The Difference Between Medicare and Medicaid

With such similar sounding names, it can be easy to confuse Medicare and Medicaid. Add in the fact that both are government-run programs designed to help beneficiaries pay for healthcare costs, and it’s no wonder many people confuse the two.

In reality, each program has vastly different requirements and benefits. However, it is possible to qualify for both. This post provides a basic overview of each program, key differences between them, and how you might qualify for both Medicare and Medicaid.

Medicare at a Glance

Medicare is a federal entitlement program designed to provide medical coverage to Americans aged 65 and over. The program also covers all those with End-Stage Renal Disease and many individuals with disabilities.

  • Part A provides inpatient hospital coverage to nearly all Americans over 65.
  • Part B provides medical coverage for doctors’ visits, outpatient care, and some preventive services and costs the same low monthly premium for almost everyone.
  • Part C refers to the Medicare Advantage plans available through private health insurance companies. It provides all the benefits of Parts A & B but may also offer additional coverage, such as vision, hearing, and prescription drugs for an extra monthly premium.
  • Part D refers to prescription drug plans available through private insurers and may be added on to one’s Parts A & B coverage.
  • The fifth component of Medicare is the Medicare Supplement Plan option, commonly known as Medigap. Offered by private insurers, it is meant to help fill in the coverage gaps of Parts A & B, like copayments, coinsurance, and deductibles. There is an additional monthly premium for Medigap plans.

To learn more about Medicare, go to our Intro to Medicare page.

What Is Medicaid?

Medicaid is a similar entitlement program meant to address the needs of a different population: the impoverished, children, pregnant women, and those with disabilities. Medicaid is a state-federal cooperative effort to provide basic medical assistance to individuals who cannot afford private health insurance on the individual market or through their employer.

Medicaid works much like having private health insurance: enrollees are given a card to present at the doctor’s office. If the doctor participates in Medicaid, the state will pay for the appointment, minus the contribution of any other health insurance the individual carries. There are different eligibility requirements in each state, but all states have income limits that recipients must meet.

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The MedicareUSA website is operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; in California d/b/a HPOne Insurance Agency, license #OF30784. HealthPlanOne, is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

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The Centers for Medicare and Medicaid Services (CMS) does not review or approve Medicare Supplement plan information.

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Last Updated 09/01/2019