Medicare VS Medicaid: What're Their Differences?

Updated: May 26


You're aware that you'll need government-sponsored insurance to help pay your medical expenses, so do you qualify for Medicare or Medicaid? After all, what's the difference between the two? If you're confused, you're not alone. Medicare Geek can help you understand the differences between the two.


The terms Medicare and Medicaid are often used interchangeably, but their distinctions are not thoroughly clarified. Medicare covers you regardless of your salary, whether you are 65 or older or have a severe injury. On the other hand, if you or your family has a really low wage, Medicaid will help you get health insurance.


It's essential to consider the difference between Medicare and Medicaid to choose the best health insurance for you.


Medicare: Older and Disabled Americans

Medicare is a federal health insurance policy that covers almost all above the age of 65. People with particular conditions, end-stage kidney disease, or ALS may also use it. Your salary status has no bearing on your qualifications for this service. Medicare Parts A and B (Original Medicare) are used in this package, and extra components such as Medicare Supplement, Medicare Part C, and Medicare Part D.


  • Part A covers inpatient and outpatient stays.

  • Outpatient or medical provision is included in Part B.

  • Part C or Medicare Advantage plans are commercial health benefit plans that Medicare has accepted to supplement the Part A and Part B coverage.

  • Prescription medication reimbursement is provided by Part D.

  • Medicare Supplement programs supplement but do not cover Parts A and B of Medicare.


Medicaid: Lower-Income Americans

Medicaid is a federal-state health insurance initiative that covers low-income individuals, households, and teenagers, as well as pregnant mothers, the elderly, and those with disabilities. Medicaid is often preferred for people who do not have access to most healthcare options.


Since Medicaid is a state-run program, each state sets its eligibility and coverage rules. Depending on your income, household size, disability, family status, and other variables, you might be eligible for Medicaid in your state. The following Medicaid benefits are required by federal law, regardless of where you live:

  • Care treatment for inpatients

  • Hospital treatment for outpatients

  • Early and intermittent screening, diagnosis, and recovery

  • Nursing homes

  • Preventive care at home

  • X-ray and laboratory

  • Services for family planning

  • Nurse-midwifery services

  • Treatment provided by a certified pediatrician and a nurse practitioner

  • Support provided by a stand-alone birth center (when licensed or otherwise recognized by the state)

  • Transportation to hospital appointments

  • Pregnant women's tobacco cessation therapy


Prescription medicine coverage, physical therapy, and hospice care are only a few of the optional programs offered by Medicaid. Nonetheless, it is up to each state to determine what is covered.


What if You Qualify for Both?

You could be eligible for both Medicare and Medicaid benefits in some cases. It's referred to as "dual" or "dual qualifying." Dual Special Needs Programs, or DSNPs, are Medicare Advantage plans designed exclusively for qualifying for both Medicare and Medicaid.


DSNPs also provide services that Medicare does not have, such as regular hearing, vision, and dental coverage. They are open to dual-eligible recipients, but so are most Medicare Advantage programs and Original Medicare plus Medicaid. Any dual-qualified Medicare recipients are eligible for direct Medicaid insurance, and others are eligible for Medicaid-funded benefits that supplement their Medicare coverage.


Need any help? Health Insurance Geeks can help you. Get in touch with us through email jason@themedicaregeek.com or call us at Tel: 808-652-5210.


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