Understanding the difference between Medicare vs Medicaid, and which one is suitable for you, is the first step towards taking control of your health insurance and your overall health. It can be confusing, especially since they both have similar names, so that’s why we’re here to fix every misunderstanding and to ensure you’re getting the advice and the care you need.

Let’s start with the key similarities. Both Medicare and Medicaid are programs that can help an individual with the various costs associated with healthcare. Both programs require you to meet a certain criteria in order to take advantage of them.

Next, here is a key difference between Medicare and Medicaid. Medicare is primarily an age-based program, whereas Medicaid is primarily income-based.

While both of these programs help pay for healthcare expenses, they are very different and they serve different groups of people.

The purpose of this page is to help you quickly determine which of these two options is a better fit for you. We’ve also taken a much more in-depth look at everything you need to know about Medicare and Medicaid here at MediClarity, so if you’re looking for more than an overview, please seek out those pages.

Medicare Fast Facts

Drawing of Medicare with Stick Men and Clipping Path

Here’s a quick breakdown of some quick facts to give you an overview of Medicare.

  • Who is Medicare For? People over the age of 65, or younger people with disabilities, or people on dialysis. 
  • What does Medicare Cover? The different Parts of Medicare include coverage for many medical procedures and supplies, including but not limited to hospital stays, skilled nursing facility stays, wheelchairs and walkers, hospice care, home healthcare, surgeries, doctor visits, lab tests, physicians and outpatient, rehab therapies, prescription drugs, and more. (See our “What is Medicare?” page for a breakdown of what’s included in each part.)
  • Who runs the Medicare program? Medicare is administered by a federal agency called Centers for Medicare & Medicaid Services.
  • Do patients have to pay for Medicare? Yes, there is a small monthly fee for certain services, and deductibles are required for other services offered through Medicare.
  • How is it organized? Medicare is divided into different parts that cover different things. These parts are referred to as Medicare Part A, B, D and C.
  • Who has to pay for Medicare? Most people aren’t required to pay for Part A, but everybody has to pay that uses Part B.

Medicaid Fast Facts

You might qualify for medicaid, and it could offer you substantial coverage depending on which state you live in.

  • Who is Medicaid For? Medicaid offers health coverage for some low-income individuals, families, and kids, along with the elderly, pregnant woman, and people with disabilities. Beyond that, in some states, Medicaid also offers coverage to any adults who fall below a certain income level.
  • What does Medicaid Cover? The federal government has a list of 15 things that each state’s Medicaid program must cover, and beyond that, there are additional optional things that each state can choose to cover, or choose not to cover. Some of the mandatory services include inpatient and outpatient hospital services, home health services, labs and x-rays, nurse midwife services, transportation to medical care, help to quit smoking for pregnant women, and more. Optional benefits, on a state-by-state level, may include prescription drugs, physical therapy, speech therapy, eyeglasses, dental, podiatry, and more.
  • Who runs the Medicaid program? The federal government creates national guidelines, and states are able to build upon those guidelines to offer additional coverage as they see fit.
  • Do patients have to pay for Medicaid? States have the option to impose copayments and other costs and some services, but not on other ones. Generally speaking, the payments are not huge, and can’t be charge for emergency services, preventative care for children, and a handful of other services.
  • Who has to pay for Medicare? The costs are shared between the federal government and state governments, and in certain cases individuals must also contribute.

A Closer Look at Medicare

This federal program helps pay for a number of different expenses related to health care through the US Department of Health and Human Services. The most common group that takes advantage of Medicare are senior citizens, after turning 65 years old. There are other conditions that will permit somebody younger to benefit from Medicare, too, including ALS, and certain disabilities.

This is an entitlement program, meaning that most applicants will have had to work and pay taxes into the program throughout their lives, for a minimum amount of time, to be eligible. It may be possible to enroll without meeting those guidelines, but the price you end up paying could be higher.

As mentioned above, Medicare is divided into four distinct parts. Here is a very quick overview of each part.

The Parts of Medicare: A Quick Overview

Part A: The purpose of Part A is to provide health insurance for hospital visits and services. The services that fall under this umbrella include inpatient care in hospitals, limited stays in skilled nursing facilities, certain health care services provided in your home, and staying in hospice care. Part A may or may not include a monthly premium, depending on your employment history. People who meet the employment eligibility are able to receive Part A Medicare benefits without a premium. Generally speaking, Part A will cover part of your hospital bills, but not the entirety. It helps to cover the costs, but you may still be responsible for a portion.

Part B: The purpose of Part B of medicare is to cover the costs associated with medical bills outside of the hospital. Benefits included in Part B include things like x-rays, blood tests, visits to your doctor, lab tests, screenings for diabetes, and more. Part B carries with it the responsibility to pay monthly premiums, which can be tied to your income level, and if you are a lower-income individual there may be assistance for you. 

Part D: The purpose of Part D is to offer optional coverage for prescription drugs. Part D is offered through insurance companies, rather than through the government, so you’ll have the option to shop around for the best plans to suit you. The costs, and the way they are distributed among different parties including yourself, will depend on the plan that you end up choosing. Some plans will charge you based on the total cost of the drug, some will charge you a deductible, and others will have a flat payment option. We can help you find a plan that’s available where you live and that will give you the benefits you need at the best rate.

Part C: Like Part D, the purpose of Part C is to provide a private option (which has been approved by Medicare) for your health insurance needs. Medicare has a set of rules that these insurance companies must follow, and in return Medicare will pay them a set amount of money for offering these plans. These are called Medicare Advantage Plans, and they can charge you an out-of-pocket amount in addition to the funding they receive from the Medicare program.

They are able to set some of their own rules, as well, like requiring a referral from a doctor in order to see a specialist for various health treatments, which can end up costing you extra for the initial visit to the doctor for a referral before even visiting ther specialist that you need to see. These plans cover Part A, Part B, and may offer things like vision, dental, hearing, wellness, and more. You’ll need to shop around to find a plan that suits you best, and we are happy to help with that.

Medicare enrollment can be a confusing process, and you don’t have to navigate it alone. We’re here to bring clarity to Medicare so that you can get the coverage you need, the peace of mind, and you can spend more time living your life instead of worrying about your health care coverage.

In a survey of their readers, eHealthMedicare found that only 3% of people were not concerned about the costs of healthcare. 60% of people are currently struggling with the costs, and 36% of people can currently afford their healthcare but are concerned about rising costs in the future. This paints a picture of stress, anxiety, and worry. Comparing and finding the best plans can help you to save money by reducing these costs.

A Closer Look at Medicaid

This program assists people who meet a certain criteria for limited income. People with less resources should still be able to access necessary health care, and Medicare can help fill that void. Could it be better? Most certainly. Everyone has their own opinions when it comes to health insurance and what level of access to health care each person deserves, but that’s another discussion.

Medicare offers free health insurance to over 70 million Americans, in some capacity. It varies from state to state, and it’s not even mandatory for each state to participate at all.

Since 1982, however, every state in America has been participating in the Medicaid program for their citizens. Some states believe in offering a lot better coverage to their residents than other states. One of the main differences between states is how they determine who is eligible, and exactly what you can receive in terms of care.

The states have a lot of room to decide what they want to provide, so to determine your eligibility, you’ll need to look into the offerings of your specific state of residence. 

Medicare vs Medicaid: What’s Next?

Now that you understand the difference between Medicare and Medicaid, it’s time to take steps towards enrolment in your plan of choice.

We’ve created a brief, informative eBook to help you understand everything that you need to know about Medicare. Please, take a moment to download it and review it. Our goal is to help you become more informed before making a very important decision that will impact your health for years to come. Our eBook will guide you towards taking the next steps. We’re here to help at each step of the way, so you don’t have to do this alone.