Medicare vs Medicaid: What are the Differences?

Medicare plan options and costs can change each year

  • Medicare and Medicaid are two U.S. government programs that provide access to healthcare.
  • Medicare covers you when you turn 65 and over, also if you have certain conditions or disabilities. 
  • Medicaid is usually available to those with a lower income that helps provide healthcare services at little or no cost. 

It’s easy to confuse the two terms Medicaid and Medicare or use them interchangeably. They sound similar, but the two programs are very different. 

They are each regulated by their own set of laws and policies aimed at different groups of people, but it is possible to be eligible for both programs. 

So you choose the right program, this Senior Affair article will help you understand the differences between Medicare and Medicaid.

What is Medicare? 

This program supports you when you need financial support for your medical needs. For example, Medicare is an insurance policy for U.S. citizens aged 65 and over that covers their treatments and medicare care. 

You can also qualify for Medicare if you have a qualifying condition under 65. For example, if you are in the final stage of some kidney diseases, you may apply for Medicare. 

You can choose between the two main branches of Medicare – Original Medicare and Medicare Advantage. 

Original Medicare

A government-funded medical insurance policy, Original Medicare, is designed for older Americans and covers: 

Inpatient hospital services – (Medicare Part A) These benefits include: covering you when you are admitted to the hospital, need hospice care, limited skilled nursing facility care, and at-home healthcare. 

Outpatient medical services (Medicare Part B) The benefits include covering you for preventative, diagnostic, and treatment services for health conditions.

Medicare Advantage

If you want more coverage than the Original Medicare provides, you might choose the Medicare Advantage insurance (Part C). Private insurance companies offer these policies. Most of these plans cover services like prescription drug coveragedental, vision, and hearing care that you don’t get in Original Medicare. 

What is Medicaid? 

This program is more broad-focused; it provides services for children, adults, and people with disabilities. It’s based on your income and funded by the U.S. state and federal governments, designed to assist low-income families and households. There are more than 72 million people signed up with Medicaid in 2020

What is the Cost of Medicare vs Medicaid? 

Medicare costs – You have to pay deductibles for significant services like hospital stays and sometimes out-of-pocket costs for prescriptions. Still, for a doctor’s visit and preventative care, you’ll have to pay a small monthly premium. Read here for an overview of original Medicare and Medicare Advantage costs.

Medicaid Costs

Usually, when you recieve Medicaid, you aren’t responsible for paying for covered expenses, but sometimes you will make a copayment.

Your state could charge premiums or enrollment fees as a form of cost-sharing; this applies to specific Medicaid recipients: 

  • qualified disabled and working people with an income above 150 percent of the federal poverty level. (FPL)
  • pregnant women and infants with an income at or above 150 percent of the FPL.
  • Medically needy people
  • disabled children eligible under the Family Opportunity Act
  • disabled working people eligible under the Ticket to Work and Work Incentives Improvement Act of 1999.

Medicare and Medicaid Eligibility

To qualify for each program, you have to meet the criteria. 

Medicare Eligibility

In most cases, to be eligible for Medicare, it’s based on your age; you also must be a U.S. citizen or permanent resident and 65 years old or older to qualify. 

Your eligibility and premiums depend on how many years of Medicare taxes you paid. For example, if you have a documented disability and are younger than 65, you may qualify for the exception. 

Generally, if you recieve Medicare, you probably recieve some Social Security benefits. Medicare benefits are also extended to you if you are eligible for Social Security disability and a widow or widower age 50 and older.

Medicaid Eligibility

Your income and family size determine if you’re eligible for Medicaid. They designed the Affordable Care Act to provide coverage for those with low incomes. To find out if you qualify in your state, visit Healthcare.gov

For most adults under 65, your income needs to be lower than 133 percent of the federal poverty level to qualify. According to Healthcare.gov, this amount for 2021 is approximately $12,880 for an individual and $26,500 for a family of four. You could also be eligible if you have a pressing medical need. 

medicare vs medicaid infographic
medicare vs medicaid differences

Medicare and Medicaid coverage

Medicare Coverage 

There are several parts of the Medicare program that offer coverage for different aspects of healthcare. 

  • Medicare Part A  – Provides most inpatient medical care coverage like hospital stays, hospice services, limited skilled nursing care, and home healthcare.
  • Medicare Part B – For all outpatient medical needs like specific medical equipment, hospital care, doctor visits, and preventative care. 
  • Medicare Part C – Medicare Advantage is provided by private companies approved to offer plans that include all the benefits of Medicare Part A and B and have additional benefits like dental, vision, and prescription drug coverage for an extra cost. 
  • Medicare Part D – Approved plans to provide coverage for prescription drugs. 

Medicaid coverage

The Medicaid benefits offered vary by state, but they include these benefits with each plan. 

  • lab and X-ray services
  • inpatient and outpatient hospital services
  • nursing facility services for adults
  • surgical, dental services for adults

Because the benefits vary, you may want to connect with your caseworker in your state to discuss your situation and get help applying. 

Can You Have Both?

You can qualify for Medicare and Medicaid simultaneously and be considered dual-eligible. You can get your coverage from Original Medicare (Parts A and B) or Medicare Advantage Plan (Part C), and Medicare will cover your prescription drugs under Part D. 

Medicaid may also cover care and drugs that Medicare doesn’t, so having both will probably cover most of your healthcare needs. 

Conclusion

Medicare and Medicaid are two U.S. government programs designed to provide access to healthcare solutions. Medicare typically covers seniors over 65 and older or those with certain chronic conditions or disabilities, with Medicaid eligibility based on income and need. 

If you qualify for Medicare but don’t know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans. Or call 1-855-980-4104  (TTY: 711)

Frequently Asked Questions about Medicare vs Medicaid

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