The United States has two major government-provided health insurance programs: Medicare and Medicaid. It can be easy to confuse these two programs with similar names and perhaps miss out on benefits or assistance you may be qualified to receive. Let’s compare Medicare vs Medicaid.

Medicare Overview

What is Medicare?

Medicare is a federal health insurance program for people who are:

• 65 years of age or older
• Under 65 years of age with disabilities
• Of any age that have End Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease)

Who Governs Medicare?

The federal government, specifically a department called the Centers for Medicare & Medicaid Services (CMS).

What Does Medicare Cover?

Depending on the Medicare coverage you choose, it may include:

• Care and services (inpatient) in a hospital or skilled nursing facility (Part A)
• Doctor visits, care and services (outpatient), and possible preventative care (Part B)
• Prescription Drugs (Part D)

Medicare Advantage (Part C) plans will combine both Medicare Part A and Part B, and often include prescription drug (Part D) coverage as well – all together in one plan. Medicare Advantage Plans generally include additional benefits as well, such as:

• Vision
• Dental
• Hearing
• Over-the-Counter Benefits
• Transportation
• Fitness Benefits

Am I Eligible for Medicare?

Once you turn 65 years old, you are most likely eligible for Medicare. To confirm that you are eligible for Medicare, contact your local Social Security office for more information.

If you haven’t paid into Social Security for 40 quarters, you may have higher Medicare costs, but you are still eligible to enroll.

Medicaid Overview

What is Medicaid?

Medicaid is a federal and state program that helps pay healthcare costs for individuals and/or families with low assets and incomes.

Who Governs Medicaid?

The governments of individual states, in collaboration with the Centers for Medicare & Medicaid (CMS), an agency of the federal government.

How Much Does Medicaid Cost?

It all depends on your current income and specific rules of the state that you are living in.

Am I Eligible for Medicaid?

Each state is different when it comes to eligibility. You can call your local Medicaid office to see if you qualify for coverage.

What’s the Difference Between Medicare and Medicaid?

What is Dual Eligibility?

People who qualify for both Medicaid (supports low-income individuals and families) and Medicare Part A/Part B are known as dual eligible. What does this mean? It means that you may qualify for benefits that are run through the state called “Medicare Savings Programs.” These programs provide coverage for certain premiums, copays, and deductibles. The benefits ultimately depend on an individual’s income level and Medicare Savings Program, but sometimes Medicaid can cover all out-of-pocket expenses. Individuals who qualify for the Qualified Medicare Beneficiary (QMB) Program may automatically qualify for the Extra Help Prescription Drug Program.

When dual eligible individuals receive Medicare and Medicaid benefits, some can vary by state.

Dual eligibility can also be categorized as “full-benefit” or “partial-benefit.” Full benefits mean that the individual would receive full coverage of Medicaid benefits. However, those with partial benefits do not receive the full Medicaid services, but Medicaid will cover their Medicare premiums.

Dual Special Needs Plans

If you are enrolled in both Medicare and Medicaid, you’re eligible for a specific type of Medicare Advantage Plan called a Dual-Eligible Special Needs Plan (D-SNP). These plans coordinate the combined benefits of Medicare and Medicaid to help you get the care and resources you need. Some plans may offer $0 premiums and additional benefits.

Enrollment Eligibility

e-TeleQuote Insurance Inc. (“e-TeleQuote”) does business as easyMed Insurance Services in all states other than New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare (TTY users should call 1-877-486-2048) 24 hours day/7 days a week, or your local State Health Insurance Program (SHIP), to get information on all of your options. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.