What is the difference between Medicare and Medicaid?
Many people confuse the terms Medicare and Medicaid. While they are both government-run health insurance programs, they generally help two different groups of people:
- Medicare provides health coverage to those older than 65 and to some younger individuals with certain disabilities, at any income level
- Medicaid provides health coverage for people with low incomes
Let’s take a closer look at the key differences between these two programs.
| Medicare | Medicaid |
|---|---|
| For people 65 and older and some people with disabilities of any income level | For people of any age with qualifying low income |
| Federally funded | Federally mandated benefits include inpatient and outpatient medical services such as hospitalization, lab work, X-rays, and doctor visits |
| Comes in 4 parts: Medicare Parts A and B (Original Medicare) and Parts C and D | Benefits that vary by state include prescription drugs, case management, physical therapy, and occupational therapy |
Can you have both Medicare and Medicaid?
If you’re 65 or older and meet your state’s income requirements for Medicaid, you can sign up for both Medicare and Medicaid. Together, they offer more comprehensive health coverage at a lower cost.
What is a dual eligible?
Dual eligibles are people who qualify for both Medicare and Medicaid coverage. If you’re enrolling in Medicare at 65 and qualify for financial assistance, you can sign up for Original Medicare or Medicare Advantage as a dual eligible. You get the healthcare coverage you need while also getting help for additional healthcare costs.
If you have Medicare and Medicaid, which is primary?
While Medicare is the primary payer for medical needs, Medicaid can cover costs that Medicare coverage does not. When you visit a provider that takes both Medicare and Medicaid, Medicare pays first for the cost of your care. Medicaid pays second, covering copays and other costs not covered.
If you qualify for both Medicare and Medicaid, you’re likely eligible for the Qualified Medicare Beneficiary (QMB) Program, one of four Medicare Savings programs. With the QMB program, you’ll get help with Part A and Part B premiums, coinsurance, and deductibles.
What are the 4 parts of Medicare?
- Medicare Part A and Part B, also known as Original Medicare, cover most of the inpatient and outpatient medical needs of beneficiaries.
- Part C (also known as Medicare Advantage) and Part D (prescription drug coverage) are available through private insurers and provide coverage beyond what is included with Part A and Part B.
What does Medicare Part A cover?
Medicare Part A is your hospitalization insurance. Medicare Part A includes:- Hospital stays (semi-private rooms) up to 60 days
- Hospital meals
- Nursing services
- Intensive care services
- Drugs, medical supplies, and equipment used on the premises
- Lab tests and X-rays taken while hospitalized
- Surgery and recovery costs
- Rehabilitation and therapy services
- Part-time home nursing care
What does Medicare Part B cover?
Medicare Part B provides for outpatient medical needs. Medicare Part B includes:- Routine doctor visits
- Tests, screenings, and X-rays
- Flu shots and other vaccinations
- Necessary medical supplies
- Outpatient mental health care
- Medically necessary preventive care
What do Medicare Part C and Part D cover?
You can add more coverage to your Original Medicare with Part C and Part D plans, which are offered through private insurers like Empire. You can add one or the other, or you can combine both Part C and Part D as a Medicare Advantage prescription drug (MAPD) plan. Part C, or Medicare Advantage, offers Part A and Part B coverage and may offer extra benefits including:- Prescription drug coverage when combined with Part D
- Routine dental care including cleanings, X-rays, and dentures
- Routine vision care including contacts and glasses
- Routine hearing care including hearing aids
- Fitness benefits including exercise classes
Part D plans only offer prescription drug coverage. These plans are a good option when you just need drug coverage added to your Original Medicare.
