Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

medicare and medicaid difference guide

The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones.

The United States has two separate national health care systems: Medicare and Medicaid. The government created the two programs for two different kinds of people. However, they often overlap. Let’s look at both programs, including their similarities and difference. We will also look at who needs or qualifies for each program.

Let’s Start with Medicare vs Medicaid.

What is Medicare?

Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.

The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis.

Medicare does not cover all of the costs associated with health care. As a result, people with Medicare will also use a Medicare Supplement Insurance Plan (Medigap Plan) or a Medicare Advantage Insurance Plan to round out their care coverage.

Please read our Ultimate Guide article on “What is Medicare.

What is Medicaid?

Medicaid is the United States National Health Care System that provides health coverage to over 64.7 Million People.

The program was created for people with low-incomes that cannot afford, or do not have access to, private healthcare insurance.

How are the programs similar?

Medicare vs Medicaid Pin

The programs are both National Health Care Systems. In fact, they are the only two nationalized heath care systems the United States has. Many other countries around the world have much more extensive national coverage for their citizens. The U.S. has a limited program for specific age, income, and health groups, and the rest of the country relies on private health insurance.

In addition, both programs cover specific hospital services, doctor services, and other health care related services.

Medicare has four parts. First, Medicare Part A, also known as “Hospital Insurance,” helps with coverage regarding: inpatient care, home health care, nursing facilities, and hospice.

Second, there is Medicare Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including: doctors visits, health care providers, outpatient, prevention services, and medical equipment. Medicare Beneficiaries pay for Part B.

Finally, Medicare has a Prescription Drug Program that is administered by private insurance carriers. Click here to lean more about What Medicare Covers and Medicare Parts A, B, C and D are.

Both Medicaid and Medicare Advantage Plans can be set up as managed care plans with networks of doctors and hospitals members have access to. If you would like to learn more about how these networks work, please read, HMO vs PPO – Which is Better?

How are the programs different?

One of the biggest differences between the two programs is who runs them. Medicare is run on a national level, by the Federal government. On the other hand, Medicaid is run by each state individually.

Of course, the biggest difference is the the different populations the programs serve:

  • Medicare – For Seniors over age 65, and some disabled people
  • Medicaid – For people with low income and few resources

Medicare and Medicaid Differences in Beneficiaries – Who Gets What Program?

The U.S. government created Medicare and Medicaid to take care of different “vulnerable” populations – the poor, the disabled, and the elderly. Let’s look at each program and population.

Who should get Medicare?

Anyone who is a citizen or qualified resident of the U.S. can enroll in Medicare when they turn 65 years old. There is a seven month window of time starting three months before turning 65, the month of your birthday, and then three months after your birthday month.

How do I Sign-up for Medicare?

First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).

Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.

Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Click here to read more about Medicare, including where to go to enroll.

From Our Article What is Medicare? A Guide to All Medicare Basics

Supplemental Medicare Insurance Options

Medicare picks up about 80% of the health care costs for its beneficiaries. For the other 20%, seniors turn to either Medicare Supplements (aka Medigap Plans) or Medicare Advantage Plans. Click here to read our article on Medicare Advantage vs. Medigap, or see the informational articles below.

What is Medicare Advantage?
What are Medicare Supplements_

Who should get Medicaid?

Medicaid is for people with limited income and resources. Medicaid is run on a state level, not on a federal level. As a result, in order to qualify for Medicaid, you will need to determine what your state defines as a qualifying income level.

How Do You Enroll in Medicaid?

Again, since Medicaid is run by State Governments, you will need to contact your state’s agency to start see if you qualify to enroll.

You can find a list of State Agencies here on the Medicaid.gov website.

Who Can Get Both Medicare and Medicaid?

People of any age who have certain qualified disabilities and people over 65, who are also below their states Medicaid income levels, can qualify for both Medicare and Medicaid.

For example, Henry is a 55 year-old disabled man who is also unemployed and living below the poverty level set by his state. Consequently, he would most likely qualify for both Medicaid (because of his income level) and Medicare (because of his qualified disability).

People that qualify for both programs are called “Dual Eligible.”

Who Can Help?

Navigating one (let alone both) of these systems can be confusing. But there is help available.

  • Finally, if you need help finding a Medicare Supplement or Medicare Insurance Plan, or if you are dual eligible for both Medicare and Medicaid, then please contact an Insurance Agent. An Independent Medicare Insurance Agent will help you explore your options, and help you make the right choice for your unique situation.

Further Helpful Reading

How to Choose A Medicare Plan
How to Dispose of Old Medications

How to Dispose of Old Medications

How to Dispose of Old Medications Do you have a stash of old or expired medications? Are you concerned about how to dispose of old medications? There are a lot ...
Read More
does Medicare pay for dentures

Does Medicare Pay for Dentures

Does Medicare Pay for Dentures? One frequently asked question we get is "Does Medicare pay for dentures?" The short answer is NO. Teeth are important part of your health. However, ...
Read More
Is acupuncture covered by Medicare

Is Acupuncture Covered by Medicare

Is Acupuncture Covered by Medicare Is acupuncture covered by Medicare? Only if you have chronic low back pain as defined by Medicare. Let's look at what that means and what ...
Read More
what does medicare cover - FAQ's to Medicare coverage questions

What Does Medicare Cover?

What Does Medicare Cover? The Most Frequently Asked Medicare Coverage Questions This is a quick directory answering what Medicare will and will not cover. We will list out frequently asked ...
Read More
does medicare cover Chiropractic Care

Does Medicare Cover Chiropractic Care?

Does Medicare Cover Chiropractic Care / Services? Yes, when deemed medically necessary, Medicare does cover chiropractic services. Original Medicare Part B pays for 80% of the cost of chiropractic services ...
Read More
does medicare cover cataract surgery

Does Medicare Cover Cataract Surgery

Does Medicare Cover Cataract Surgery? Yes, Medicare covers cataract surgery. Medicare Part B covers the costs associated with cataract surgery. This includes if you need corrective lenses as a result ...
Read More
medicare part b costs 2021 chart - Medicare Part A Costs Chart

Medicare Part B Premium 2021 Changes

Medicare Part B Premium 2021 The Center for Medicare Services has announced the costs of Medicare Part B Premium 2021. In addition, they have announced the changes to Part A ...
Read More
Does Medicare Cover Ambulances medicare FAQs

Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulance Services? Yes, Medicare covers ambulance services in approved emergency situations. As with all Medicare covered costs, you will pay 20% of the cost of service, unless ...
Read More
hearing aid alternatives with medicare life health - what is a psap

Best Hearing Aid Alternatives

Best Hearing Aid Alternatives Hearing aids are expensive. We are talking thousands of dollars, sometimes even with insurance. In addition, they may be overkill for the amount of hearing support ...
Read More
HMO vs PPO Which is better in regards to health insurance, Medicare Advantage Plans and dental insurance

HMO vs PPO Which is Better?

HMO vs PPO Which is Better? Insurance has changed a lot over the last 20 years, and there is no better example than the way we define and use provider ...
Read More
How Long Does Medicare Pay for Rehab

How Long Does Medicare Pay for Rehab?

How Long Does Medicare Pay for Rehab? How Long Does Medicare Pay for Rehab? It depends on what Medicare Plan you have. Medicare often pays for at least part of ...
Read More
does medicare pay for stem cell therapy article from medicarelifehealth.com

Does Medicare Pay for Stem Cell Therapy?

Does Medicare Pay for Stem Cell Therapy? When does Medicare pay for stem cell therapy? The answer is: in a limited amount of cases. Stem cell therapy is still controversial ...
Read More
What is MAPD + PDP+ Medicare Jargon Made simple

What is MAPD?

What is MAPD? There are a lot of acronyms in Medicare, and even more in insurance. We know, it can get very confusing when you are not hip to the ...
Read More
attained age vs issue age in medigap pricing

Attained Age vs Issue Age

Attained Age vs Issue Age Medicare Supplement Insurance Companies all price their plans differently. One of the biggest differences between plan prices is whether or not an insurance company uses ...
Read More
What is Medicare Plan G - medigap plans made clear

What is Medicare Plan G?

What is Medicare Plan G? When people talk about Medicare Plan G, they are referring to the Medicare Supplement Plan G. It can also be called a Medigap Plan G ...
Read More
what are medicare part b excess charges

What are Part B Excess Charges?

What are Part B Excess Charges? Medicare Part B Excess Charges are important to understand when you are deciding what Medigap Plan (Medicare Supplement) to get. Every once-in-a-while, we hear ...
Read More
how to apply for medicare article - medicare enrollment questions and answers

How to Apply for Medicare

How to Apply for Medicare (An Ultimate Guide) With so many rules, regulations, exceptions and unique situations, Medicare enrollment can get confusing. We are here to make it simple and ...
Read More
how much does an mri cost

How Much Does an MRI Cost?

How Much Does an MRI Cost? There is nothing worse than getting a hospital bill with an unexpected number on it. So, if your doctor says you need an MRI, ...
Read More
What is Medicare Plan F - simple answers to medigap questions

What is Medicare Plan F?

What is Medicare Plan F? You may have heard, but there have been changes with who can get what Medicare Supplement Plans (aka Medigap Plans) now. Plan F and Plan ...
Read More
Medicare Easy Pay

Medicare Easy Pay

Medicare Easy Pay - What is it & How do I get it? Medicare Easy Pay is the automatic payment system set up by CMS to pay your Medicare Premiums ...
Read More
medicare and medicaid difference guide

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones. The ...
Read More
Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away? As a Medicare Health Insurance Agent I hear this question over and over: "Is Medicare Plan F Going Away?" The simple answer is, no, ...
Read More
Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers

Renew Active vs Silver Sneakers Does it sometimes seem like Medicare and Insurance companies are trying to make things as complicated as they possibly can? Just when you think you ...
Read More
what is Silver Sneakers Senior Fitness

What is Silver Sneakers?

What is Silver Sneakers? Maybe you just overhead your neighbor talking about his free gym membership, or maybe your doctor asked you if you are a SilverSneakers user. You might ...
Read More
What Does Medicare Part A Cover

What Medicare Part A Covers

What Medicare Part A Covers Here is what Medicare Part A Hospital Insurance covers: Inpatient Hospital CareSkilled Nursing CareStays at Skilled Nursing Facilities (short-term)Home Health CareHospice Care In addition: Part ...
Read More
What is the Medicare Donut Hole? Or Doughnut Hole?

What is the Medicare Donut Hole?

What is the Medicare Donut Hole? The Medicare Donut Hole (or Doughnut Hole) is a coverage gap in the Part D Prescription Drug Plan where beneficiaries could pay more for ...
Read More
2020 Part B Deductible

2020 Part B Deductible / 2021 Part B Deductible

2020 Part B Deductible / 2021 Part B Deductible for Medicare The 2021 changes for Medicare were released this month. The 2021 Part B Deductible is just one of the ...
Read More
qualities of a good insurance agent

Qualities of a Good Insurance Agent

The Top 6 Qualities of a Good Insurance Agent What are the qualities of a good insurance agent you should be looking for when you are searching for an agent? ...
Read More
medicare open enrollment 2019

Medicare Open Enrollment

Medicare Open Enrollment Medicare Open Enrollment runs from October 15th to December 7th. These are the same dates every year. What is Medicare Open Enrollment? Also called AEP - Annual ...
Read More
Railroad Medicare Benefits and Choices at MedicareLifeHealth.com

Railroad Medicare

Railroad Medicare - What You Need to Know Here is what you need to know about Railroad Medicare Benefits to be successful in your retirement planning. Introduction to Railroad Medicare ...
Read More
Does medicare cover hearing aids doctor examining patient

Does Medicare Cover Hearing Aids?

Does Medicare Cover Hearing Aids? One questions we hear a lot at Medicare Life Health is "Does Medicare Cover Hearing Aids? The simple answer is NO. However, some Medicare Advantage ...
Read More
how to read Medicare and You 2020 guidebook

Medicare and You 2020 & 2021

Medicare and You 2020 & 2021 Guidebook - Read This First Your Introduction to the Medicare and You 2020 & 2021 Book, and where to get a copy. The Medicare ...
Read More
Medicare Parts A B C D Explained

Medicare Part A B C D

Medicare Parts A B C D Explained Medicare has four different parts: Medicare Part A B C D. Each of these parts serve a different function in our national health ...
Read More

Medicare For All Explained

Medicare For All Explained The Presidential Debates have started, and once again, the rising costs of health care is a hot topic. You will hear people (like Bernie Sanders and ...
Read More
5 Biggest Medicare Mistakes

5 Biggest Medicare Mistakes

The 5 Biggest Medicare Mistakes and How to Avoid Them No one wants to make a mistake that will cost them hundreds (or thousands) of dollars down the road if ...
Read More
how much does medicare cost price tag image from medicarelifehealth.com

How Much Does Medicare Cost?

How Much Does Medicare Cost? Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and ...
Read More
independent medicare insurance agent near me

Using an Independent Medicare Insurance Agent

Should I Use an Independent Medicare Insurance Agent? When it comes to making decisions on and signing up for Medicare health care planning, you will have a few paths to ...
Read More
medicare penalties for late enrollment

Medicare Penalties For Late Enrollment

What are the Medicare Penalties for Late Enrollment? There are two main Medicare penalties for late enrollment to be aware of when you are planning your health care in retirement ...
Read More
just what is AEP or annual enrollment period with medicare

What is AEP? Medicare’s Annual Enrollment Period

What is AEP? Medicare's Annual Enrollment Period AEP stands for Annual Enrollment Period. It is the time of year when Medicare Beneficiaries can switch or enroll in Medicare Part D, ...
Read More

Medicare Questions “FAQ’s”

The Most Frequently Asked Medicare Questions (FAQ's) & Answers Once you are familiar with the basics of Medicare, these are the Medicare questions we hear the most often that you ...
Read More
Medicare Part D Prescription Drug Plans

Part D Prescription Drug Plans

Medicare Part D Prescription Drug Plan Information Part D of Medicare covers Prescription Drugs. There are different Part D Prescription Drug Plans available. When you choose a plan you will ...
Read More
Medicare Advantage Vs Medicare Supplement

Medicare Advantage vs Medicare Supplement

Medicare Advantage vs Medicare Supplement (Medigap): What Medicare Plan is Best for Me? I am a firm believer that there is a good Medicare health plan out there for everyone ...
Read More
What is Medicare Advantage?

What is Medicare Advantage

What is Medicare Advantage? In this article, we look at what is Medicare Advantage (aka Medicare Part C). As we discussed in our Medicare 101 Post, there are two different ...
Read More
What are Medicare Supplements_

What are Medicare Supplements?

What are Medicare Supplements? What are Medicare Supplements? First, Medicare Supplements have many names: Medigap Policies, Med Sup, Medicare Supplement Insurance. However, they all refer to the optional insurance coverage ...
Read More
What is Medicare

What is Medicare?

What is Medicare? Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance. The U.S. government started the ...
Read More

6 thoughts on “Medicare and Medicaid Difference Guide”

Leave a Comment