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Medicare vs. Medicaid

Medicare vs. Medicaid: They sound similar, but have different purposes. And if you’re not already confused enough, you may qualify for both!

Medicare is an insurance program, mainly for people over 65, but also for some disabled people and those with End-Stage Renal Disease. Medicare is not income-related. Medicare is federal, although Medicare Supplements and Medicare Advantage programs are administered by private insurance companies, and Med Advantage plans vary between state and county.

Medicaid is an assistance program, mainly for people with low income. Medicaid is not age-related. Medicaid is a combined federal and state program. Each state manages their own program, so you’ll need to look at what’s available in your state specifically.

Medicare vs Medicaid
Medicare vs Medicaid

If you have any questions, reach out to us!

Medicare/Medicaid Differences FAQ

Medicaid eligibility is about income and family size. Keep in mind that some assets you have DO NOT affect your Medicaid eligibility. Here’s a link to apply for Medicaid.

The Affordable Care Act extended coverage to fill in healthcare gaps for people who have the lowest incomes. It established a minimum income threshold that’s consistent nationally. Find out if you qualify by visiting Healthcare.gov.

If you have children, check out CHIP, the Children’s Health Insurance Program.

Income eligibility levels for children in Medicaid/CHIP

 

Medicaid also can help with coverage for people who need immediate assistance, like pregnant women or people with pressing medical needs.

Yes. You may qualify for Medicare because of your age (they’re age 65 or older) or due to having a disability, AND you may eligible for Medicaid if you meet the requirements to qualify for Medicaid in your state.

Medicare Medicaid dual eligibility

If so, you are “dual eligible” because you’re eligible for both Medicaid and Medicare, and that qualifies you a special Medicare plan not available to others. These are called Special Needs Plans (SNPs). One good thing about SNPs is they all cover prescription drugs. If you’re dual eligible, you qualify for the D-SNP plan.

Medicare plan options
Medicare plan options

 

Certain services are covered by Medicaid in every state, including:

  • Laboratory and X-ray
  • Inpatient hospital services
  • Outpatient hospital services
  • Doctor-related services
  • Skilled nursing facilities (SNFs)
  • Some home health care
  • Transportation
  • Prescription medications

Children can receive more Medicaid benefits:

  • Physical therapy services
  • Vision visits and glasses
  • Audiology and hearing aids
  • Podiatry
  • Prosthetic devices
  • Mental health
  • Dental
  • Hospice

But you’ll need to see doctors who accept new Medicaid patients. Medicaid’s reimbursement schedule – what they pay physicians – is not appealing to many of them.

For Medicare, check out our “What Does Medicare Cost” article.

If you qualify for Medicaid coverage, there are typically no, or very small, monthly payments, co-pays or deductibles. But make sure you check how your state runs Medicaid, because it does vary.

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