How does Medicaid differ from Medicare? - Zupnick Associates

( By Stephen Weru )

Despite being around since 1965, Medicare and Medicaid continue to trigger confusion among most Americans.  While taxpayers fund both, they serve different population groups and are run by different parts of the government.

But how do you know which one applies to your needs? If you’ve been wondering this, you’re in the right place.

In today’s article, we discuss the differences between Medicaid and Medicare. By understanding this difference, you’ll be in a better position to choose the best program for your healthcare needs.

Medicaid and Medicare Definitions

Medicaid is a Federal and State program designed to provide health care coverage for people unable to afford quality health care.

Medicare is a federally sponsored program designed to provide coverage for Americans with severe disabilities, those aged 65 years or older, and those requiring dialysis.


One of the significant differences between Medicaid and Medicare lies in eligibility.

For Medicaid, eligibility is mainly dependent on income level. With Medicaid, your income should be at or below 133% of the Federal poverty level (approximately $14,500 for an individual and $29,700 for a family of four). Thanks to this requirement, nearly all low-income Americans are eligible for Medicaid. Qualified pregnant women, people receiving supplemental security income, and children from low-income families also qualify for Medicaid.

Medicaid also comes with a non-financial eligibility requirement that requires applicants to be US citizens and residents of the State where they receive Medicaid.

Not sure about your eligibility status? You can confirm your eligibility for Medicaid here.

Eligibility for Medicare, on the other hand, is mainly dependent on the applicant’s age. To qualify for Medicare, you need to be 65 years or above. People with disabilities and those with end-stage renal failure also qualify for Medicare, even if they aren’t 65 years old. Most people who receive any social security benefits tend to be eligible for Medicare.



Since Medicaid is partly State-funded, benefits may vary from State to State. However, every Medicaid program comes with the following benefits:

  • Hospitalization
  • Family planning services
  • X-rays
  • Laboratory services
  • Midwife services
  • Nursing services
  • Health screening

Some states offer additional benefits, including dental services, physical therapy, prescription drug coverage, prosthetic devices, and optical care.

And that’s not all!

If you need long-term care coverage, Medicaid is the Insurance for you. This is because Medicare and most private health insurance policies don’t cover long-term care.

Medicare benefits, on the other hand, are the same everywhere in the USA. However, benefits may vary depending on which program you choose.

At the most basic is Medicare Part A, which provides cover for all hospitalization-related charges. For most employed people, Medicare Part A is premium-free, with the only payments being yearly deductibles.

Eligibility for Medicare Part A automatically qualifies you for part B, mainly covering costs associated with medical services. These include:

  • Disease screenings
  • Outpatient surgeries
  • Flu shots
  • Laboratory services
  • X-rays
  • Doctor’s visits
  • Wheelchairs and walkers

To get access to Medicare Part B, you’ll need to pay a premium of $148.50.

Medicare Part A and B don’t provide coverage for vision, dental, and prescription drugs. To gain access to these, you can either enroll in Medicare Part C or Medigap. Medicare part C offers the same benefits as Medicare Part A and B and includes dental and vision.

Medicare Part C is offered by private companies with Medicare approval.

If you don’t want to pay for Medicare part C but still need prescription drug coverage, you can register for Medicare Part D.  

Does Either Medicare or Medicaid Cover COVID-19 Related Treatments?

Yes, both Medicare and Medicaid provide coverage for Coronavirus-related treatments.

Thanks to the CARES (Coronavirus Aid, Relief and Economic Security) Act of 2020, Medicare and Medicaid programs were expanded to cover treatment for COVID-19.

The CARES Act also resulted in Medicare adding telehealth services to its benefits,


Another notable difference between Medicaid and Medicare is the enrollment period. For Medicare, the annual open enrollment runs between October 15 to December 15.

Medicaid enrollment, on the other hand, is all year round.

What Happens if I Qualify for Medicare and Medicaid?

If you qualify for both Medicare and Medicaid (dual eligibility), you can have both. In most instances, Medicare Part A and B will cover most of the costs, Medicaid will cover drugs and services that Medicare doesn’t cover.

In certain instances, Medicaid may also pay for Part B premiums.

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