Medicare vs. Medicaid
Understanding the Differences and Your Options
Medicare and Medicaid are two government-established programs designed to provide healthcare coverage to those in need. Although they sound similar, they serve different groups, operate separately, and are funded in different ways.
Medicare Basics
Medicare is a federal health insurance program primarily for:
⦁ Individuals age 65 and older.
⦁ Younger individuals with a serious or permanent disability.⦁ Eligibility is based on age or disability, not income level.
Medicaid Basics
Medicaid is a joint federal and state health insurance program designed for:
⦁ Individuals and families with low income.
⦁ Eligibility is determined by income level and varies by state.
⦁ Certain individuals with disabilities.⦁ For more details, visit: ⦁ www.medicaid.gov
Key Differences Between Medicare and Medicaid
Category
Who It Serves
Coverage
Program Management
Long-Term Care
Providers
Large Call to Action Headline
Large Call to Action Headline
Medicare
Seniors (65+) and younger individuals with disabilities
Hospital, medical, and limited prescription drug coverage
Federally administeredLimited coverage
Providers nationwide who accept Medicare
Large Call to Action Headline
Medicaid
Low-income individuals and familiesCoverage
Broad medical services, often including dental, vision, and long-term care
Administered by each state
Covers nursing homes and long-term care services extensively
Providers who participate in the state’s Medicaid program.
Understanding the Differences and Your Options
⦁ You can be enrolled in both programs.
⦁ Enroll in Medicare Part A and Part B first to start receiving coordinated benefits.
⦁ Medicare Savings Programs (MSP) help dual-eligible individuals by covering healthcare costs based on income level.
⦁ Some dual-eligible individuals may owe little to no copayments.
⦁ Medicare pays first, and Medicaid pays second, helping with:
Premiums
Deductibles
Coinsurance
Copayments
Learn more at: www.healthcare.gov/medicaid-chip
If You Already Have Medicaid
⦁ You should still enroll in Medicare Part A and Part B.
⦁ Medicare will be your primary payer, with Medicaid providing secondary coverage.
⦁ Medicaid may assist with your out-of-pocket Medicare costs.
⦁ You may be eligible for a Special Needs Plan (SNP) or Dual Special Needs Plan (D-SNP):
These Medicare Advantage plans are designed specifically for individuals with both Medicare and Medicaid.
They often offer extra benefits not typically included in standard Medicare or Medicaid plans.
Availability depends on your location.
⦁ Additionally:
Dual-eligible individuals are automatically enrolled in the Extra Help program to assist with prescription drug costs.
Medigap insurance is generally not necessary for individuals with Medicaid.
(In fact, it is illegal to sell a Medigap policy to someone known to have Medicaid, except in very limited circumstances.)
Copyright © 2012–2025 Powered by SBI Benefits. All Rights Reserved
Disclaimer | Privacy Policy | Sitemap Mailing Address:
We do not offer every plan available in your area. We currently represent 20 organizations offering 56 products. For a complete list of options, contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Program (SHIP). By submitting your contact information, you consent to receive marketing communications from Matthew Lawson's Account, including calls and texts (automated, AI-generated, or pre-recorded). Message and data rates may apply. Consent is not required for enrollment and can be withdrawn at any time, even if your number is on a Do Not Call list.