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.
Medicare is a federally funded program available to most U.S. citizens and permanent legal residents who have lived continuously in the country for five years or more and are age 65 or older.
People younger than 65 may also be eligible for Medicare if they:
- Have received at least 24 months of Social Security disability benefits or a disability pension from the Railroad Retirement Board (RRB).
- Have permanent kidney failure and need routine dialysis or a kidney transplant.
- Have amyotrophic lateral sclerosis (Lou Gehrig's disease).
To qualify for premium-free Medicare Part A, you or your spouse need to have worked at least 10 years and paid Medicare payroll taxes while working. Medicare Part B has a premium that most people pay. To cover additional costs or provide more health-care services, you may enroll in a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage plan (Part C). Medicare Advantage plans and Medicare Prescription Drug Plans are offered by private Medicare-approved insurance companies, and costs, coverage details, and availability may vary among plans.
Medicaid is jointly funded at the state and federal levels. Medicaid supports low-income individuals and families by covering costs associated with both medical and long-term custodial care for those who qualify. Some of the benefits covered under Medicaid overlap with Medicare, such as inpatient and outpatient hospital care and doctor services. However, depending on the state, Medicaid may also offer coverage that is not included under Original Medicare, such as personal care, optometry services, and dental services. Also, the service providers (such as hospitals and doctors) available to people using Medicaid are often different than those available to people using Medicare.
Eligibility for Medicaid is means-based, and the program has strict income eligibility requirements that vary from state to state. The Affordable Care Act expanded Medicaid eligibility levels in some states beginning on January 1, 2014. For more information on current qualification requirements, individuals should call their State Medical Assistance (Medicaid) office or visit Medicaid.gov.
Outlined below are further differences between Medicaid and Medicare.
|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:
||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?||It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance.||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.||Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify.|