What is the difference between Medicare and Medicaid?

MEDICARE and Medicaid have two very similar names and functions, though one is managed by states and the other is federal.

However, they are both government health insurance programs seeking to help lessen the burden of medical costs.

What is the difference between Medicare and Medicaid?

Medicare and Medicaid are programs that pertain to the US healthcare system.

Medicare is a national health insurance program run by the federal government.

It typically covers people aged 65 or older and certain individuals under age 65 who may qualify due to a disability or another special situation.

There are four parts to Medicare, which include:

  • Part A: Helps pay for hospital stays and inpatient care.
  • Part B: Helps pay for doctor visits and outpatient care.
  • Part C: Combines Part A (hospital insurance) and Part B (medical insurance) in one plan that often includes prescription drug coverage too.
  • Part D: Prescription drug coverage.

Medicaid, however, is a way to get health care at a lower cost or sometimes at no cost at all depending on income. 

Medicaid is managed by each state, so the eligibility requirements vary. 

Each state may have its own name for its Medicaid program and you have to recertify for Medicaid each year.

Medicaid typically covers children, pregnant women, elderly adults and people with disabilities, and eligible low-income adults.

Are Medicare and Medicaid free?

You can get premium-free Part A of Medicare at 65 if you already get retirement benefits from Social Security or the Railroad Retirement Board, are eligible to get Social Security or Railroad benefits but have not filed for them yet, or you or your spouse had Medicare-covered government employment.

If you're under 65, you can get premium-free Part A if you got Social Security or Railroad Retirement Board disability benefits for 24 months or if you have End-Stage Renal Disease (ESRD) and meet certain requirements.

Medicaid can be free depending on a person’s income status.

Can you have both Medicaid and Medicare?

Some people qualify for both Medicaid and Medicare because of age (they’re age 65 or older) or because of a disability. 

They could also qualify for Medicaid because they meet their state requirements.

Those that qualify for both Medicare and Medicaid are considered “dual eligible.”

Dual eligible persons have a special type of Medicare Part C (Medicare Advantage) plan. 

Dual health plans combine hospital, medical and prescription drug coverage while keeping all the Medicaid benefits.

Some may also be eligible for greater benefits than with original medicare and for as low as a $0 plan premium.

Check your state’s health website to see if you qualify for Medicaid based on household size and income.

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