Medicare vs Medicaid
Medicare is generally for people who are older or disabled, whereas Medicaid is a state-administered program for low-income and disabled U.S. citizens and legal aliens. Although many of the coverage details are determined by individual states, each state must provide certain services, such as specific hospital and doctor services.
It's possible to be eligible for both Medicare and Medicaid. If you think you might qualify, you need to fill out a Medicaid application. If you do qualify, Medicaid can help pay for your Medicare premiums, deductibles, and/or coinsurance. Outlined here are further differences between Medicaid and Medicare.
| Medicare | Medicaid |
|---|---|
| What is it? A federal health insurance program for people who are:65 or olderUnder 65 with certain disabilitiesOf any age and have End Stage Renal Disease 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 facilityCare 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 servicesAnd 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. |