What’s the Difference between Medicare and Medicaid?

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What’s the Difference between Medicare and Medicaid?

 

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.

 

Medicare

Medicaid

What is it?

A federal health insurance program for people who are:

  • 65 or older

  • Under 65 with certain disabilities

  • Of any age and have End-Stage Renal Disease (ESRD)

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:

  • 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.

 

 

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 facility

  • Care 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 services

  • And more

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.

For information about dual eligible programs, you can call Social Security at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday, or contact your state Medical Assistance or Medicaid office.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more at 1-877-619-5582, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Resources:

What is Medicare? What is Medicaid?: Medicare.gov

Financial Help with Medicare: MedicareMadeCear.com

Medicaid and Children’s Health Insurance Program (CHIP): Medicaid.gov

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