Medicare vs Medicaid Coverage
Health & Fitness

Medicare vs Medicaid Coverage: The Differences Explained

Some 44 million people across the US receive coverage from Medicare. Yet, it’s not uncommon for people who hear the terms Medicare and Medicaid and get them confused. After all, both are government-based programs involving health care. 

So, how are they different? How does Medicare vs Medicaid coverage differ and who gets coverage from each program?

Read on to learn more about Medicare and Medicaid and how the coverage of each program differs. 

What Is Medicare?

Medicare is a federal government-run program providing health care coverage for seniors 65 and older and some individuals who have disabilities. Eligibility for Medicare is based on age and taxes paid into the program over the course of your work life.

Medicare covers individuals, not entire families. So, one spouse might qualify based on age, while the other might not yet qualify for coverage. 

What Is Medicaid?

Medicaid is a program run jointly by the federal and state governments. Instead of being based on age like Medicare, it’s based on income. If a person or family has a limited income or resources, they can qualify themselves or even their whole family.


Another key difference between Medicare and Medicaid, aside from who gets coverage, is cost. 

Medicare recipients pay co-pays for hospital stays and doctor visits. They also pay for some prescription drugs. Often people who sign up for Medicare purchase supplemental insurance to cover some of the missing coverage in Medicare. It’s smart to work with Medicare Health Experts to find the right coverage for you if eligible for Medicare.

Medicaid, on the other hand, has very little out of pocket expenses. Since it covers people who already have a low income, any costs would be prohibitive. On some services, there will be a small co-pay.

Coverage for Medicare and Medicaid

Medicare coverage is often referred to as the alphabet soup of coverage. You get coverage based on the different letters of Medicare. 

Medicare Part A covers hospital care. It includes things like:

  • Skilled nursing care
  • Hospital services
  • Hospice services
  • Home healthcare

Medicare Part B covers health insurance needs like a doctor visit. It includes things like outpatient hospital care and physician services.

Medicare Part D covers prescription drug costs. 

The Medicare Advantage, or Medicare Part C plans, include both Part A and Part B and includes coverage for extra care. You can get additional coverage for things like:

  • Dental
  • Vision
  • Additional prescription drug coverage

Medicaid coverage, remember, is also a state-run program and therefore, coverage varies from state to state. Many common things covered include:

  • Lab and X-ray services
  • Inpatient and outpatient hospital services
  • Family planning services
  • Health screenings and applicable medical treatments for children
  • Nursing facility services for adults
  • Surgical dental services for adults

Since coverage varies for Medicaid by state, it’s important to know what is covered before you seek medical care. 

Understanding the Difference Between Medicare vs Medicaid Coverage

Medicare vs Medicaid coverage is easier to understand once you know who is covered under each plan.  Coverage for each plan, while important, varies depending on who is getting covered. 

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