Difference between Medicare and Medicaid

Difference between Medicare and Medicaid

Medicare and Medicaid are programs sponsored by the government to help people cover healthcare costs. Since these two programs have similar names and pronunciation, they are always confusion about the coverage they provide and how they work.


This is a program designed by the federal government to cover the elderly healthcare. It is available in the US for those at 65 years of age or older. Medicare also covers people with some disabilities. This program has four parts including:

Part A: Hospitalization Coverage – If you are around 65 years or older, you are eligible for Medicare Part A hospitalization coverage free regardless of your income, and you are not going to pay a monthly premium, but deductibles for service apply. This is most important especially if you or your spouse have worked and paid Medicare taxes for the past ten years or more. This is also important for those who are already receiving retirement benefits from the Railroad Retirement Board or Social Security.

Part B: Medical Insurance – You will surely qualify for Part B once you qualify for Part A. Part B provides health insurance coverage. This part covers medically necessary services and equipment like the lab work, x-rays, walkers, doctor’s office visits, wheelchairs, and outpatient surgeries. This part also covers preventive services like flu shots and disease screenings. Once you are eligible, you do not have to sign up. However, you may have to pay if you are not covered by employer insurance.

Part C: Supplemental Insurance – You are automatically eligible for Part C once you are eligible for Part A and Part B. Part C is also known as Medicare Advantage, and it covers all what Part A and Part B cover and additional ones like vision and dental coverage. This Part functions exactly like the HMOs (health maintenance organizations) and the PPOs (preferred provider organizations); these are some ways through which some people receive medical services while in service.

Part D: Prescription Drug Coverage – This Part covers prescription drug; its costs include a yearly deductible, monthly premiums, and copayments for some prescriptions. Part D is usually provided once you registered for Part C.

Medicare Costs – If you buy Part A, you will pay up to $437 per month, and you will pay $240 for Part A premium. For standard Part B premium, you will pay $135.50 while part C premium and Part D premium vary by plan.


This is a joint federal and state program that is designed to help low-income Americans, no matter their age. This will pay for the costs associated with their health and long-term custodial care. For children who need low-cost care, they will be covered by the Children’s Health Insurance Program (CHIP); this has its own set of requirements and complex rules.

Eligibility and Costs – There are 50 different Medicaid programs; each state has one. This program is meant for people with income as low as 133% of the federal poverty level or low, and this turns out to be 138% when calculated. All Medicare recipients at the age of 65 remain eligible for Medicaid. While higher-income people discover that Medicaid covers their Medicare Part B premiums, lower-income people may continue to receive full benefits.

Medicaid Benefits – Medicaid benefits vary by states but the following are the services offered by the federal government mandates – hospitalization, laboratory services, X-rays, nursing services, doctor services, family planning, clinic treatment, midwife services, nursing facility services, pediatric and family nurse practitioner services, and home healthcare for people who are eligible for nursing facility services.

Each state also has additional benefits like medical transportation, prosthetic devices, optometrist services, prescription-drug coverage, physical therapy, eyeglasses, and dental services.

Key Differences Between Medicare and Medicaid

  • The Medicare eligibility is not attached with income level
  • Medicaid eligibility is determined on a state-by-state basis
  • Medicaid is a program designed for people with limited income.
  • For people who do not have access to other resources, Medicaid is their last option.
  • Medicare is the main primary medical coverage provider for those with a disability and people aged 65 and above

The Bottom Line

The greatest burden faced by most retirees is paying for their healthcare. These two programs (Medicare and Medicaid programs) were designed to provide medical coverage for the elderly, retirees and people with low-income levels. This is one of the best programs that will help improve the health of the people in the nation, and they have several benefits to prolong the lives of our elders.

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