While they sound similar, Medicare and Medicaid are actually two entirely different programs.
Both programs can help you pay for healthcare and medical expenses but are completely different in nature. Medicaid is a state and federal program that provides health coverage for low-income Americans regardless of their age. Medicare, on the other hand, is a federal health insurance program that guarantees coverage for individuals ages 65 and over and people under the age of 65 with certain disabilities. Here’s the difference between Medicare and Medicaid.
If you are eligible for both Medicare and Medicaid, also referred to as dually eligible, you can have both. They will work together to provide you with health coverage and lower your costs.
Let’s break these down further:
What is Medicare?
Medicare is a federal insurance program where medical bills are paid from trust funds which those covered have paid into. While mainly for people over 65, there are individuals under 65 that also qualify.
The different parts of Medicare help cover specific services:
- Part A (Hospital insurance)
- Part B (Medical insurance)
- Part C (Medicare Advantage)
- Part D (Prescription drug coverage)
- Supplemental (Medigap Insurance)
Who qualifies for Medicare?
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
What is Medicaid?
Medicaid is an assistance program that serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses, though a small co-payment may sometimes be required.
Who Qualifies for Medicaid?
As long as you meet the low-income requirements, you may qualify for Medicaid if:
- You’re pregnant. Whether you’re single or married you can qualify. Both you and your baby will be covered.
- You’re have a disability or are over 65. Medicare can be expensive and not everyone can afford the premium payments. If you are over 65 and can’t afford healthcare coverage, you can apply for Medicaid, as well. People with medical needs may apply regardless of age.
- You have no disabilities or children under 18. The Affordable Care Act allows states to provide Medicaid to low-income individuals under the age of 65 without a disability or minor children. Will need to verify with your state agency and get more information.
As you can see, while the names are similar, the programs are very different.