Medicare vs. Medicaid

Medicare Basics

What’s the difference between Medicare and Medicaid? The words are so much alike that it’s easy to get them confused. Both are government programs and both help people pay for health care. But that’s where the similarities end.

Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. The table below provides more information about Medicare and Medicaid and how they compare.
 

Medicare  Medicaid
What is it?
A federal health insurance program for people who are:
  • 65 or older
  • Under 65 with certain disabilities
  • Of any age and have End Stage Renal Disease (ESRD) or ALS
What is it?
A joint federal and state program that helps pay health care costs for certain people and families with limited income and resources. Different programs under the Medicaid umbrella are designed to help specific populations. 
Who governs it?
Federal government
Who governs it?
State governments
What does it cover?
Depends on the coverage you choose and may include:
  • Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
  • Doctor visits, care and services received as an outpatient, and some preventive care (Part B)
  • Prescription drugs (Part D)

Note: Medicare Advantage plans (Part C) combine Part A and Part B coverage, and often include drug coverage (Part D) as well - all in one plan.

What does it cover?
Each state creates its own Medicaid programs, following federal guidelines. There are mandatory benefits and optional benefits. Mandatory benefits include, in part:
  • Care and services received in a hospital or skilled nursing facility
  • Care and services received in a federally-qualified health center, rural health clinic or freestanding birth center (licensed or recognized by your state)
  • Doctor, nurse midwife, and certified pediatric and family nurse practitioner services
  • And more
What does it cost?
It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance. 
What does it cost?
It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance. Certain groups are exempt from most out-of-pocket costs. 
How do I get it?
Many people are enrolled in Parts A and B automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible. 
How do I get it?
Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify. 

Peter Talks Fruit (Medicare vs Medicaid)

Do you know the difference between Medicare and Medicaid? Peter uses fruit to explain the programs, which are as different as apples and oranges.

Can you get Medicaid if you have Medicare?

If you qualify for both Medicare and Medicaid, you are “dual eligible.” Sometimes the two programs can work together to cover most of your health care costs.

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