanci ga duka, ka zama dual eligible. Medicare ya zama babban inshorarka, kuma Medicaid yana ci gaba da biyan kuɗin fito, kuɗin da aka biya kafin samun sabis, da ƙarin fa'idodi. Ba ka rasa rufin Medicaid kawai saboda ka cika shekaru 65 ko ka cancanci Medicare ba. Iyakokin kuɗin shiga har yanzu suna aiki don Medicaid, duk da haka, don haka duba bukatun sabuntawa.

Wanne ke rufe kuɗin gidajen jinya? 

Medicaid yana rufe mafi yawan kulawa na dogon lokaci a gidajen jinya a Amurka. Medicare yana rufe kwanaki 100 kawai na kulawa a wurin jinya mai kulawa, kuma kawai bayan kwanciya a asibiti da ta cancanci. Bayan iyakar Medicare ta ƙare, iyalan suna biyan kuɗi na sirri ko kuma neman Medicaid. Kimanin kashi 60% na mazauna gidajen jinya a ƙasa ana biyan kuɗin kulawarsu ta Medicaid.

Shin Medicare ko Medicaid ke rufe hakori? 

Asalin Medicare (Sassa A da B) ba ya rufe mafi yawan kulawar hakori. Shirye-shiryen Medicare Advantage sau da yawa sun haɗa da rufin hakori. Rufin hakori na Medicaid ya bambanta sosai ta jiha. Wasu suna rufe cikakken hakori ga manya, wasu kuma suna rufe kawai cirewar gaggawa. Yara a Medicaid suna samun cikakken rufin hakori a kowace jiha a ƙarƙashin dokokin EPSDT na tarayya.

Abin da ke da mahimmanci

Medicare vs Medicaid yana da kamanceceniya da tambayar wanne ne ya dace da ku. Medicare shine inshorar lafiya ta tarayya wanda aka dogara da shekaru ga mutane 65+ da wasu mutane masu nakasa. Medicaid shine rufin kiwon lafiya wanda aka dogara da kudin shiga wanda ya bambanta ta jiha. Kimanin mutane miliyan 12.5 ne suka cancanci duka biyun kuma suka amfana da mafi cikakken rufewa da ake samu. Idan kana gab da cika shekaru 65, neman Medicare ta SSA atomatik ne ga mafi yawan mutane. Idan kana da karancin kudin shiga, neman Medicaid ta hukumar jiha ita ce hanyar. Idan ba ka da tabbacin wanne ya dace da kai, mai ba da shawara na SHIP na jiha yana ba da kyauta, jagora marar nuna son kai.