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What’s the Difference between Medicare and Medicaid?

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 09/01/2017

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It might be easy to confuse Medicare and Medicaid. Both are government-administered health-care programs. Both program names begin with the same six letters. It’s worthwhile to know the difference so you can know which program (or both) you may be eligible for, what the program may cost, and which health-care benefits may be covered for you.

What is Medicare?

Medicare is a health insurance program that is available to U.S. citizens and permanent legal residents of at least five years in a row who are age 65 or older. Younger people may qualify if they have received 24 consecutive months of Social Security disability benefits, or some disability benefits from the Railroad Retirement Board. People under 65 may also qualify if they have certain health conditions such as end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant), or amyotrophic lateral sclerosis (Lou Gehrig’s disease). As of April 2017, there are nearly 58 million Medicare enrollees in America, according to the Centers for Medicare & Medicaid Services.

Many people are automatically enrolled in Medicare Part A and Part B (Original Medicare) when they become eligible. Part A generally covers hospital care and hospice care, and Part B may cover services such as medical care, durable medical equipment and supplies, and some preventative services. Part A may be premium-free if you or your spouse have worked and paid Medicare taxes for at least 10 years, but Part B comes with a monthly premium. Medicare Part A and Part B both have deductibles and coinsurance or copayment amounts set at the federal level and these amounts may change annually.

Medicare Advantage (Medicare Part C) is another way to get your Medicare benefits from a private company. Medicare Advantage plans must cover everything Original Medicare covers (besides hospice care, which Part A covers) and often include additional benefits not generally covered by Original Medicare, such as routine vision and routine dental care. With Medicare Advantage, you must continue to pay your Part B premium and not all plans are available in all areas.

Stand-alone Medicare Part D Prescription Drug Plans cover certain prescription drugs, which aren’t typically covered under Original Medicare (except in certain situations). Like Medicare Advantage, stand-alone prescription drug plans are offered by private, Medicare-approved companies.

What is Medicaid?

Medicaid is jointly funded at state and federal levels. It is generally intended for low-income individuals and families, and may help cover their medical costs and long-term custodial care. Medicaid eligibility is determined by income, and requirements vary by state. Some Medicaid coverage may overlap with Medicare, such as hospital care and doctor’s services. However, depending on the state, Medicaid may offer additional benefits that Medicare doesn’t, such as routine dental and routine vision services and hearing aids. State governments maintain much more control over Medicaid than Medicare. Unlike Medicare, Medicaid generally has no federally-set premiums, deductibles, or coinsurance.  States have the option to charge premiums and set cost sharing requirements for Medicaid enrollees. States may charge higher income people more.

Medicaid provides significant assistance to children. In 2015, the average number of monthly enrollees in Medicaid was about 69 million, with 29.6 million (43%) being children, according to the Centers for Medicare & Medicaid Services.  Unlike Original Medicare, Part A and Part B, Medicaid generally supplies all beneficiaries with prescription drug coverage.

As of the writing of this article in 2017, there is legislation pending that may change Medicaid or other parts of the healthcare system in the US.  Be sure to stay informed about the latest developments that may affect you.

Can I have Medicare and Medicaid?

If you’re a low-income person over 65 or a low-income person with a disability, end-stage renal disease, or amyotrophic lateral sclerosis, you may be eligible for both Medicare and Medicaid; this is called being dual-eligible. The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office works to coordinate benefits between the two programs. The office has several goals, such as eliminating regulatory conflicts between rules under Medicare and Medicaid programs and improving the quality of health care and long-term services for dual-eligible individuals.

If you have questions about Medicare and Medicaid, please don’t hesitation to contact me.

  • If you want to request some Medicare plan information to review, use the links below; you can either schedule a phone call with me or have me email you some plan options.
  • If you’d like to start by comparing Medicare plans on your own, use the Find Plans button to begin.
  • Would you like to discuss your options? Just pick up the phone and call us to speak to a licensed eHealth insurance agent at 1-844-847-2660; TTY users, call us at 711, Monday-Friday 8 AM-8 PM.

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