What’s the Difference Between Medicare and Medicaid?

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Written by: Vanessa Jerusalimiec (*Amsive Digital)  |  Reviewed by: Kristin Van Dusen  |  *MHP partners with Amsive Digital on news content


What’s the Difference Between Medicare and Medicaid?

Medicare and Medicaid are government health insurance programs that offer health care to Americans. But there are a few key differences between Medicare and Medicaid.

Medicare vs. Medicaid

Medicare and Medicaid may sound the same, but they’re very different. Medicare is a federally funded program, and eligibility is mainly based on age. Medicaid is managed at the state level, and eligibility is based on income.

What is Medicare?

Medicare is a national health insurance program for adults over age 65. Younger adults with disabilities can also qualify for Medicare. There are four Parts of Medicare, and each Part provides different coverage options.

  • Medicare Part A pays for some hospital stays and inpatient care.
  • Medicare Part B pays a portion of doctors visits, outpatient care, ambulance services, and preventive preventative care.
  • Medicare Part C includes Part A and Part B coverage and usually includes additional benefits such as dental, vision, and hearing coverage. Many Part C plans also include prescription drug coverage.
  • Medicare Part D pays a portion of prescription medications.

Medicare beneficiaries pay monthly premiums for their Medicare plan. Along with this monthly bill, plans may also include a yearly deductible. Finally, coinsurance and copayments may also apply every time beneficiaries access health care. Costs vary significantly between plans.

What is Medicaid?

Medicaid is a joint state and federal program. Medicaid eligibility is based on income instead of age. Low-income Americans of all ages can access affordable health care through Medicaid. Eligibility requirements are different for each state, and some states offer more coverage than others.

Medicaid provides health insurance for:

  • Children
  • Pregnant women
  • Low-income adults
  • Adults with disabilities

This assistance program offers health care at a low cost. Depending on your income, you may even access health care services at no cost. You can find out if you’re eligible for Medicaid using the Income levels tool to calculate your household income and eligibility.

What’s Covered?

Original Medicare Part A and Part B coverage is determined by the federal government and it’s the same across the country. Medicare Part C and Part D plans are offered by private insurance agencies, so coverage is different for each plan.

Medicaid coverage is mandated at the state level. All states must offer basic health care coverage, such as hospital and medical care, preventive preventative services, family nurse practitioner services, and nursing home care. Each state can also choose to offer more coverage through Medicaid.

Can You Have Both Medicare and Medicaid?

Some individuals are eligible for both Medicare and Medicaid. Dually eligible beneficiaries meet the age or disability requirements for Medicare as well as the income requirements for Medicaid.

If you’re dual eligible, you can choose to enroll in Medicare and Medicaid. Enrolling in both programs can help you access additional health care coverage. For example, Medicaid may help cover the costs of Medicare coinsurance or copayments. Depending on your income level, Medicaid may also pay for Medicare Part B monthly premiums so you can access the health care you need.

MDwise offers affordable health insurance to adults and children in Indiana. We work alongside the State of Indiana and Centers for Medicare and Medicaid Services to bring you high-quality health care. Check your eligibility online or call us at 1-800-356-1204 to find out more about our coverage options.