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What is the difference between Medicare and Medicaid?

Healthcare and insurance can be difficult to navigate, but everyone at the Medicare Policy Center is here to help simplify it for you. Medicare and Medicaid both sound similar and are often used interchangeably, but there are actually a few important distinctions. You may qualify for one, but not the other, or you could qualify for both! 

Medicare vs. Medicaid

Medicare and Medicaid are both government-run health coverage programs, but they are different in a few ways. They are operated and funded by different parts of the government and tend to serve different groups of individuals. Let’s break it down.

Medicare

Medicare is a federal program for people 65 years of age or older or younger individuals who have a disability or a kidney disorder. Original Medicare also has no limits on income. Individuals with Medicare pay part of hospital costs through deductibles and non-hospital costs through monthly premiums.

There are several different parts of Medicare. Original Medicare includes Part A and Part B, but there are other options, as well.

  • Part A (Hospital Insurance), which helps cover inpatient care, skilled nursing facility care, hospice care, and home health care.
  • Part B (Medical Insurance), which helps cover services from doctors, outpatient care, home health care, medical equipment, and preventative services.
  • Part C (Medicare Advantage), which is an alternative to Original Medicare with lower out-of-pocket expenses and an option to add extra coverage, like vision, hearing, and dental services. Medicare Advantage usually includes Parts A, B, and D.
  • Part D (Prescription Drug Coverage), which helps cover the cost of prescription drugs and protect against high drug costs in the future.

Medicaid

Unlike Medicare, Medicaid is a federal-state program that provides health coverage specifically for those who have a very low income. Individuals who are eligible for Medicaid may also get coverage for services that Medicare doesn’t cover or only partially covers. Individuals with Medicaid usually do not have to pay out of pocket for covered medical expenses, although a small copayment may sometimes be required.

Since eligibility is decided primarily on income and family size, the range of individuals is wider with Medicaid, as long as the income limit is not exceeded. Eligible individuals may be:

  • 65 or older
  • A child under 19
  • Pregnant
  • Living with a disability
  • A parent or adult caring for a child
  • An adult without dependent children (in certain states)

Medicaid covers a wide range of healthcare benefits, as well. However, since Medicaid is a federal and state program, some benefits may depend on the state you live in. Coverage may include:

  • Doctor visits
  • Hospital stays
  • Long-term services
  • Preventive care
  • Prenatal and maternity care
  • Mental health care
  • Necessary medications
  • Vision and dental care (for children)

What do I enroll in?

Whether or not to enroll in Medicare or Medicaid is going to come down to your eligibility, the most important factors being your age and income level. More information on both Medicare and Medicaid can be found on the Centers for Medicare and Medicaid Services website.

It’s worth noting, too, that it is possible to be eligible for both Medicare and Medicaid (dually eligible) and enroll in both. If you are in both programs, the two will work together to provide you with healthcare coverage and lower costs. In instances of dual eligibility, Medicare pays first and Medicaid pays second. Medicaid always follows Medicare, employer health plans, and/or Medicare Supplement (Medigap) Insurance. Learn more about Dual Eligible Special Needs Plans here.

If you’re unsure about your options and what is best for you, speak with a qualified Medicare professional. They can help you determine your eligibility and which Medicare or Medicaid plans will provide you the best coverage and benefits.

The Medicare Policy Center is here to help you get the Medicare coverage you need.

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