Jessica Fox Last Updated On: August 4, 2023

Home / Blog / Medicare Insurance / Medicare vs. Medicaid: Everything You Need to Know About These Health Programs

Medicare vs. Medicaid: Which Government-Run Program is Best for You?

Medicare vs Medicaid

Both Medicare and Medicaid are government-run health programs designed to help Americans access proper healthcare. Though their purpose is the same, their function differs. This article will cover everything you need to know about the difference between Medicare and Medicaid.

The key difference between the two programs is how they determine their eligibility. Medicare’s eligibility is based on age. Those who are 65 and up and/or those who have specific diseases such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Medicaid eligibility, on the other hand, is based on income.

Though eligibility is the main difference between the two programs, several others exist. So, let’s get into the details. 

Free Medicare Insurance Comparison - Save up to 30%

No junk mail. No spam calls. Free quotes.

No Signup required

An Overview of Medicare

Medicare is run on a federal level, for seniors over 65 and qualifying individuals. If you are on Social Security Disability Insurance, you are also eligible for Medicare after two years of payments. 

To apply for Medicare, you must do so during the enrolment period; otherwise, you may be penalized. Open enrollment occurs between October 15 and December 7. A more limited enrolment period occurs between January 1 and March 31. Outside of these open enrolment periods, you may apply within three months of your 65th birthday.

Medicare has various options to choose from. You may select Part A, B, C, or D based on your needs. 

  • Part A covers hospital services and is usually free. You will only pay for your hospital visit if you’re new to Medicare.
  • Part B covers doctors or physician appointments.
  • Part D is an optional coverage that covers the cost of prescription medications.
  • Part C is also known as Medicare Advantage. Medicare Advantage is offered through insurance companies for purchase. Part C plans are ACA-compliant and include Part A, Part B and whichever supplemental add-on you purchase, e.g., Part D prescription medication.

An Overview of Medicaid

To be eligible for Medicaid depends on your income level. For instance, eligibility requirements depend on how far below the federal poverty line you are. Because this program is run on the federal and state levels, the exact parameters for eligibility vary between states, as will the coverage. 

Generally speaking, those below the poverty line (as determined by their state) are eligible. Although, Americans who are close to the poverty line but have applicable extenuating circumstances may also be able to take out a Medicaid policy. 

Here are some examples of applicable extenuating circumstances:

  • Pregnant women
  • Teenagers who live alone
  • Parents with sick children
  • People who live with an applicable disability
  • For those who are on Supplemental Security Income, you immediately qualify

In other words, factors such as household size, disability, and family status are weighed against an applicant’s income to determine eligibility.  

Unlike Medicare which only applies to the policyholder, Medicaid will cover the whole family. Another feature of Medicaid is that you can apply anytime, even outside the open enrollment period. 

Though the extent of the benefits will vary from state to state, generally speaking, these are the benefits included:

  • Vision Care 
  • Dental Care for Children
  • Hospitalization and clinic treatment
  • Laboratory and x-ray services
  • Doctor services, nursing services, medical and surgical dental services
  • Family planning and midwife services
  • Nursing facility services for people aged 21 or older
  • Home healthcare for people eligible for nursing facility services
  • Pediatric and family nurse practitioner services
  • Screening, diagnosis, and treatment services for persons under the age 21

Free Medicare Insurance Comparison - Save up to 30%

No junk mail. No spam calls. Free quotes.

No Signup required

Jessica Fox Jessica Fox has been a freelance writer for five years, with a specialty in health, wellness, and insurance. During this time, she’s written for some of the biggest B2B and B2C brands from around the world. Jessica is also the mother of two young daughters and loves coffee, writing, and working out.

Stay Up-to-Date
Subscribe to our newsletter and receive alerts, offers, education, and updates in your inbox.