What Are the Differences Between Medicare and Medicaid?

Medicare and Medicaid are both federal healthcare programs, but there are some major differences between the two – namely, the people who are involved.

The key information for each is outlined below:

Medicare Medicaid
What: What:
Medicare is a federally sponsored health plan run by the Centers for Medicare & Medicaid Services, an agency of the Federal Government. Medicaid is a federal and state sponsored health plan.
Who: Who:
Medicare is available for qualifying people who are aged 65 or older or those people who have suffered a qualifying disability for more than 24 months. Individuals may include those who are receiving retirement benefits from Social Security or the Railroad Retirement Board; those who are eligible to receive Social Security or Railroad benefits but have not yet filed for them; and individuals and/or spouses who had Medicare-covered government employment. User satisfaction is high. It is available to people who have limited income and limited resource such as children, women who are pregnant, seniors with low incomes, parents, and people with disabilities. User satisfaction is relatively high.
Coverage: Coverage:
Medicare includes Medicare Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage) and Part D (Prescription Drug Coverage). Medicaid includes health benefits such as doctor visits, hospital stays, long-term services and support, preventative care including immunizations, mammograms, colonoscopies and other needed care, prenatal and maternity care, mental health care, necessary medications and child vision and dental care.
Cost: Cost:
This depends on the coverage you choose and may include deductibles, premiums, copays and coinsurance. This depends on your income and state rules and may include deductibles, premiums, copays and coinsurance. Certain groups are exempt from out-of-pocket costs.
Enrollment: Enrollment:
Many people are enrolled in Part A and Part B when they turn 65. You can contact your local Social Security office for questions with eligibility. Eligibility depends on the rules of each state. Contact your State Medical Assistance (Medicaid) office for qualification questions.
Funding: Funding:
This comes from payroll taxes, interest earned on trust fund investments and Medicare premiums. Along with Medicaid, Medicare accounts for roughly 25% of federal budget. This comes from a variety of taxes, but most funding comes from Federal Government. Sometimes hospitals are taxed at the state level. Along with Medicare, Medicaid accounts for roughly 25% of federal budget.
Populations: Populations:
Medicare serves all states, D.C., U.S. territories and Native American reservations. Around 15% of the population is on Medicare. Medicaid serves all states, D.C., territories and Native American reservations. Around 20% of the population is on Medicaid, 40% of all childbirths are covered by it and half of all regular AIDS/HIV patients.

Dual Eligibility

What Medicaid Covers for Medicare Enrollees:

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit1.

2016 Dual Eligibility Standards (Based on Percentage of Federal Poverty Level)1

Qualified Medicare Beneficiary (QMB):
Monthly Income Limits: (100% FPL + $20)*
All States and DC (Except Alaska & Hawaii): $1,010 – Individual $1,355 – Couple
Alaska: $1,257 – Individual $1,689 – Couple
Hawaii: $1,160 – Individual $1,556 – Couple
Asset Limits: $7,280 – Individual $10,930 – Couple
Specified Low-Income Medicare Beneficiary (SLMB):
Monthly Income Limits: (120% FPL + $20)*
All States and DC (Except Alaska & Hawaii): $1,208 – Individual $1,622 – Couple
Alaska: $1,504 – Individual $2,022 – Couple
Hawaii: $1,387 – Individual $1,863 – Couple
Asset Limits: $7,280 – Individual $10,930 – Couple
Qualifying Individual (QI):
Monthly Income Limits: (135% FPL + $20)*
All States and DC (Except Alaska & Hawaii): $1,357 – Individual $1,823 – Couple
Alaska: $1,690 – Individual $2,273 – Couple
Hawaii: $1,558 – Individual $2,094 – Couple
Asset Limits: $7,280 – Individual $10,930 – Couple
Qualified Disabled Working Individual (QDWI):
Monthly Income Limits: (200% FPL + $20)*
(Figures include additional earned income disregards)
All States and DC (Except Alaska & Hawaii): $4,045 – Individual $5,425 – Couple
Alaska: $5,032 – Individual $6,759 – Couple
Hawaii: $4,642 – Individual $6,229 – Couple
Asset Limits: $4,000 – Individual $6,000 – Couple

*$20 = Amount of the Monthly SSI Income Disregard

In summary, the Medicare and Medicaid programs are designed to work together to provide ample medical coverage to elderly and poor populations. Medicare is the primary medical coverage provider for many persons aged 65 and older and for those with a disability and eligibility is not associated with income level. On the other hand, Medicaid was created for people with limited income and is often offered as a last resort for those with access to other healthcare resources.

Resources

  1. Medicaid.Gov, Seniors & Medicare and Medicaid Enrollees