Medicare Vs. Medicaid: What’s the Difference?

Sep 10, 2022

When it comes to Medicare Vs. Medicaid many individuals are often confused. Medicare and Medicaid are both government-sponsored health insurance programs, but there are some important differences between the two. To clear the confusion, let’s take a closer look at what each program offers.

What is Medicare?

Medicare is a federal health insurance program available to adults 65 years of age or older or younger individuals with certain disabilities. It is made up of four parts which include:

  • Part A:  Inpatient hospital services
  • Part B:  Outpatient medical care like doctor visits and preventative care
  • Part C:  Also known as Medicare Advantage
  • Part D:  Prescription drug coverage

What is Medicaid?

Medicaid is another federal assistance program that provides health coverage to eligible low income adults, children, pregnant women, elderly adults and people with disabilities. The program is designed to assist households in low-income groups with healthcare expenses. Medicaid assistance is administered by the state but is regulated by the Federal government.

Medicare Vs. Medicaid Eligibility

Medicare Eligibility

An individual is eligible for Medicare once they turn 65 years of age (or younger for those with certain disabilities). All U.S. citizens are eligible to receive Medicare coverage regardless of income or medical history. Enrollment in Medicare Part A and Part B is automatic once you turn 65 years of age and have already claimed social security benefits, otherwise you may enroll during specific enrollment periods.

Medicaid Eligibility

Eligibility for Medicaid is determined by income.  For children, pregnant women, parents, and adults income eligibility is based on Modified Adjusted Gross Income (MAGI). For adults 65 years of age or older, eligibility is determined using the income methodologies of the SSI program administered by the Social Security Administration. Once eligibility has been determined, Medicaid benefits begin immediately. An individual may apply for Medicaid benefits anytime – there are no specific enrollment periods.

Medicare Vs. Medicaid Cost

Medicare Cost

Medicare is made up of four parts with each part varying in cost. Generally, the costs associated with each part consist of a monthly premium, deductible, copay and/or coinsurance. Most individuals don’t have to pay a premium for Medicare Part A because they or their spouse have worked at least 10 years and have paid Medicare taxes while working.

Medicaid Cost

Medicaid recipients often pay nothing for covered healthcare expenses, but in some cases may be required to cover a small copayment. State governments can charge limited premiums and enrollment fees as cost-sharing with Medicaid coverage to certain groups of enrollees. To find out more about Medicaid costs visit

Can you have both Medicare and Medicaid?

Yes. Medicare enrollees who also qualify for their state Medicaid program are considered dual eligible. There are specific dual eligible special needs plan (D-SNP) that covers both Medicare and Medicaid benefits. These plans may also pay for expenses not covered by either one individually, including over-the counter items, hearing aids, etc. Dual eligible individuals generally do not have to pay any out of pocket healthcare costs. When a dual eligible individual receives a covered health related service Medicare pays first and Medicaid covers the rest.

Unsure Whether you Qualify for both Medicare and Medicaid?

We Can Help!  Speak to a Qualified Independent Insurance Agent to Find Out.

Sep 10, 2022 | | 0 comments


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