Medicare vs Medicaid: Ingingo Yuzuye Inyigisho Ku Itandukaniro, Ubujyamo N’Uburyo Bwo Kwivuza

Itandukaniro riri hagati ya Medicare na Medicaid ribabaza miliyoni nyinshi z’Abanyamerika buri mwaka kandi amazina ntabwo bifasha. Byombi ni gahunda z’ubuzima za leta. Byombi bitangira na "Medi." Byombi byatangiye gushyirwa mu bikorwa ku munsi umwe mu 1965. Ariko kandi bikorana n’abantu batandukanye rwose, ntibigende mu buryo bumwe, kandi bifite amategeko atandukanye. Medicare ni ubwishingizi bw’ubuzima bushingiye ku myaka, bivuze cyane cyane ku bantu bafite imyaka 65 kuzamuka. Ubwishingizi bw’ubuzima bushingiye ku gwinja ku bantu bafite munani, uko byamera kose ku myaka, ni ibisobanuro bya Medicaid. Hari abantu bashobora kwiyandikisha kuri byombi.

Inyigisho iri iraguza uko buri gahunda ikora, ubuhe bwemerewe, iki kirimo, icyo kirimo n’uburyo kwiyandikisha kuri byombi bikora. Inkomoko y’amakuru ni CMS, Medicare.gov, Medicaid.gov, na KFF. 

Ni iki Medicare na Medicaid?

Medicare ni gahunda y’ubwishingizi bw’ubuzima bwa leta mu bantu bafite imyaka 65 kuzamuka, n’abafite imyaka munsi ya 65 bafite ubumuga butandukanye cyangwa indwara y’impyiko. Ni ubwishingizi bucurwa ku misoro yo ku mushahara bwakoreshejwe cyane cyane ku musoro w’umushahara waba warishyuye kuva ku igice kinini cy’ubuzima bwawe bwo gukora. Nta kwishyuza, cyangwa ibindi, bisabwa kugira ngo ubone ubujyamo, kandi inyungu ziba zisa mu ntara zose.

Medicaid ni gahunda ya leta n’umuryango, itanga ubwishingizi bw’ubuvuzi ku bakoresha amafaranga make. Burige ntara ikora ihindurwa, kandi leta y’umuryango irayifasha nk’intara. Amategeko, ubujyamo n’serivisi bikubiyeho bitandukanye cyane bitewe n’intara. Dukurikije imibare ya CMS, abantu bagera kuri miliyoni 80 bashyirwa mu bwishingizi bukomeye muri Amerika, ni Medicaid.

Ikinyabwonko abakoresha ubwishingizi benshi bakoresha: Medicare ni iy’abakuze, Medicaid ni iy’abafite munani.

Medicare vs Medicaid: ihuzwa kuruhande

Itandukaniro rya Medicare na Medicaid ryagaragaye neza mu kwerekanwa kuruhande. Byombi bikubiyeho gusura abaganga, kurarama mu bitaro, n’imiti, ariko ubujyamo n’uburyo bwo kwishyuza biratandukanye cyane.

Medicare ifite ibice bine (A, B, C, D), buri kimwe gihindura serivisi zitandukanye. Medicaid ifite gahunda imwe ikomeye mu ntara buri, hamwe n’ibindi bishya bifite amahitamo. Imiterere y’imishinga iratandukanye ku buryo "Medicare vs Medicaid" atari yo nkibazo kubantu benshi. Ikibazo nyakuri ni ikihe ufite uburenganzira, kandi niba ushobora kwiyandikisha kuri byombi.

Ni iki gitandukanya ubujyamo bwa Medicare na Medicaid?

Ni gute Medicare na Medicaid bitandukanya umubare w’abantu bafite uburenganzira? Bivuye ku myaka n’amafaranga.

Ubujyamo bwa Medicare busaba cyangwa imyaka (65 kuzamuka) cyangwa ubumuga. Medicare.gov ivuga ko abenshi mubantu bahabwa ubuzima bwo kwandikisha nimba wowe cyangwa abakubashyigikiye bakoreye byibuze imyaka 10 (40 kwaba) wishyuye imisoro ya Medicare. Abafite imyaka munsi ya 65 bashobora kwiyandikisha niba babona Social Security Disability Insurance (SSDI) mu mezi 24, cyangwa bafite ALS cyangwa indwara y’impyiko.

Ubujyamo bwa Medicaid butandukanye hashingiye ku gwinja, umubare w’abantu mu rugo, n’amategeko ya leta yawe. Hariho ibipimo ngengamico bya leta, ariko intara zishiraho imipaka yazo. Mu ntara zashyizeho Medicaid hakurikijwe ACA, abakuru bashobora kwiyandikisha bafite kugeza kuri 138% bya Federal Poverty Level (agera kuri 20.800 mu mwaka wa 2026). Mu ntara ntizashyizeho, imipaka y’amafaranga ni munsi cyane cyangwa ibice bimwe gusa nibyo bifite ubujyamo (ababyeyi batwite, ababyeyi, abana, abafite ubumuga).

Uzakoresha Social Security Administration kugira ngo usabe Medicare. Uriyandikisha muri Medicaid ku ntara yawe ya Medicaid cyangwa healthcare.gov. Kugira ngo ubone inama z’intara, urugero rw’uburyo amategeko y’intara akora ni inyigisho yacu ya Medicaid Illinois.

Ni iki buri gahunda ikubiyeho?

Byombi bikubiyeho ibintu byinshi by’ibanze byo kwivuza, ariko ibisobanuro biratandukanye.

Kwivuza kwa Medicare:

• Igice A (ibitaro): Kurama mu bitaro, kwitabwaho mu mavuriro akomeye, hospice

• Igice B (ubuvuzi): Gusura abaganga, kwivuza hanze, uburyo bwo kwirinda, ibikoresho bikomeye. Reba inyigisho yacu yuzuye ya Medicare Part B kugira ngo ubone ibisobanuro.

• Igice C (Medicare Advantage): Igice A + B (kandi kenshi D) binyuze ku bishingizwa byigenga

• Igice D (imiti): Imiti ivura yo hanze. Reba ibisobanuro byacu ku Medicare Part D

Medicare ntikubiyeho byinshi ku amenyo, ijisho, amatwi, cyangwa kwivuza igihe kirekire. Iki ni cyo gitangaza gikomeye kubagenerwabigerwa bashya. Kugira ngo umenye byinshi ku bwoko bw’amenyo, reba inyigisho yacu ku nibyo Medicare ikubiye ku amenyo.

Kwivuza kwa Medicaid: Amategeko ya leta asaba buri gahunda ya Medicaid kwakira ibitaro n’abaganga, ibizamini bya laboratwari n’ibya X-ray, igenzura ry’umuryango, kwitabwaho mu mavuriro, kwita ku rugo ku bantu bashobora kwakira mavuriro, gutwara abantu ku nama z’ubuvuzi, n’EPSDT (kwivuza kwa profilaxi) ku bana munsi ya 21. Intara zirashobora kongeraho imiti, amenyo, ijisho, ubuvuzi bugaragara, n’izindi serivisi nk’inyungu zifite amahitamo. Reba inyigisho yacu Medicaid ku amenyo ku bakuru ibigenga by’intara nk’urugero rumwe rw’uburyo ibi bitandukanye.

Medicaid iragutse kuruta Medicare ku kwivuza igihe kirekire. Ibice byinshi byo kurama mu mavuriro mu Amerika byishyurwa na Medicaid, atari Medicare.

Birashoboka ko ufite byombi?

Yego. Abantu bashobora kwiyandikisha kuri byombi babizwa "dual eligible," kandi hafi miliyoni 12.5 z’Abanyamerika babikora, hashingiye kuri ubushakashatsi bwa KFF. Benshi ni abantu 65+ bafite munani.

Uburyo bwo kwivuza kuri Medicare na Medicaid bikora: Medicare ni igiciritse cyo kwivuza ibyo ikubiye, na Medicaid yinjira mu kwishyura ibishyu bya Medicare, kwishyurwa hamwe, n’ibindi, hamwe n’ibyo Medicare idakubiye (kwivuza igihe kirekire, kenshi amenyo n’ijisho).

Kwivuza guhuze ni kimwe mu bishobora gutanga ubwishingizi bw’ubuzima mu buryo bwuzuye muri Amerika. Abafite uburenganzira kenshi baba bishyuye $0 hanze ku isanduku kubintu byose byo kwivuza, harimo imiti binyuze muri gahunda ya Medicare Savings n’Ubufasha Bwiyongereye.

Kugira ngo umenye niba washobora kwiyandikisha kuri byombi, wifatanya na State Health Insurance Assistance Program (SHIP) cyangwa usabe binyuze ku ntara yawe ya Medicaid.

Ibibazo Bishobora Kwibazwa

Ni ibihe Medicare cyangwa Medicaid biruta?

Nta kintu kiruta ikindi. Bafasha abantu batandukanye. Medicare ni gahunda nziza niba ufite 65+ cyangwa ubumuga bukwiriye. Medicaid ni gahunda nziza niba ufite munani, uko byamera kose ku myaka. Koko 1 muri 8 bafite Medicare bagana kandi bashobora kwiyandikisha muri Medicaid, ibyo bibaha ubwishingizi bwuzuye kuruta ubundi bw’ubwishingizi muri Amerika.

Mbese nkeneye byombi Medicare na Medicaid? 

Ntabwo uhitamo kugira byombi. Ufite uburenganzira kuri byombi hashingiye ku myaka n’amafaranga. Niba ufite 65+ bafite munani, gusaba byombi birakwiriye kwihanganirwa. Byombi hamwe byishyura ibyaha byinshi byo kwivuza, harimo ibishyu byishyurwa hamwe, n’ibyo Medicare idakubiye. Vugana n’umujyanama wa SHIP kugira ngo ubone ubufasha bw’ubuntu.

Nshobora gutakaza Medicaid ninkurikira Medicare? 

Oya. Niba ufite uburenganzira kuri byombi, uba "dual eligible." Medicare iba ubwishingizi bwawe bwambere, kandi Medicaid irakomeza kwishyuza ibishyu, kwishyurwa hamwe, n’inyungu z’inyongera. Ntabwo utakaza kwivuza kwa Medicaid kubera gusa w’imyaka 65 cyangwa ufite uburenganzira kuri Medicare. Imipaka y’amafaranga irakomeza kuba ku Medicaid, ariko, wemeza ibyo gusubiramo.

Ni iki gikubiyeho ibyaha byo mu mavuriro? 

Medicaid ikubiye ibice byinshi byo kurama mu mavuriro muri Amerika. Medicare ikubiye kugeza ku minsi 100 yo kwitabwaho mu mavuriro akomeye, kandi nyuma yo kwakira igitaramo cy’ibitaro. Nyuma y’uko igipimo cya Medicare kirangiye, imiryango isanzwe yishyura cyangwa isaba Medicaid. Koko 60% by’abatuye mu mavuriro mu gihugu hose byishyurwa na Medicaid.

Ni Medicare cyangwa Medicaid bikubiye ku amenyo? 

Medicare yambere (Ibice A na B) ntikubiyeho byinshi ku kwivuza amenyo. Imishinga ya Medicare Advantage kenshi ikubiye kwivuza amenyo. Kwivuza kwa Medicaid ku amenyo bitandukanye cyane muri leta. Bamwe bakubiye mu kavukiro k’amenyo ku bakuru, abandi bakubiye ibyaha by’ikizamini gusa. Abana ba Medicaid babona kwivuza kwuzuye mu ntara zose hakurikijwe amategeko ya leta ya EPSDT.

Ibisobanuro by’ibanze

Medicare vs Medicaid ni muto nk’ikigereranyo kandi ni ikibazo cyo ni ikihe gukoreshwa kuri wewe. Medicare ni ubwishingizi bw’ubuzima bwa leta bushingiye ku myaka ku bantu 65+ n’abantu bamwe bafite ubumuga. Medicaid ni ubwishingizi bw’ubuzima bushingiye ku gwinja buri mu ntara. Koko 12.5 miliyoni y’abantu bashobora kwiyandikisha kuri byombi kandi bakungukira mu bwishingizi bwuzuye buri. Niba uri hafi y’imyaka 65, gusaba Medicare binyuze muri SSA byishira ubwabyo kubantu benshi. Niba ufite munani, gusaba Medicaid binyuze ku ntara yawe ni inzira. Niba utazi icyo gukoreshwa kuri wewe, umujyanama wa SHIP w’intara yawe atanga ubufasha bw’ubuntu, butagize uruhande.