Medicare and Medicaid are government programs that provide health care coverage for eligible recipients who live in the United States.
Medicaid follows federal government guidelines, but each U.S. state runs its own Medicaid program with different eligibility requirements and coverage allowances. Today in this country there are around 87 million people enrolled in Medicaid, and it’s the largest health care program for people of all ages who are living on a limited income.
Medicare, on the other hand, is a federally run program that covers over 65.7 million people in the United States today. It also provides health care, but enrollees are eligible because of age or disability, not income level.
If you’re researching health care options, you might be wondering what differences there are between Medicare and Medicaid, so here’s a look.
Differences in eligibility requirements between Medicare and Medicaid
You may be eligible for enrollment in Medicare if you are a U.S. citizen or a legal permanent resident who has lived in the country for at least five continuous years, and you are entitled to receive Social Security retirement benefits.
You must also meet at least one of the following criteria:
- You are 65 years old or older.
- You are under 65 but have a qualifying disability.
- You are under 65 and have end-stage renal disease or ALS (Lou Gehrig’s disease).
You may qualify for your state’s Medicaid program if you:
- Are a U.S. citizen or a qualified and eligible alien admitted for permanent residency
- Reside in the state where you’re applying for Medicaid benefits
- Are in a qualifying group or a qualifying individual based on the requirements listed further below
U.S. federal law requires mandatory Medicaid coverage for the following groups or individuals in every state:
- Low-income families or individuals who meet the financial eligibility requirements that are based on their modified adjusted gross income (MAGI)
- Pregnant women who qualify
- Children who qualify
- People who are receiving Supplement Security Income (SSI)
Each state has additional eligibility options for Medicaid coverage and some cover groups or individuals that receive home or community-based services and children who are in foster care, for example.
To find out more about your state’s eligibility rules, you can contact your state’s Medicaid office, or visit the official website.
Differences in health care coverage
Medicare health care coverage is divided into four parts:
- Original Medicare Part A covers inpatient hospital care, skilled nursing facility care, nursing home care, hospice care, and home health care.
- Original Medicare Part B covers medically necessary services and supplies like doctor’s visits, diagnostic exams, preventive services, and other outpatient care.
- Medicare Advantage (Part C) is an alternative way to get Medicare Parts A, B, and sometimes D (prescription drugs) benefits bundled together into one plan. Part C plans are required by federal law to provide all benefits included in Original Medicare Parts A and B, but most plans include prescription drug coverage as well as extra benefits like vision, hearing, and dental care services.
- Medicare prescription drug (Part D) plans cover prescription drugs that your physician prescribes for you to take at home.
In all 50 states, Medicaid covers the following:
- Inpatient hospital care
- Outpatient hospital services like lab tests, minor surgery, colonoscopies, MRIs, CTs, etc.
- Visits to physician’s offices or medical clinics
- Pregnancy care
- Pediatric care
- Screenings (preventive) care
- Transport for emergency and non-emergency care
- Outpatient prescription drugs
Optional types of care that vary according to the state’s Medicaid program:
- Prescription drugs
- Physical, occupational, and speech therapy
- Hearing and language disorder services
- Vision care
- Dental care
- Chiropractic care
- Private nursing care
- Hospice care
- Psychologist visits
- Podiatrist care
- Hearing aids
- Prosthetics and orthotic devices
- Durable medical equipment
You should contact your state’s Medicaid office or visit the website for a list of covered services in your service area.
Enrolling as a dual-eligible beneficiary
If you qualify for Medicare and Medicaid, you may have the option of enrolling in a Medicare Advantage Dual-eligible Special Needs Plan (D-SNP) if one is available in your area. D-SNPs cater specifically to those individuals who are eligible for both Medicare and Medicaid. Compare your options before enrolling to find the plan that’s right for you.