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Medicare vs Medicaid and Dual Eligibility

Medicare and Medicaid
 

The words "Medicare" and "Medicaid" are so much alike that it's easy to get them confused. Both are government programs and both help people pay for health care. Some people can have both Medicare and Medicaid, and these benefits can work together to cover most of your health care costs. If you qualify for both Medicare and Medicaid, you are considered "Dual Eligible", which you can learn more about below.


But first, what are the differences between Medicare and Medicaid? Check out the charts below to see the side-by-side differences between Medicare and Medicaid.

Differences between Medicare and Medicaid

What is Medicare vs. Medicaid?

Medicare

  • A federal health insurance program for people who are:
  • 65 or older
  • Under 65 with certain disabilities
  • Of any age and have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's Disease)

Medicaid

A joint federal and state program that helps pay health care costs for certain individuals and families with limited income and resources.

Who offers Medicare vs. Medicaid?

Medicare

Federal government

Medicaid

State governments

What is covered by Medicare vs. Medicaid?

Medicare

Depends on the coverage you choose and may include:
 

  • Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
  • Doctor visits, care and services received as an outpatient and some preventive care (Part B)
  • Prescription drugs (Part D)
  • Medicare Advantage (Part C) plans: combine Part A and Part B coverage, and often include drug coverage (Part D), as well—all in one plan.

Medicaid

Each state creates its own Medicaid program, but has to follow federal guidelines, like the required and optional benefits they include. Some of the benefits Medicaid programs have to include are:
 

  • Care and services received in a hospital or skilled nursing facility
  • Care and services received in a federally-qualified health center, rural health clinic or freestanding birth center (licensed or recognized by your state)
  • Doctor, nurse midwife, and certified pediatric and family nurse practitioner services

What is the cost of Medicare vs. Medicaid?

Medicare

It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance.

Medicaid

It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance.

How to get Medicare and Medicaid

Medicare

Many people are enrolled in Parts A and B (also known as Original Medicare) automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible based on your individual circumstances.

Medicaid

Eligibility depends on the rules in your state. Call your State Medical Assistance (Medicaid) office to see if you qualify.

Medicare vs. Medicaid 101

Can you get Medicaid if you have Medicare?


Dual Eligibility

If you qualify for both Medicare and Medicaid, you are considered "dual eligible." Sometimes the two programs can work together to cover most of your health care costs.


Individuals who are dual eligible can often qualify for special kinds of Medicare plans. One such example is a Dual Special Needs Plan (D-SNP).



Learn more about Dual Special Needs Plans from UnitedHealthcare 

 

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