Medicare vs Medicaid: What’s the Difference?

Medicare vs Medicaid: What’s the Difference?

Sometimes, people mix up "Medicare" and "Medicaid" because they sound alike. But they are not the same thing! It’s important to know the difference so you can get the right help if you need it. Let’s break it down in a way that’s easy to understand.

What Is Medicare?

Medicare is a health insurance program for people who are 65 years old or older. Some younger people with certain disabilities can also get Medicare. You don’t have to worry about how much money you make—Medicare is mostly about age or certain health conditions.

• Who is eligible? Most people 65 or older, or younger people with certain disabilities or health problems (like kidney failure).
• What does it cover? Medical treatment like doctor visits, hospital stays, surgeries, therapies, and medicines.

(It helps pay, but you may also have to pay a portion - sometimes called your patient liability, deductible, or co-pay.)

What Is Medicaid?

Medicaid is a health program for people who don’t have a lot of money or assets. It covers healthcare treatments for children and adults of any age who qualify based on income. Medicaid is run by both the federal government and each state, so eligibility and coverage are often different from one state to the next.

• Who is eligible? People who have a low income, including children, adults, older adults, and people with disabilities.

Note: Low-income adults on Medicare are often eligible for Medicaid, as well. This is called "dual eligibility" - and in this case, Medicaid covers the co-pays.

• What does it cover? Medical treatment like doctor visits, hospital stays, surgeries, therapies, medicines, and sometimes extra help like long-term care ( sometimes called a nursing home).

Key Differences

Let's make the difference even clearer:

Medicare

• Eligibility: Mostly for people 65+ or adults with certain disabilities
• Managed by: Federal program (same benefit coverage in every state)
• Your costs: Patients typically have a 20% co-pay, and also have a monthly premium

Medicaid

• Eligibility: For people with low income of any age
• Managed by: Federal funding, managed by states (eligibility and coverage can change by state)
• Your costs: No monthly premium to get coverage; patients typically do not owe a co-pay or have any patient liability

Can you have both? Yes! Some people (like older adults with low income) can have both Medicare and Medicaid. This is called being "dual eligible."

Conclusion

Medicare and Medicaid both cover costs of health care treatments, but they help different groups of people. Medicare is usually for older people and some with disabilities, no matter how much money they have. Medicaid is for people who need help with insurance and health care costs because they don’t have a lot of money, and it can help people of all ages.

If you want to learn more, you can visit this easy-to-read guide from AARP.

Remember, it’s always good to ask questions if you’re not sure which one you or your loved ones might need!