Medicare and Medicaid are similar programs, but these programs do have their differences. Knowing the similarities and differences between the two is important in determining which program, or if both, is right for you.
Medicare and Medicaid are government-sponsored. Medicare comes from the federal government. Medicaid is a joint federal and state program.
Medicare requires either being 65 or older, or receiving disability benefits for 24 consecutive months.
Medicaid eligibility is based on Modified Adjusted Gross Income (MAGI). Each state sets its own standard regarding the qualifying amount that you must earn at or below.
This comparison requires focusing on the traditional form of Medicare and the federally mandated benefits of Medicaid. Medicare has four parts – Part A, Part B, Part C (Medicare Advantage), and Part D.
Many hold Medicare Parts A and B together – a combination known as Original Medicare. Part A offers inpatient coverage for hospital and skilled nursing facility stays, while Part B offers outpatient coverage, including screenings, immunizations, x-rays, and exams.
Medicaid’s federally mandated benefits also include inpatient (hospital, skilled nursing, and hospice) and outpatient services.
Original Medicare offers hospice coverage under Part A, but hospice isn’t a mandatory benefit for Medicaid. Medicare’s Part B-covered preventive services are more expansive, as Medicaid’s preventive coverage extensiveness varies by state.
Original Medicare doesn’t cover nursing midwife services, tobacco cessation counseling for pregnant women, or family planning services. Medicaid, on the other hand, has all of these as mandatory benefits.
In terms of plans outside of Original Medicare, the optional benefits are seen in Medicare Advantage and Part D. Medicare Advantage has many types of plans. Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) plans are examples.
Optional Medicare benefits include dental, vision, and hearing, as well as access to wellness programs and gym memberships. Part D and certain Medicare Advantage plans offer prescription drug coverage.
Medicaid doesn’t have alternative forms. However, some states include prescription coverage and dental, vision, and hearing among other optional benefits.
You can have both programs. You can add Original Medicare, or, you can enroll in a Dual Eligible Special Needs Plan (D-SNP) from Medicare Advantage if you want to secure additional benefits.
When you have both, Medicare will cover as much as it can, and then once that coverage is exhausted, Medicaid will cover what it can.