What’s the Difference between Medicare and Medicaid?
The words “Medicare” and “Medicaid” are so much alike that it’s easy to get confused. To add to the confusion, both are government programs and both help people pay for health care. But that’s where the similarities end.
Medicare and Medicaid are two completely different programs. The main difference is that Medicare is generally for people who are older or disabled, and Medicaid is for people with limited income and resources. The table provides more information about each program and how they compare.
|What is it?||A federal health insurance program for people who are:
||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||State governments|
|What does it cover?||Depends on the coverage you choose and may include:
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.
|Each state creates its own Medicaid programs, following federal guidelines. There are mandatory benefits and optional benefits. Mandatory benefits include, in part:
|What does it cost?||Depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance.||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?||Most 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.||Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify.|
What if I Qualify for Both Medicare and Medicaid?
People who qualify for both Medicare and Medicaid are said to be “dual eligible.” If you qualify and enroll in both programs, then sometimes the two can work together to cover most of your health care costs.
Medicare Savings Programs are the Medicaid programs designed to help with the cost of Medicare. There are four different programs with slightly different qualifications and benefits.
Like all Medicaid programs, Medicare Savings Programs are governed by the states. Qualifying income and resource levels are set by the federal government, but each state decides what counts when calculating this for an individual.
While Medicaid and Medicare sound similar, they are in fact very different programs. One of the biggest differences is Medicaid is a state governed program and Medicare is a federal governed program. Here are some other differences:
Medicaid is for low income:
- Pregnant women
- Children under the age of 19
- People 65 and over
- People who are blind
- People who are disabled
- People who need nursing home care
Application for Medicaid is at the State’s Medicaid agency.
Medicare is for:
- People 65 and over
- People of any age who have kidney failure or long term kidney disease
- People who are permanently disabled and cannot work
Medicare is applied for at the local Social Security office.