The Differences between Medicaid and Medicare

Medicare and Medicaid are government programs providing healthcare coverage to certain populations. Here’s an overview of who can benefit from the programs and the main differences between the two:

Medicaid

Medicaid is a federal- and state-funded program that provides healthcare coverage for low-income individuals and families, families with children, pregnant women, and people with disabilities. Medicaid benefits can vary from state to state and most plans include behavioral health benefits.

Medicaid recipients must qualify through a redetermination process that occurs every 12 months. Individuals and families must report any adjustments to annual income while on a Medicaid plan.

If you meet income requirements, Medicaid eligibility can cover the entire household. If a family’s household income exceeds the limits for Medicaid eligibility, yet the family cannot afford to purchase private health insurance, children up to the age of 19 can be covered by the Children’s Health Insurance Program (CHIP).

For more information about Medicaid, visit medicaid.gov. For CHIP eligibility information, visit medicaid.gov/chip.

Medicare

Medicare is a federally funded program that covers adults age 65 or older, younger people with disabilities, and those with either End-Stage Renal Disease (permanent kidney failure requiring dialysis) or Lou Gehrig’s disease (ALS). Medicare coverage is only for individuals—it doesn’t cover an entire family or household.

The Medicare program has different types of coverage:

• Part A: Inpatient coverage
• Part B: Medical coverage, outpatient procedures, and office visits
• Part C: Medicare Advantage plans
  • Private health plans approved by Medicare, administered by a third party
  • Benefits can vary but must offer all services that Original Medicare covers
  • May require a monthly premium
  • May include Part D (prescription) benefits
• Part D: Prescription drug plan that is supplemental to Parts A and B

You can enroll for Medicare when you turn 65 (either three months before your birth date, the month of your birth date, or three months after your birth month). If you don’t enroll during this period, you can enroll each year from January to March, but waiting to enroll could incur a late enrollment penalty fee.

At age 65, you are eligible for premium-free Part A Medicare coverage if you or your spouse worked and paid Medicare taxes for at least ten years. There is a premium required for Part B coverage.

For more information on Medicare benefits, visit medicare.gov.

Related: 4 Things to Know Before Choosing a Medicare Advantage Plan

Dual coverage

In some instances, individuals may qualify for coverage on Medicare and Medicaid—this is called dual coverage. People age 65 and older who also meet income requirements may be eligible for dual coverage. In dual coverage situations, Medicaid is always secondary to Medicare or any other commercial coverage.

For help finding a Select Health Advantage plan, call 855-442-9940 or visit selecthealth.org/plans.

Related: Why Select Health?