Medicare vs. Medicaid – Understanding the Difference
Side-by-Side Comparison: What Are Medicare and Medicaid?
Medicare is a federal health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities, regardless of income or assets. Medicaid, on the other hand, is a joint federal-state program that provides health coverage to people with low income and limited resources, and it serves individuals of all ages—including specific programs for seniors. While both programs aim to make healthcare accessible, their rules, benefits, and purposes are distinct. Many seniors interact with both systems at some point, especially as their health and financial needs evolve. Understanding these core differences is key to making the best choices for your situation.
Eligibility Differences: Who Qualifies?
Medicare eligibility is based mainly on age (65+) or qualifying disabilities, and it does not consider your income or savings. Medicaid eligibility is determined by income and asset limits, which vary by state and program type. Some people qualify for both—these are known as “dual eligibles”—and may get additional help with costs and coverage through both programs. Even if you think you might not qualify for Medicaid because you’re on Medicare, it’s worth reviewing the latest rules, as assistance programs can change. True North Associates can help you check your eligibility for either or both.
Coverage Differences: What Do They Pay For?
Healthcare Services
Medicare covers hospital stays, outpatient care, doctor visits, and usually prescription drugs if you enroll in a Part D plan. Medicaid often covers these same services, plus extras like dental, vision (for adults in some states), and most importantly, long-term care such as nursing home stays—services Medicare generally does not cover.
Costs to the Individual
Medicare has set premiums, deductibles, and copays, though assistance is available for those with limited income. Medicaid usually has minimal or no premiums and very low cost-sharing, especially for seniors, making it much more affordable for those who qualify.
How Medicare and Medicaid Work Together for Dual-Eligibles
If you’re eligible for both Medicare and Medicaid, you can receive benefits from both at the same time. Medicare acts as your primary insurance, paying for covered hospital, medical, or prescription costs first. Medicaid then steps in as a secondary payer, covering Medicare’s premiums, copays, and providing additional services like long-term care or extra home health support. This dual coverage can make healthcare more affordable and comprehensive, reducing financial burdens for those who need the most support.
Your Medicare Advantage Questions, Answered
Can I switch from Medicare Advantage back to Original Medicare?
Yes, you can switch during certain periods each year—such as the Medicare Advantage Open Enrollment or Annual Election Period. We’ll explain the process and help you understand any coverage or timing issues.
What if I travel frequently? Will my Medicare Advantage plan cover me out of state?
Most Medicare Advantage plans cover emergencies anywhere in the U.S., but routine care is usually limited to your network area. PPO plans offer a bit more flexibility—let’s review options based on your travel needs.
Is Medicare Advantage right for someone with my doctors or medications?
It depends—some plans have broad networks and great coverage, while others are more restrictive. We’ll check which plans your providers accept and confirm your prescriptions are covered before making a recommendation.
Common Misconceptions About Medicare and Medicaid
Many people assume Medicare covers all healthcare needs, including nursing homes—but in reality, Medicare only covers limited short-term stays for rehabilitation, not long-term care. Medicaid is the main payer for long-term nursing home care if you meet eligibility rules. Another misconception is that Medicaid is only for unemployed or very low-income individuals, but many working people, seniors, and families use Medicaid for critical health coverage and support. Understanding what each program does and does not cover is the first step toward getting the help you need.
Which Program Is Right for You?
Choosing between Medicare and Medicaid—or knowing how to use both—can be confusing, especially as your health or financial situation changes. Some people need only Medicare, others qualify for Medicaid support, and some will benefit most from both. True North Associates is here to guide you through the options, explain how the programs interact, and help you secure the coverage that fits your real needs. Reach out for a clear explanation tailored to your circumstances.
