Understanding Two of America's Largest Health Programs
Millions of Americans rely on Medicaid and Medicare for health coverage, but many people confuse the two programs or aren't sure which one they qualify for. While both are federally supported, they have distinct purposes, eligibility rules, and coverage structures.
Medicare: Health Coverage for Older Americans and People with Disabilities
Medicare is a federal health insurance program primarily for people aged 65 and older. It also covers certain younger individuals with qualifying disabilities and people with End-Stage Renal Disease (ESRD) or ALS.
Medicare is divided into four parts:
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don't pay a premium if they or their spouse paid Medicare taxes while working.
- Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and medical equipment. Requires a monthly premium.
- Part C (Medicare Advantage): A private insurance alternative that bundles Parts A and B, often with added benefits like dental and vision.
- Part D (Prescription Drug Coverage): Covers prescription medications through private plans.
Medicaid: Health Coverage Based on Income
Medicaid is a joint federal and state program that provides free or low-cost health coverage to people with limited income and resources. Eligibility and benefits vary significantly by state.
Medicaid typically covers:
- Low-income adults and families
- Pregnant women
- Children (also through the CHIP program)
- Elderly individuals who need long-term care
- People with disabilities
Under the Affordable Care Act, most states expanded Medicaid to cover adults earning up to 138% of the Federal Poverty Level (FPL). If your state expanded Medicaid, you may qualify even without children or a disability.
Side-by-Side Comparison
| Feature | Medicare | Medicaid |
|---|---|---|
| Primary eligibility | Age 65+, certain disabilities | Low income, limited resources |
| Who runs it | Federal government | Federal + state governments |
| Cost to enrollee | Premiums, deductibles, copays | Usually free or very low cost |
| Long-term care coverage | Limited | Extensive (nursing home, home care) |
| Dental/vision | Limited (Part C may include) | Varies by state, often included |
| Income-based | No | Yes |
Can You Have Both? Dual Eligibility
Yes. People who qualify for both programs are called "dual eligible" beneficiaries. This group includes many low-income seniors and people with disabilities. If you're dual eligible, Medicaid often covers Medicare premiums, deductibles, and cost-sharing, dramatically reducing your out-of-pocket costs.
How to Apply
- Medicare: Enroll through the Social Security Administration at ssa.gov or call 1-800-772-1213. You're automatically enrolled if you're already receiving Social Security benefits.
- Medicaid: Apply through your state's Medicaid agency or via the federal Health Insurance Marketplace at healthcare.gov. Eligibility is determined year-round.
Get Free Help
The State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling on Medicare and related benefits. Find your local SHIP at shiphelp.org or call 1-877-839-2675.