Medicare vs. Medicaid

Medicare vs. Medicaid

While Medicare and Medicaid sound similar, the programs are largely different with different regulations and functions.


Medicare is a health program created for United States citizens aged 65 or older to help cover the expenses relating to medical care and treatment. The program is also available to people under 65 who have certain health conditions or disabilities. People with end-stage renal disease who are under 65 can also apply for a Medicare policy.

Generally, eligibility for Medicare depends on the age of the applicant. Also, the applicant must be a citizen of the United States or a permanent resident to qualify. The premiums and eligibility depend on the number of years of Medicare taxes paid by the applicant. There are different parts of Medicare, each with its own coverage options.

Part A covers inpatient hospital care and home healthcare services and is available without premiums to individuals who have paid up to 40 quarters of Medicare taxes while they were employed. People who do not qualify for premium-free Medicare Part A can still purchase the policy once they are eligible.

Medicare Part B covers outpatient care, doctor visits, medical supplies, and preventive services. Medicare Part C is also known as Medicare Advantage. It is offered by private insurance companies but is regulated by the government. Medicare Advantage plans offer the same benefits offered by Original Medicare (Part A and B), in addition to extra benefits, such as prescription drug coverage.

Medicare Part D also offers prescription drug coverage.


Medicaid is a health program run by the federal and state governments to help low-income individuals or households with medical costs. Medicaid offers some benefits that are not usually offered by Medicare.

To qualify for Medicaid, you must fall within the income limit needed to qualify. Qualification largely depends on income and family size. Medicaid offers benefits which may vary depending on the state, but there are some general benefits which include inpatient and outpatient care, lab and X-ray services, family planning, health screenings, dental services for adults, and nursing facility care.

Dual Eligibility

It is possible to qualify for both Medicare and Medicaid. People in this category are called dual eligible. They can get coverage through Medicaid as it may cover other expenses Medicare does not cover. If you are dual eligible, you can enroll in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP).

To determine your eligibility for Medicare and Medicaid, reach out to us today!