Medicare, Social Security, and Insurance

9/30/2021 | By Seniors Guide Staff

The terms are so similar that they often trigger confusion when it comes to the difference between Medicare and Medicaid. And to add to the uncertainty, they’re both U.S. government-run healthcare programs, although each is designed to benefit different segments of the population.

Medicare is a federal insurance program for people 65 and older and those with a disability, regardless of income. Medicaid is a state and federal program providing health coverage to people of all ages with limited income and resources.

Take a look at the details of these two popular programs to find out how they compare and, mostly, how they are different.

What is Medicare?

Medicare is provided for Americans over 65 or younger people diagnosed with a disability or illness. Medicare is made up of four parts: Part A (hospitals), Part B (doctors), Part C (Medicare Advantage plans), and Part D (prescriptions). The federal government provides Parts A and B, while Parts C and D are offered by private insurance companies but are still federally governed.

Medicare is not an income-based program. Most U.S. citizens have paid taxes into the Social Security fund throughout their working lives and are automatically enrolled in Medicare Part A when they turn 65. At that point, they can choose and purchase the other parts to create a comprehensive plan.

The Caregiver’s Guide to Medicare

What is Medicaid?

Medicaid provides health coverage to over 80 million Americans, making it the largest source of health coverage in the United States. Eligible individuals may include low-income adults, children, pregnant women, elderly adults, and those with disabilities. Medicaid is funded jointly by states and the federal government, and it is administered by states meeting federal requirements.

The difference between Medicare and Medicaid includes income; unlike Medicare, Medicaid is an income-based program using Modified Adjusted Gross Income (MAGI) to determine eligibility. While Medicaid beneficiaries typically must be residents of the state where they are receiving benefits, they must also be citizens of the United States or qualified non-citizens, such as lawful permanent residents. 

Medicare vs. Medicaid chart: a side-by-side comparison

Who is eligible for coverage?Individuals 65 and over or disabledLow-income individuals
What is covered?Hospital, doctors, and prescriptionsHospital, doctors, medications, and other benefits
How does coverage vary?By the plan that is purchasedBy the state where you live
How much does it cost?Determined by the planDetermined by income level
Who provides funding?Federal governmentState and federal governments

Can you have both Medicare and Medicaid?

Yes, you can. Some people qualify for Medicare because they are age 65 or older or have a disability. They could also be eligible for Medicaid by meeting the requirements for coverage in their state. These people are considered to be “dual eligible” since they qualify for Medicaid and Medicare. 

Those eligible individuals who choose to enroll in both programs can have coverage for most of their health care costs. They may also qualify for a unique Medicare Advantage plan called a Dual Special Needs Plan. Private insurance companies offer these plans. A dual health plan will not change Medicaid eligibility or benefits.

Seniors Guide Staff

Seniors Guide has been addressing traditional topics and upcoming trends in the senior living industry since 1999. We strive to educate seniors and their loved ones in an approachable manner, and aim to provide them with the right information to make the best decisions possible.

Seniors Guide Staff