Wooden blocks labeled "Medicare" and "Medicaid" are surrounded by a stethoscope, pills, and medical supplies.

MEDICARE. MEDICAID.

Do you know the difference? You should if you want to obtain all the benefits your specific situation warrants.

Medicare and Medicaid are two separate health insurance programs run by the government. While many people who qualify for one may be eligible for the other, there are differences in the services covered, eligibility requirements, and the amount a recipient will pay in copays and deductibles.

What Is Medicare?

  • Medicare is run by the U.S. government and provides health coverage to people over age 65 and people under 65 who have a qualifying disability. Patients pay part of their medical costs through deductibles or small monthly premiums. Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare advantage plans), and Part D (prescription drugs). Since Medicare is a federal program, the rules are essentially the same in every state.

What Is Medicaid?

  • Medicaid is a needs-based state and federal assistance program that provides health care coverage to people with limited income and resources. Medicaid is a program for low-income persons whose income and/or resources are below certain levels. Eligible populations include children, pregnant women, single individuals, families and individuals certified blind or certified disabled.
  • Each state administers its own Medicaid programs, so there are different rules and types of benefits depending on where you live. For example, New York Medicaid covers essential benefits like doctor visits, lab tests, prescription drugs, and more; and has no copays for covered medical services, including primary care, immunizations, specialist visits, and emergency care.
Feature Medicare Medicaid
Who It’s For Primarily for people 65+ or those under 65 with certain disabilities or conditions (like ESRD or ALS). For low-income individuals and families, including children, pregnant women, elderly, and disabled individuals.
Who Runs It Federal government (same program nationwide). State and federal government (varies by state).
Cost Part A is usually free; Part B, Part C, and Part D require premiums, deductibles, and copays. Usually low or no cost; states set their own rules on eligibility and coverage.
Coverage Covers hospital stays (Part A), doctor visits (Part B), prescription drugs (Part D), and Medicare Advantage (Part C) plans. Covers hospital care, doctor visits, nursing home care, home health, and sometimes dental and visions (varies by state).
Income-Based? No – eligibility is based on age or disability, not income. Yes – based on income and household size.
Can You Have Both? Yes, people who qualify for both Medicare and Medicaid are called “dual eligible” and may receive extra benefits (e.g., help with Medicare costs). Yes, Medicaid can help cover Medicare premiums, deductibles, and copays.

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