These Are the Differences Between Medicare and Medicaid

Health care is a big topic in the United States and one that can be quite polarizing. There’s a lot of debate over government programs such as Medicare and Medicaid.

If you’re not familiar with these programs, it’s easy to get confused. After all, they have almost the same name! However, at heart, these programs are dramatically different. If you don’t already know, it’s important to get informed about the differences between Medicare and Medicaid.

What does each program cover and who benefits? Read on and we’ll walk you through what you need to know.

Basics of Medicare

Medicare is a program funded by the federal government that provides adults sixty-five years or older with healthcare coverage. Most people over the age of sixty-five are eligible, though an individual or their spouse must have worked at a job and paid Medicare taxes for at least ten years prior to enrolling.

Medicare only covers individuals, not entire families or households. An individual can apply in a three-month window around their birthday in either direction.

There are different types of Medicare coverage that one can obtain. Some cover only inpatient care, while others cover more elaborate things such as outpatient care and prescription medicines.

There are different eligibility requirements for different parts of the Medicare program. You can read more at

Basics of Medicaid

Medicaid, on the other hand, is funded by both the federal and state governments. Medicaid programs provide healthcare coverage for families and individuals with very low incomes. Age is not a factor, unlike the Medicare program. It’s all about income.

Medicaid recipients must qualify through a thorough process that occurs every 12 months. Any increases in income are reported while on a Medicaid plan. It is possible for a low-income individual or family to make more money than they are expected to and get bumped off of their current health plan.

The benefits of a low-income family or an individual can obtain from Medicaid programs varies from state to state. Some plans cover nearly all areas of health while others are more limited in what they can provide.

Most plans also do provide behavioral health benefits as well as physical.

Dual Coverage

It is possible for an individual to be covered under both Medicare and Medicaid. It happens more often than you might think. This is known as having dual coverage.

If a person is both over the age of sixty-five and making a low enough income level in their state, they will be eligible for both forms of health coverage.

With dual coverage, Medicare always takes precedence over Medicaid or any other type of commercial health coverage.

The Differences Between Medicare and Medicaid

Navigating the United States health system can be complicated. Understanding the differences between Medicare and Medicaid is a good way to start getting your bearings in terms of how things work.