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Medicare and Medicaid are both health plan options for seniors.

What is the Difference Between Medicare and Medicaid?

What is Medicare and Medicaid?

Medicare and Medicaid sound like the same thing, but they actually are not. They are both useful for beneficiaries but, knowing the difference between the two is important. This will help you choose which one is right for you, based off your lifestyle.

What is Medicare?


Medicare is the federal government’s health insurance plan and is only federally funded. It is split into three different types of coverage. These types include Part A: Hospital Insurance, Part B: Medical insurance and Part C: Prescription Drug Coverage.

Different Types of Medicare Coverage

Part A Medicare is usually premium free for anyone over 65 years of age, as well as some people with physical disabilities and anyone with renal failure. Part A covers inpatient care in a hospital, skilled nursing facility care, hospice care and some in-home health care.

Part B Medicare has a monthly premium that is deducted from your monthly social insurance benefit. The premium is calculated based on your yearly income. Part B covers clinical research, ambulance services, durable medical equipment, mental health (inpatient, outpatient and partial hospitalization) and some outpatient prescription drugs.

Part C costs vary depending what kind of plan you sign up for, if you choose to do so. As stated above, Part C covers prescription drugs. There is also another coverage known as Part D: Medicare Advantage, which is an alternative bundled package.

The Benefits of Medicare

The benefit of Medicare advantage is that there is a cap on how much money you pay for medical expenses out-of-pocket each year, whereas there is no out-of-pocket payment cap on the original Medicare unless you have supplemental coverage. Supplemental coverage would be any insurance coverage you keep after retiring from your employer. If you choose to use Medicare Advantage, you will not be able to use that supplemental insurance with your plan.

The big takeaways to remember about Medicare is that it covers people aged 65 and over, it is federally funded with the same coverage across the nation, and people pay a deductible and part of the costs of coverage.

What is Medicaid?

Medicaid on the other hand is a federally and state funded health insurance for low-income households. In some states, people can qualify for Medicaid based only on their income. Through Medicaid, people pay little to no money for coverage.

The coverage you get through Medicaid depends on the state. The coverage that is offered does generally line up with a lot of the coverages from Medicare. For the best way to determine whether you qualify for Medicaid, what the cost would be and what your coverage would be based on your state, go to HealthCare.gov and if you are having trouble you can call for help at 1-800-318-2596.

How Are Medicare and Medicaid Similar?

Both Medicare and Medicaid cover people with disabilities, offer prescription drug coverage and cover inpatient and outpatient care. Other than what qualifies a person for Medicare or Medicaid, the two are very similar in what they offer. The main difference is just how they offer those things.

Which One Suits You?

If you are over the age of 65 and are not low income, then the best option for you would be Medicare. If you are under the age of 65, you can still purchase Medicare, but it will cost you more money and it may cost the same to purchase regular private insurance.

If you are under the age of 65 and you are in the income bracket where your state considers you to be low income, then it would be a good idea to apply for Medicaid as this means you can have health insurance for a very small or non-existent fee. Though, in some cases, it may be a better option to purchase private health insurance.

What to Keep in Mind

Maybe now you are wondering if there are different lifestyles that one of these plans would work better for, but please keep in mind that what the government has to offer is based solely on your age, health conditions and economic level, so the type of lifestyle you live will not be a factor in whether or not you qualify for Medicare or Medicaid.

Both Medicare and Medicaid are great for people who are eligible to receive them because they offer more financially sound options. Again, if you are not sure if you would qualify for Medicaid, you can call 1-800-318-2596. It may be good to talk over your options with your family members and doctor too, as they can provide insight into which option is the best for you. Sometimes it is good to get a second, more educated opinion.