You may have Medicare, Medicaid, or in some cases both. These programs are different in several ways. Let’s compare Medicaid vs. Medicare to give you a better understanding of these two government-funded programs.

What are the Differences Between Medicare vs. Medicaid?

Medicare is a federally funded program and Medicaid is a state-funded program. These programs have different eligibility criteria and provide different insurance coverage.

Medicaid Eligibility vs. Medicare Eligibility

Medicaid is a state-funded program for low-income individuals and families. Each state has its own requirements for eligibility. Also, nursing home Medicaid or Medicaid waivers providing home and community-based services likely have different criteria than standard Medicaid.

Medicare eligibility is for anyone 65 years or older that is a U.S. citizen or permanent resident for at least five years. You only get premium-free Part A if you pay Medicare taxes for at least 10 years. Some people under the age of 65 will be eligible for Medicare if they are on Social Security Disability for more than 2 years or have certain medical issues.

Medicaid Coverage vs. Medicare Coverage

Medicaid is for low-income families, so when it comes to copayments, there are virtually none. While families may have to select a managed care plan through a private insurance provider, there are no in-network copayments.

Medicaid networks are strict, but they cover the entire bill. You can expect inpatient and outpatient services, lab tests, x-rays, home health, prescriptions, therapy, and more to be covered by Medicaid. Also, Long-term care and nursing homes have coverage through Medicaid.

Original Medicare only covers 80% of your medical bills, after deductibles are met. Medicare will cover inpatient and outpatient services, including lab tests, X-rays, therapy, and more. However, Medicare won’t cover doctor prescriptions for medications you take daily at home, long-term care, or nursing home care.

Who Qualifies for Both Medicare and Medicaid?

You may qualify for Medicare and Medicaid if you have an income low enough to qualify for your state Medicaid program and you have Medicare. Applying for Medicaid is easy. If you have Medicare, but don’t qualify for Medicaid, you may be eligible for extra help with your prescription costs.

To be eligible for Medicare you must be at least 65 years of age or have a qualifying disability.

Does Medicare or Medicaid Have Better Coverage?

Medicare has some affordable options. But Medicaid pays the whole or most of your bill so that coverage is difficult to beat. But the program is for people who need it and qualify.

A Medicare Savings Program can also help with medical costs.

Do Medicare and Medicaid Pay for Nursing Home Care?

Meeting the requirements for Medicare coverage in skilled nursing care isn’t easy. You must have Part A, the facility needs to accept Medicare, you must need care for more than custodial, care must improve your condition, and they only cover up to 100 days.

Medicaid will cover you in full in a nursing home, including medications. Just be sure to choose a nursing home that accepts Medicaid.

You could be eligible for nursing home Medicaid and not standard Medicaid. For those that had applications denied in the past, applying again when you’re going into the nursing home would be wise.

Which Medicare Plans Help Dual-Eligible Beneficiaries?

Medicare Advantage Dual Eligible plans combine Medicare, Medicaid, Part C, and Part D to make an awesome option.

These plans are only available to beneficiaries that qualify for Medicare and Medicaid. Also, beneficiaries need to live in the service area of the policy to be eligible.

You can enroll in one of these policies any time of the year, being eligible for Medicare and Medicaid gives you a “Special Enrollment Period.” The Medicare Advantage Part C plan is great for people that want the dental, vision, hearing, and gym membership benefits of an advantage plan.

While there may be a monthly premium amount listed for the “Dual-eligible” policy, Medicaid will pay that premium. You will need to see doctors that accept the plan and Medicaid.

FAQs

What is the advantage of Medicaid over Medicare?

Medicaid will cover virtually all of the cost of health care for those who qualify, while Medicare doesn’t. But just like Medicare has special requirements to join, so does Medicaid. It’s designed for people who can’t necessarily afford to pay for health care.

Does Medicaid cover mental health?

Yes. In fact, Medicaid is the largest provider of mental health services in the U.S. As an added note, Part B of Medicare also covers mental health but — unlike Medicaid which probably covers everything — there is a premium and co-pay involved.

Do I need supplemental insurance if I have Medicare and Medicaid?

If you have Original Medicare, which is Part A and Part B, supplemental insurance can be extremely helpful. But that’s something you should look at for your individual needs.

As for Medicaid, it’s very comprehensive, so additional insurance is probably not necessary. Plus, if you qualify for Medicaid, it might be hard to add on more health insurance from a cost perspective.

How to Find the Right Plan Between Medicare vs. Medicaid

If you’re having trouble figuring out if you qualify for Medicare or Medicaid — or if you qualify for both, but are not sure which would benefit you more — you can free, no-obligation assistance from a licensed agent.

If you don’t qualify for Medicare but you have a low income or qualifying condition, consider applying for Medicaid. For those that are eligible for Medicare and Medicaid, working with a Medicare expert can save you time.

Our agents can compare top carriers in your area and share plan options with you. Give us a call or fill out our convenient and easy online rate form now.

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.