What is Medicare? What is Medicaid?

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Medicare is a federal program generally for people who are 65 or older.  Medicare may also be provided to those with a qualifying disability or medical condition.  The federal government provides Medicare Part A and Part B.   Medicare Part C and Part D are generally provided by private insurance companies and are federally governed. 

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Medicaid helps cover medical costs for some people with limited income and resources and is a joint Federal and state program.  Medicaid plans may vary from state-to-state but follow federal guidelines for benefits.   Medicaid can offer benefits not normally covered by Medicare, like nursing home care and personal care services. 

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Qualifying for Medicaid

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Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state).  

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What do Medicare and Medicaid cover?

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Medicare Part A is hospital insurance and Part B is medical insurance. Medicare Part D is prescription drug coverage. Medicare Part C (Medicare Advantage) is an all-in-one coverage option that combines Parts A, B and D, as well as other benefits that may include items like dental, vision, fitness and hearing.

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Medicare Part A and Part B coverage is generally standard.  Medicare Advantage Part C and Part D will vary based in terms of coverage provided depending on the insurance provider, the plan and your location.

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Medicaid programs normally include some optional benefits and federally mandated benefits.

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What care services are covered by Medicaid?

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The full range of benefits that Medicaid covers is generally decided upon by each state.  Certain benefits that are called mandatory benefits are required by Federal Law.   States may also choose to offer other benefits and services by Medicaid.   Normally, each state will establish and administer their own Medicaid programs.  

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How much does Medicaid cost? How much does Medicare cost?

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Generally, premiums, deductibles, copays and coinsurance are part of both Medicare and Medicaid.  For Medicare, how much you pay may vary based on when you enroll, what coverage options you select and what health services and items you use throughout the year.  Generally, the amount you pay for Medicaid depends on the rules in your specific state and on your income.

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What Medicaid helps pay for:

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Generally, if you have Medicare and qualify for full Medicaid coverage:   

1) Your state may pay for your Medicare Part B (Medical Insurance) monthly premiums. 

2) You may get Extra Help with your drug costs. 

3) Medicaid may pay for additional drugs and services that Medicare does not cover.

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Your state may pay for the following based upon the level of Medicaid you qualify for:

1) Your share of Medicare costs, such as deductible, coinsurance and copayments.

2) Part A (Hospital Insurance premiums if you are required to pay a premium for that coverage.

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Can you have both Medicare and Medicaid?

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Some people can have both Medicare and Medicaid.  Individuals who qualify for both Medicare and Medicaid are called “dual eligible”.  If you qualify and choose to enroll in both programs, the dual programs can work together to help cover much of your health care costs.  A special kind of Medicare Advantage plan called a Dual Special Needs Plan is available for those that are eligible.