Medicare ki a Medicaid: Te Aratohu Matawhānui ki te Rerekētanga, te Tika, me te Tiaki

Ko te rerekētanga i waenganui i te Medicare me te Medicaid e whakapouri ana i ngā miriona tāngata o Amerika ia tau, ā, ehara i te mea kei te āwhina ngā ingoa. Ko ngā hōtaka hauora ā-kāwanatanga ngā mea katoa. Ka tīmata ngā mea e rua ki te "Medi." Ka mana hoki ngā mea e rua i te rā kotahi i te tau 1965. Heoi, ka mahi tahi rātou me ngā tāngata rerekē rawa, kāore hoki e mahi i te ara kotahi, ā, he ture kē atu ōna. Ko te Medicare he inihua hauora i runga i te pakeke, arā, te nuinga ki ngā tāngata 65 tau, ā, kua pakeke ake rānei. Ko te tiaki hauora i runga i te moni whiwhi o ngā tāngata whai moni iti, ahakoa te pakeke, koinei te whakamaarama mō te Medicaid. Kei reira ētahi o ngā tāngata e tika ana ki ngā mea e rua. 

Ka arahina koe e tēnei aratohu ki ngā mahi a ia hōtaka, ko wai te hunga e tika ana, ko te utu, ko te mea e tiakina ana, ā, me pēhea te mahi o te tika takirua. Ko te puna o ngā mōhiohio ko te CMS, Medicare.gov, Medicaid.gov, me te KFF. 

He aha te Medicare, he aha hoki te Medicaid?

Ko te Medicare he hōtaka inihua hauora ā-kāwanatanga i waenganui i ngā tāngata 65 tau, ā, kua pakeke ake rānei, me ngā tāngata kei raro i te 65 tau te pakeke me ngā mate motuhake, te mate whatukuhu whakamutunga rānei. He mōhiohio i utua e te takatika utu, ko te nuinga i runga i ngā takatika utu i utua e koe mai te nuinga o tō ora mahi. Kāore he moni whiwhi, ā, ko etahi atu whakaritenga e hiahiatia ana hei uru ki te tika, ā, ko ngā painga ka rite tonu ki ngā whenua katoa. 

Ko te Medicaid he kaupapa ā-kāwanatanga, ā- ā-kāwanatanga hoki, e tuku tiaki hauora ana ki ngā kaimahi whai moni iti. Ka whakahaerehia e ia whenua tana ake momo, ā, ka utua e te kāwanatanga ā-kāwanatanga te rite tonu ki ngā whenua. Ka rerekē nui ngā ture, te tika, me ngā ratonga i tiakina, i runga i te whenua. E ai ki ngā tatauranga CMS, tata ki te 80 miriona tāngata e tiakina ana e te hōtaka inihua hauora nui rawa atu i Amerika, ko te Medicaid taua hōtaka. 

Ko te whakapoto e whakamahia ana e te nuinga o ngā kaiwhakawhitiwhiti inihua: ko te Medicare mō ngā kaumatua, ko te Medicaid mō te hunga whai moni iti. 

Medicare ki a Medicaid: te whakarite taha ki te taha

Ka kitea te rereketanga o te Medicare me te Medicaid i te tirohanga taha ki te taha. Ka tiakina e ngā hōtaka e rua ngā toro atu ki te tākuta, ngā noho hōhipera, me ngā rongoā, engari he tino rerekē te tika me te hanganga utu. 

E whā ngā wāhanga o te Medicare (A, B, C, D), ka tiakina e ia ngā ratonga rerekē. Ko te Medicaid he kotahi hōtaka matua i ia whenua, me ngā taapiri kōwhiringa. He rerekē te hanganga o ngā mahere, kāore hoki te "Medicare ki a Medicaid" te anga tika mō te nuinga o ngā tāngata. Ko te pātai tūturu ko wai te mea e tika ana koe, ā, mehemea ka tika koe mō ngā mea e rua. 

He aha te rereketanga o te Medicare me te Medicaid ki te tika?

He pēhea te rereketanga o te Medicare me te Medicaid i te maha o ngā tāngata e tika ana? Ka hoki katoa ki te pakeke me te moni whiwhi. 

Ko te Medicare Tika e hiahiatia ana te pakeke (65 tau, ā, kua pakeke ake rānei) te mate rānei. E kii ana a Medicare.gov ko te nuinga o ngā tāngata ka tika aunoa mena kua mahi rātou, ā, kua utua e rātou te takatika Medicare mō te 10 tau (40 hauwhā) neke atu rānei. Ko ngā tāngata kei raro iho i te 65 tau ka tika mena kua whiwhi rātou i te Social Security Disability Insurance (SSDI) mō te 24 marama, me te mate ALS rānei, te mate whatukuhu whakamutunga rānei. 

Ko te tika o te Medicaid ka rereke i runga i te moni whiwhi, te rahi o te whare, me ngā ture o tō whenua. Kei reira ngā paerewa iti rawa mai te kāwanatanga ā-kāwanatanga, engari ka whakatōtō ngā whenua i ō rātou ake rohe moni. I ngā whenua kua whakawhānuitia te Medicaid i raro i te ACA, ka tika ngā pakeke ki te 138 ōrau o te Taumata Rawakore Ā-kāwanatanga (tata ki te 20,800 i te tau 2026). I ngā whenua kāore i whakawhānuitia, ka tino iti ake ngā rohe moni, ka tika rānei ngā ropu motuhake anake (ngā wahine hapū, ngā mātua, ngā tamariki, ngā tāngata mate). 

Ka whakamahi koe i te Social Security Administration ki te tono mō te Medicare. Ka takiuru koe ki te Medicaid i tō tari Medicaid ā-whenua, ā, ki te healthcare.gov rānei. Hei tiki mōhiohio motuhake mō te whenua, he tauira o te mahi o ngā ture ā-whenua ko tā mātou arahi Medicaid Illinois. 

He aha te tiaki a ia hōtaka?

Ka tiakina e ngā hōtaka e rua ngā ratonga hauora nui, engari ka rereke ngā taipitopito. 

Tiaki Medicare: 

• Wāhanga A (hōhipera): Ngā noho hōhipera, te tiaki nēhi mō te hunga nēhi, te atawhai mate whakamatemate

• Wāhanga B (hauora): Ngā toro atu ki te tākuta, te tiaki waho, ngā ratonga aukati, ngā taputapu rongoā roa. Tirohia tā mātou arahi Medicare Wāhanga B mō ngā taipitopito. 

• Wāhanga C (Medicare Advantage): Wāhanga A + B kua whakakotahi (me te maha o D) mā ngā kaiwhakarato inihua motuhake

• Wāhanga D (rongoā): Ngā rongoā waho. Tirohia tā mātou whakamārama Medicare Wāhanga D

Kāore te Medicare e tiaki i te nuinga o te niu, te tirohanga, te whakarongo, te atawhai roa rānei. Koinei te tino ohorere mō ngā painga hou. Mō ētahi atu mō ngā āputa niu, tirohia tā mātou arahi mō te tiaki niu Medicare. 

Tiaki Medicaid: Ka tono te ture ā-kāwanatanga kia tiakina e ia hōtaka Medicaid ā-whenua ngā ratonga hōhipera me ngā tākuta, ngā tātai ira me ngā x-ray, te whakamahere whānau, te tiaki nēhi, te tiaki hauora ki te kāinga mō ngā tāngata e tika ana ki te nēhi, te kawe ki ngā whakaritenga hauora, me te EPSDT (tiaki aukati) mō ngā tamariki kei raro iho i te 21 tau. Ka taea e ngā whenua te taapiri rongoā, niu, tirohanga, rongoā tinana, me ētahi atu ratonga hei painga kōwhiringa. Tirohia tā mātou arahi niu Medicaid mō ngā pakeke ā-whenua mō tētahi tauira o te rereketanga o tēnei. 

He nui ake te atawhai o te Medicaid i te Medicare i te tiaki roa. Ko te nuinga o ngā noho whare nēhi i Amerika ka utua e te Medicaid, ehara te Medicare. 

Ka taea e koe te noho tokorua Medicare me Medicaid?

Āe. Ko ngā tāngata e tika ana mō ngā mea e rua ka huaina ko "dual eligible," ā, tata ki te 12.5 miriona tāngata o Amerika kei roto i tēnei rōpū, e ai ki ngā rangahau KFF. Ko te nuinga ko ngā tāngata 65+ whai moni iti. 

Ko te tiaki Medicare Medicaid ā-tūrua ka mahi pēnei: ko te Medicare te kaituku matua mō ngā ratonga hauora e tiakina ana e ia, ā, ka uru te Medicaid ki te utu i ngā utu Medicare, ngā utu mahi tahi, me ngā utu whakaiti, me ngā ratonga kāore e tiakina e te Medicare (tiaki roa, te niu me te tirohanga maha). 

Ko te tiaki tahi tetahi o ngā mahere inihua hauora tino matawhānui kei Amerika. Ko ngā tāngata e tika ana ka utua te 0$ te nuinga o te wāhi mai i te putea mō te tata katoa o te tiaki hauora, tae atu ki ngā rongoā mā te Hōtaka Tiaki Medicare me te Āwhina Tāpiri. 

Hei tirotiro mēnā ka tika koe mō ngā mea e rua, whakapā atu ki tō State Health Insurance Assistance Program (SHIP) ā-whenua, ā, tono mā tō tari Medicaid ā-whenua. 

Ngā Pātai Auau

He pai ake te Medicare, te Medicaid rānei?

Kāore tētahi e "pai ake." Ka mahi rāua mō ngā tāngata rerekē. Ko te Medicare te hōtaka tika mena koe ko te 65+ te pakeke, me te mate whai tohu rānei. Ko te Medicaid te hōtaka tika mena he iti tō moni whiwhi, ahakoa te pakeke. Tata ki te 1 i te 8 kaipāhi Medicare ka tika hoki mō te Medicaid, e hoatu ana ki a rātou te tiaki tino matawhānui o ngā mahere inihua katoa o Amerika. 

Me hiahia koe ki ngā mea e rua, ki te Medicare me te Medicaid? 

Kāore koe e whiriwhiri ki te noho tokorua. Ka tika koe mō ngā mea e rua i runga i te pakeke me te moni whiwhi. Mena koe ko te 65+ te pakeke me te moni iti, ka tika te tono mō ngā mea e rua hei whakaaro. Ko ngā hōtaka e rua tahi ka utu mō te nuinga o ngā utu hauora, tae atu ki ngā utu, ngā utu mahi tahi, me ngā ratonga kāore e tiakina e te Medicare. Kōrero ki tētahi tohutohu SHIP mō te āwhina kore utu. 

Ka taea e au te ngaro te Medicaid mena ka whiwhi au i te Medicare? 

Kāore. Mena ka tika koe mō ngā mea e rua, ka noho koe hei dual eligible. Ka noho te Medicare hei inihua matua mō koe, ā, ka utu tonu te Medicaid i ngā utu, ngā utu mahi tahi, me ngā painga tāpiri. Kāore koe e ngaro i te tiaki Medicaid i te mea ka eke koe ki te 65 tau, me te tika mō te Medicare. Ko ngā rohe moni ka tono tonu mō te Medicaid, engari, tirohia ngā whakaritenga whakahou. 

Ko wai te mea e tiaki ana i ngā utu whare nēhi? 

Ko te Medicaid te tiaki i te nuinga o te tiaki whare nēhi roa i Amerika. Ko te Medicare anake e tiaki ana mō te 100 ra o te tiaki nēhi mō te hunga nēhi, ā, i muri noa iho i te noho hōhipera whai tohu. I muri i te mutunga o te rohe o te Medicare, ka utua e ngā whānau te utu tūmataiti, ā, ka tono rānei mō te Medicaid. Tata ki te 60 ōrau o ngā kainoho o te whare nēhi i te motu ka utua tā rātou tiaki mā te Medicaid. 

Ka tiakina e te Medicare te Medicaid rānei te niu? 

Kāore te Medicare taketake (Ngā Wāhanga A me B) e tiaki i te nuinga o te tiaki niu. Ko ngā mahere Medicare Advantage ka uru ki te tiaki niu. Ko te tiaki niu Medicaid ka rereke nui i ia whenua. Ko ētahi ka tiaki i te niu katoa mō ngā pakeke, ko ētahi ka tiaki anake i ngā whakaputa ohorere. Ko ngā tamariki i runga i te Medicaid ka whiwhi tiaki niu katoa i ia whenua i raro i ngā ture EPSDT ā-kāwanatanga. 

Te mutunga

Ko te Medicare ki a Medicaid ehara i te mea he whakarite engari he pātai mō te mea e tono ana ki a koe. Ko te Medicare he inihua hauora ā-kāwanatanga i runga i te pakeke mō ngā tāngata 65+ me ētahi tāngata whai mate. Ko te Medicaid he tiaki hauora i runga i te moni whiwhi e rereke ana i ia whenua. Tata ki te 12.5 miriona tāngata ka tika mō ngā mea e rua, ā, ka whai painga mai i te tiaki tino matawhānui e wātea ana. Mena kei te tata koe ki te 65 tau, ko te tono mō te Medicare mā te SSA ka aunoa mō te nuinga o ngā tāngata. Mena he iti tō moni whiwhi, ko te tono mō te Medicaid mā tō tari ā-whenua te ara. Mena kāore koe e tino mohio ko wai te mea e tono ana ki a koe, ko tō tohutohu SHIP ā-whenua ka hoatu he aratohu kore utu, kāore he pōhēhē.