Difference Between Medicare and Medicaid

by Ryan Guina

Despite the similarities in their names, Medicare and Medicaid are two different public health care programs designed to help different groups of people, although some people may qualify for and receive both benefits.  The programs are funded differently, with Medicaid being a state governed program and Medicare being funded and governed on a federal level.

Comparing Medicare and Medicaid

What Does Medicare Cover and Who is Eligible?

Medicare is a federal program designed to help people afford health care. People who qualify for Medicare coverage are generally permanently disabled and unable to work, or over the age of 65.  Medicare will also provide coverage for people of any age who have long term kidney disease or kidney failure. To be eligible for Medicare coverage, you must have entered the United States lawfully and have lived here for at least five years to be eligible.

There are two parts to Medicare: Hospital Insurance (Part A)and Medical Insurance (Part B).  Hospital Insurance helps you pay for inpatient care received in a hospital, nursing facility or hospice.  It may cover home health care under certain conditions.  Most people receiving Hospital Insurance under Medicare do not have to pay a monthly premium because they paid Medicare taxes during their working years (or their spouse did).  Individuals not eligible for free Medicare Part A coverage may still enroll, but may have to pay a premium.

Medical Insurance helps you pay for outpatient care and doctor’s appointments.  It will provide coverage for some preventative services like flu shots or to prevent an illness from getting worse.  Most people receiving Medicare Part B pay a monthly premium of around $100.

If you are limited with income and financial resources, there are often assistance programs to help you pay for your Medicare health costs or prescription drug coverage.

If you are eligible for Medicare or want to find out if you are eligible, you can apply for the program at your local Social Security Office, visit www.socialsecurity.gov, or call 1-800-633-4227.

What Does Medicaid Cover and Who is Eligible?

People eligible for Medicaid coverage include those who have low income, who are pregnant, under the age of 19 or over the age of 65, blind, disabled, or living in a nursing home.  How your income and resources are counted will depend on the state in which you live.  If you’re unsure if you qualify for Medicaid, have limited income and financial resources and do not have any other health insurance coverage, you should still apply and let a caseworker determine your eligibility.

Some individuals receiving Medicaid are asked to pay a small percentage of the costs for certain medical services, like a copayment.  If you qualify for both Medicare and Medicaid, you will probably not have any medical fees since the two programs work together to cover your medical expenses.

You can apply for Medicaid coverage at your State’s Medicaid agency.  Learn more at www.medicare.gov.

Published or updated April 27, 2011.
Print or e-mail this article:

{ 2 comments… read them below or add one }

1 Pat S

Great article, Ryan. I like how you cover concrete topics like this. Entitlement programs are frequently confusing, but an important thing to understand as a citizen.


2 Arrica Lee

Strict eligibility requirements made it hard to apply for Medicaid. It is great to know that there is Medicare that has more flexible rules, regardless of income. Medicare is indeed a better choice for the elderly.


Leave a Comment

Previous post:

Next post: