Medicaid Versus Medicare – What’s the Difference?


Health coverage is something that everyone needs and that some people simply cannot afford. Private healthcare is a billion dollar industry that millions of people are not able to be a part of. In an attempt to provide coverage for all citizens, the United States Government created the Medicare and Medicaid programs. Though both offer similar coverage, they are both somewhat different and knowing the difference can help you to determine which you might be qualified for.

What is Medicaid?

Medicaid provides healthcare coverage to a wide range of individuals including those that are eligible low income participants. These eligible participants are those that are adults, children, pregnant women, elderly adults and even those that have disabilities. This program is open to those individuals that fall below a certain threshold and these benefits are provided jointly by the state that the person lives in as well as the federal government.

Medicaid has a different name from state to state. In Kentucky, the program is known as Passport.  Each state has a different name for this specific coverage. This type of coverage is accepted at hospitals, doctor’s offices, and various other medical and healthcare applications.

What is Medicare?

Medicare is a bit different in that it is available to those that are over the age of 65, certain people with disabilities, and certain people with end stage renal disease that is likely to be terminal. Medicare is accepted by most hospitals and doctor’s offices but those that are privately owned may have the right to reject this type of insurance. Medicare is a type of insurance that is going to be available to those that are older in most cases with a few exceptions for those that are struggling with other issues.

How are Medicare and Medicaid Similar?

Both of these insurances are similar in that they are available to those in need for little to no cost. There are minimal costs associated with Medicare in order to keep the insurance active. Both Medicare and Medicaid are widely accepted and each state has their own spin on these insurances. Both Medicare and Medicaid are available to those in need that may not be able to be part of the private insurance sector.

Another similarity is that both of these insurances are designed to be funded by tax dollars so that those that are benefitting from them can get good coverage without having to spend a ton of money to do so. Often these coverages are paired with other benefits as well. Medicare and Medicaid have both been adjusted and changed over the years to reflect the needs of those that are part of the program as it pertains to the current market.

Both come with a basic coverage that helps to cover the cost of doctor’s visits, hospital visits, and other major issues that may arise. Both Medicare and Medicaid are funded at both the state and federal level meaning that these are well funded programs designed to help participants as much as possible.

How do Medicare and Medicaid Differ?

The first major difference is the overall design and structure of the program. Medicaid is designed in one single program that is adjusted from person to person. Rather than having a coverage for this or that, your Medicaid is going to cover what you need to have done and is applying for this program gets you the basic coverage. This means that if you are an expectant mother or a mother with a child and you qualify for the program, both you and your child are going to be covered under the umbrella of Medicaid coverage.

Medicare is a bit different. Medicare is broken up into several different parts that you have to choose which is going to work best for you. Since you pay for Medicare you must choose which coverage you want and what coverage is going to work for your needs. There are three parts to Medicare, Part A, Part B, and Part D.

Part A is coverage for hospital. This is a basic coverage that most older people like to have in case they have to make a trip to the emergency room and need insurance coverage. Part A coverage also covers some skilled nursing facilities, hospice care, and some home health care to a certain extent or as needed. You can always speak with the caregiver of the particular facility to see if this service is covered by part A Medicare coverage.

Part B is medical insurance, this means things like the doctor’s office, outpatient care, medical supplies in your home, and preventative services like yearly physicals and checkups to make sure that you are faring well and to catch issues before they have a chance to become full blown and serious. Part B is what most people over the age of 65 get Medicare for as it is the most commonly used part of Medicare at retirement age before health begins to decline.

Part D is optional care that is known as prescription drug coverage. This is the part of Medicare that you may or may not need to have if you are not taking any daily medications. For those that are over the age of 65, daily medications are not that uncommon and as such you may need to have this sort of coverage to help pay for your prescriptions.

Who is Eligible for Medicaid?

There is a certain subset that is eligible for Medicaid. Those that qualify for Medicaid fall within a certain financial bracket. Generally, each state has a threshold set that tells those that want to apply for Medicaid if they qualify or not. The upper threshold for earning if you are a single person is $16,753 per year. This means that if you are a single person, you need to make under this amount in order to be able to apply for Medicaid. For families the threshold is a bit higher at $28,676 for a family of three with higher thresholds for larger families.

It is important that if you are applying for Medicaid in your state that you take the time to find out just how much money you can make, what documents you need to be able to get Medicaid, and what types of coverage you can get. In most cases, you can discuss your Medicaid options with your family health services representative to find out if you qualify. In some cases, even those that are not under this threshold are going to be able to benefit from Medicaid if they are disabled and cannot work.

Who is Eligible for Medicare?

Those that are eligible for Medicare are a bit different. Anyone that applies for Medicare needs to be over the age of 65, be disabled, of have end stage renal failure that is likely going to be terminal. This group is going to be protected and covered by Medicare as a measure to care for them as they cannot pay for private insurance on their own. The reasoning behind this is that at the age of 65, people often start to retire and therefore have a lesser income and may not be able to pay for expensive private insurance.

Also, Medicare cares for those that are disabled and cannot hold a job as well as those with end stage kidney failure that likely cannot have a job due to dialysis and other time consuming treatments. Medicare was designed with a bit more freedom that Medicaid to allow those that are part of the plan to be able to customize it based on what coverage they want and need.

Why is Medicaid Beneficial?

Medicaid is beneficial to those that qualify for it in that it is necessary for those cannot afford to pay for expensive private insurance such as single parents, those without good paying jobs, and those that have jobs that may not offer any sort of viable insurance option. Often, a child that qualifies for Medicaid with also have a parent that is on Medicaid as it takes a healthy parent to raise a healthy child.

Your coverage can change at any time and if you do go above the amount that you are allowed to earn you may not be eligible for coverage any longer. In most cases, your state and federal governments are going to go above and beyond to make sure that children in any situation have some sort of insurance coverage.

Medicaid covers the same things that a private insurance company is going to cover. It covers preventative care, hospital visits, prescription drugs, checkups, immunizations, and so much more. Medicaid is going to be highly beneficial to anyone that takes the time to apply. If you qualify for Medicaid you may also qualify for other benefits like food assistance, lowered rent, and more.

Why is Medicare Beneficial?

Medicare is beneficial for those older individuals that may not have insurance through their job any longer and simply cannot afford the price of private insurance costs. In most cases, before retirement age individuals have some sort of coverage through their employer. When they retire they often lose insurance and Medicare is a fantastic option. In most cases, if you qualify for Medicare you are also going to qualify for Social Security benefits as well which the cost of the Medicare can be taken from.


Both of these insurance coverages are highly beneficial to those that qualify and can make a huge difference between a great quality of care and being able to go to the doctor and not being able to afford insurance coverage. These two coverages, though they are both federally funded, are different in their own rights. Both coverages are essential and wonderful for those that qualify and can truly make a difference. If you feel that you may qualify it is always best to talk with a Medicare or Medicaid official to see what coverage you may be able to get and to see if you can enroll.

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