Skip to main content

Medicare vs. Medicaid: What’s The Difference?

Published January 13, 2021

4 minute read

Cora Walker

By Cora Walker

Just what are the differences between Medicare and Medicaid? It’s easy to get them confused, and that would be understandable. Both programs are managed by the government and have very similar-sounding names. They are intended to support groups that may need additional help in accessing healthcare. Typically, that means older individuals, people with certain disabilities, or those who simply don’t make enough to afford healthcare. Although both programs have notable gaps in coverage, they are fundamentally intended to fill in for what private insurance would normally cover.

It can also be confusing to find out which program you are eligible for. It’s possible to meet the enrollment requirements for both. Or neither. To further complicate things, exact thresholds for the programs (Medicaid, in particular) can vary by state. Learning how to distinguish the two programs, as well as identify key features, will help you determine your best options for coverage.

Medicare vs. Medicaid

Medicare is a federal program largely aimed at supporting senior citizens and disabled people. The age of eligibility for Medicare is 65, which means the program gears towards older Americans. Those above 65 are less likely to have health insurance through their jobs — or the month-to-month funds to afford their own care. If you or someone you know requires dialysis treatments, then Medicare also covers that.

Medicaid, on the other hand, is managed at the state level. Eligibility is primarily determined by how much you make. However, it’s worth noting that not all states have expanded their Medicaid programs to cover residents based on income when they were given the opportunity. This means that where you live will be a big factor in whether you are able to access Medicaid benefits or not. Here’s a simple map that shows which states adopted the expansion.

According to reports, about 17.2% of Americans are enrolled in Medicaid. Meanwhile, 15% of the population is enrolled in Medicare. Both of these numbers are expected to rise over the next decade.

Original Medicare and Medicare Advantage

Original Medicare can be considered very bare-bones, with different coverage options depending on your needs. Medicare Advantage should be thought of as a selection that allows you to bundle different care options.

While looking at your insurance options, it’s possible you’ve seen the terms “Medicare Part A,” “B,” “C,” or “D” before. This lettering system is your guide to knowing if a plan is part of Original Medicare or Medicare Advantage. It refers to Part A and Part B, which are hospital insurance and medical insurance respectively. Medicare Advantage plans also have opportunities for vision, hearing, dental, and other health-related costs not covered by Parts A, B, or D.

Medicare Advantage is not to be confused with Medicare Supplemental Insurance. That represents various plans you can purchase via a private firm that are intended to fill in for some of the cracks that Medicare can leave.

Age

Your age matters most when it comes to access to Medicare. Adults under 65 are not covered, except in the case where they have a qualifying, documented disability. However, it can get confusing, as some states have Medicaid programs for seniors.

Income

While this is probably the easiest way to remember the difference between the two systems, it’s not guaranteed to be a component. Eligibility for Medicaid enrollment is typically determined by income, but this can be very different across state lines. For instance, Alabama has Medicaid options in place for some children, pregnant women, disabled, and elderly people. However, their programs do not provide coverage on the basis of income alone.

Federal or State?

While Medicaid programs often receive federal funds (or have the option to), Medicaid is still organized at the state level. The federal government issues block grants which the state then uses to fund part of its Medicaid program. As we previously discussed, that means that states have a great deal of freedom and leeway in how they implement their individual systems.

On the other hand, Medicare is managed by the federal government. This means that requirements are far more consistent throughout the country. However, it also means that Medicare is far more limited in who and what they can provide coverage for.

Can You Be Eligible for Both Medicare and Medicaid?

Depending on your situation, it is possible to be eligible for both Medicare and Medicaid. It’s also possible to be enrolled in both simultaneously. This can be a good thing since each system can prioritize different kinds of healthcare and invest resources in different needs. Original Medicare not covering prescription drug costs is a prime example.

Medicare vs. Medicaid

Shutterstock

Cora Walker

Cora Walker

Contributor

Cora is a Northwest-based writer and editor who wants to make information as accessible as possible in the internet age. Video games are this writer’s primary vice. With a degree from the University of Washington as well as 5+ years of experience in web writing and publishing, Cora is here to share financial tips from experts and talk about good habits.

Explore Insurance

Young couple talking to insurance agent Insurance

How To Choose The Right Insurance Policy For You

Whether you are looking for homeowner’s, life, auto, renter’s insurance (or something a bit more random), it makes sense to get the best insurance policy for you. That also means getting it at the right price. Making sure you have the appropriate insurance is vital, since it will determine the type of protection you receive. […]

Read More about Post Title

8 minute read

Auto Insurance

The Best Car Insurance For Millennials

Millennials, also known as Generation Y, are the demographic sandwiched between Generation X and Generation Z. They are typically considered to be propleg born between 1981 to 1996. Most Millennials are the children of baby boomers and early Generation Xers. Today, most Millennials are between the ages of 25 and 40. They are working, raising […]

Read More about Post Title

6 minute read

See All In Insurance

More from WalletGenius

TSP Loans Loans

TSP Loan: Everything You Need To Know

TSP loans are specialized loans designed for employees of the United States federal government. They offer federal employees access to a unique loan class that uses their retirement plans to finance their borrowing needs. Financial advisors often liken them to the 401(k) loans available to members of the general public. Yet, TSP loans differ from […]

Read More about Post Title

5 minute read

Woman enjoying a sudden windfall of money Financial Advice

What To Do With a Sudden Windfall

Getting an unexpected windfall can cause plenty of emotions. On one hand, there’s the hoopla of getting a sudden cash infusion. It’s simple human nature to go wild when a large sum of extra money shows up unexpectedly. After all, it’s not earmarked for any of your normal expenses. It’s just extra money. Can you […]

Read More about Post Title

8 minute read

Young couple worried about finances Save Money

How To Tell If Your Retirement Is In Jeopardy

One of the most common financial concerns for adults these days is retirement. It comes up over and over again. For anyone concerned about money, retirement is a very big problem to confront. Current (and future) generations of working-aged Americans aren’t exactly fairing well, when it comes to retirement savings. Some studies have shown that […]

Read More about Post Title

7 minute read

Young woman worried about student loans Perkins loans Student Loans

Perkins Loans: Everything You Need To Know

A Perkins Loan was a federal program that provided low-interest loans to college students who demonstrated exceptional financial need. The program, which operated as the “Perkins Loan Program,” no longer exists. It was discontinued on September 30, 2017. The final disbursements were permitted through June 30, 2018. Although the program has been discontinued, many current […]

Read More about Post Title

5 minute read

Capital budgeting paperwork Budgeting

Capital Budgeting: A Complete Guide

Capital budgeting is a business term used to describe the process of determining how to best use the capital the company has on hand. Should they expand? Should they reinvest in a new factory to increase capacity? Is it profitable to acquire another business for expansion? In other words, capital budgeting is the process of […]

Read More about Post Title

7 minute read

Woman checking her credit score Credit

What You Need to Know About Free Credit Scores

You probably know that your credit score is an important aspect of your finances. Your credit score goes beyond just helping you get a loan with a good interest rate. It can also influence your insurance rates and even impact what happens when you sign up for internet or a cell phone plan. Knowing your […]

Read More about Post Title

7 minute read

Trusted provider of accurate rates & financial information