Medicare vs. Medicaid Comparison: What Are the Differences?
- February 15, 2022
Given the similar names and some shared benefits, it’s understandable why so many people confuse Medicare and Medicaid. Both programs are federally regulated by the Centers for Medicare & Medicaid Services (CMS), though Medicaid programs can have some variations from one state to the next.
The chart below outlines the major differences between Medicare and Medicaid to help you better understand each program and how they are distinguished from one another.
Medicaid vs. Medicare Chart
|
|
Medicare |
Medicaid |
|---|---|---|
|
What it is |
A federal health insurance program for individuals age 65 and over or who have a qualifying disability. | A federal and state program for individuals and families with limited income or resources. |
|
Who administers the program |
Federal government | State governments |
|
Funding |
Federal government, FICA taxes, plan premiums | Federal and state governments |
|
Coverage |
|
Each state Medicaid program must cover certain mandatory benefits such as inpatient and outpatient care. A state can also offer optional benefits, which can include prescription drugs, dental and vision care, physical therapy, eyeglasses and more. |
|
Costs |
Part A and Part B costs are standardized, and premiums are based partly on work history and income. Medicare Part C and Part C costs may vary. Medicare costs are generally higher than Medicaid. |
Costs are minimal and are generally lower than Medicare. Beneficiaries may pay limited premiums and small copayments. Certain beneficiaries are exempt from most or all Medicaid costs. |
|
Eligibility |
Eligibility is based on age (65) and citizenship or legal resident status. Some people may qualify before 65 because of a disability or health condition such as ESRD or ALS. |
Eligibility varies by state but is primarily based on income and resources. |
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Can you have both Medicare and Medicaid?
While Medicare and Medicaid are two different programs, many people are eligible for — and have — both Medicare and Medicaid.
Those who are eligible for both programs are called “dual eligible” beneficiaries. The two programs work together, with Medicare acting as the primary payer and Medicaid serving as a supplemental payer.
Dual eligible beneficiaries can receive coverage from both programs through a Medicare Savings Program, and some beneficiaries may be able to enroll in a private plan called a Dual Eligible Special Needs Plan (D-SNP) if any are available where they live.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
