Medicare vs. Medicaid: Everything You Need to Know About These Health Programs
Jessica Fox Last Updated On: March 9, 2022

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 have access to proper healthcare. Though their purpose is the same, their function differs. This article will tell you 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, there are several others. So, let’s get into the details. 

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An Overview of Medicare

Medicare is run on a federal level, and as previously stated is for seniors over the age of 65 and people with specific diseases. 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 Plan A, B, C, or D based on your needs. 

Plan A covers hospital services and is usually free. The only circumstance in which it is not free is if you have not worked long enough to qualify. 

Plan B covers medical services from physicians and includes a cost. Plan B may include eye exams during the “Welcome to Medicare” visits or the yearly “Wellness” visits. Otherwise, eye and dental care are not included in these medical services. 

Plan D includes plans A and B as well as covering prescription drugs. This plan also includes a cost. 

Part C is also known as an Advantage Plan. It includes the same coverages of Plans A and B as well as supplemental benefits. Advantage Plans are offered by independent insurance organizations. So, the supplemental benefits will vary but they may include vision care, dental care, and prescription drugs. 

An Overview of Medicaid

As previously stated, Medicaid’s eligibility is determined based on income. Because this program is run on both the federal and state level, the exact parameters for eligibility will vary between states, as will the coverage. 

Generally speaking, those below the poverty line (as determined by their state) are eligible. People who are close to the poverty line, but not necessarily below who have other extenuating circumstances are also eligible. Some examples of these extenuating circumstances are pregnant women, teenagers who live alone, parents with sick children, and people who have disabilities. In other words, factors such as household size, disability, and family status are weighted alongside income to determine eligibility. For those who are on Supplemental Security Income, you immediately qualify. 

Unlike Medicare that only applies individually, Medicaid applies to one’s whole family. And you may apply whenever your situation warrants it. There are no specific periods in which you must enroll. 

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
  • Paediatric and family nurse practitioner services
  • Screening, diagnosis, and treatment services for persons under age 21

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Medicare vs. Medicaid or Both?

It is entirely possible to be eligible for both Medicare and Medicaid. In such a scenario, the Coordination of Benefits will decide which program covers which services. 

Medigap is worth looking into for those who qualify for just one of the two, but who may require some additional services. 

Both programs are extremely beneficial for those in need of healthcare support.

Jessica FoxJessica 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.