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Medicare. Medicaid. Just the two names alone can be confusing. After all, they’re both forms of government-provided health care—and they both start with the same six letters.
“While it’s generally true that the first program benefits Americans age 65 and over, and the second serves those with limited incomes and resources, it’s possible for certain people to be eligible for both Medicare and Medicaid,” added Medicare expert Brandy Bauer, former Director of NCOA’s MIPPA Resource Center. “This understandably adds to the confusion.”
NCOA is here to help you sort it through. In this article, you’ll learn exactly what each of these health insurance programs is, including:
- What Medicare covers
- What Medicaid covers
- What the major differences are between Medicare and Medicaid
- What are the eligibility guidelines
- How to apply
- Where to find more help
Get started in understanding the differences between Medicare and Medicaid below.
What is Medicare?
Medicare is a federal health insurance program that covers a wide range of services to keep you healthy as you age. Medicare is generally intended for older Americans, but some younger people with certain disabilities can also receive this benefit. Medicare enrollees share the costs of coverage through monthly premiums, co-pays, and deductibles.
What are the 4 types of Medicare?
Medicare is an umbrella term that includes four different categories: Medicare Part A (hospital insurance, or inpatient care); Medicare Part B (medical insurance, or outpatient care); Medicare Advantage Part C (voluntary private insurance); and Part D (private prescription drug coverage). Together, Parts A and B are often called Original Medicare.
What is Medicaid?
Medicaid is a public health insurance program for people with limited income and resources, regardless of age. Because Medicaid is a joint program of the federal government and individual states, it can have a different name depending on where you live. Generally speaking, Medicaid enrollees have minimal or no out-of-pocket costs for covered health care expenses.
What is the major difference between Medicare and Medicaid?
Actually, there are two core differences: who administers the program and who can enroll.
- Medicare is managed by the federal government and eligibility is based on age or disability.
- Medicaid is managed by each individual state and eligibility depends on income.
Medicare vs Medicaid Chart: A Comparison
| FACTOR | MEDICARE | MEDICAID |
| Eligibility |
Age: 65 and up except:
Income: No requirement |
Age: Varies* Income: Varies* *Each state maintains its own Medicaid rules. For information on your specific situation, it’s best to contact your state’s Medicaid office. |
|
Coverage* See Costs, below |
Original Medicare (Parts A & B):
Medicare Advantage (Part C):
Medicare Prescription Drug Coverage (Part D) Varies by plan |
Mandatory (federally required):
Optional (state determined*):
*This list is partial and depends on each state. Please visit Medicaid.gov for the most recent guidelines. |
| Costs |
Enrollees share the costs of care. Out-of-pocket expenses vary but can include:
|
States are limited on what they can require enrollees to pay:
|
| When benefits start | Typically, on the first of the month following enrollment. (See Medicare.gov for specific details on each enrollment scenario). | On the date of application, or first day of that month. |
Can I have both Medicare and Medicaid?
In a word, yes. If you are 65 or older, you qualify for Medicare. However, Medicare isn’t free, and the costs can quickly mount—especially if you have limited income. In this situation, you may also qualify for Medicaid. This is called being “dual eligible.” Medicaid can help you pay for the out-of-pocket costs associated with Medicare, which can be a crucial lifeline.
How do I apply for Medicare?
There are three ways you can apply for Medicare:
- Online: Visit the Social Security website.
- By phone: Call the Social Security national toll-free customer hotline at 1-800-772-1213.
- In person: Visit your local Social Security office.
How do I apply for Medicaid?
You can apply for Medicaid through your state Medicaid agency or through the Health Insurance Marketplace. Unlike Medicare, which has specific enrollment periods, you have the option to apply for Medicaid any time of year.
If I'm an older adult who needs help choosing which option is right for me, what’s the next step?
Contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare advice. Find your SHIP by visiting the program website or by calling 1-877-839-2675.
You can also get a free, 100% confidential Medicare cost estimate and connect with advisers who meet NCOA's Medicare Standards of Excellence (or SOE).
We’ve identified trustworthy Medicare brokers who meet rigorous guidelines to ensure you can be confident in the enrollment choices you make. Each one has gone through our intensive SOE training and certification process, enabling them to provide in-depth Medicare education and practical decision-making support. Talking to these certified advisors costs you nothing.
"Working with a licensed Medicare broker that meets NCOA’s Standards of Excellence can give you the peace of mind that you’re making the best choice for your health care coverage,” said Josh Hodges, NCOA’s Chief Customer Officer.
