Medicare vs Medicaid: Understanding the Differences

More than 8% of Americans don’t have health insurance coverage.

If you fall into that category, how will you handle the financial impacts of a medical emergency? Not having health insurance can make you feel a bit like you’re always waiting for the other shoe to drop.

Fortunately, there are a few government programs that can help: Medicare and Medicaid.

But, how do you know if you qualify for these programs? This Medicare vs Medicaid guide is here to help.

Keep reading to learn more about each program, the eligibility requirements, and the average costs.

Knowing your options could quite literally be a matter of life and death.

What Is Medicare?

Medicare was created as a federal health insurance program in 1965. Its coverage is broken down into four parts, depending on which aspect of coverage you need.

Here’s a closer look at each part.

Medicare Part A

Medicare Part A covers the costs involved when you have to stay in the hospital for treatment. It also covers other longterm treatment costs, like hospice care, nursing facilities, and in some cases, home health care.

Medicare Part B

Medicare Part B, on the other hand, covers doctor’s visits and outpatient care costs. This includes the costs associated with preventative care and medical supplies.

Medicare Part D

If you have to take medication on a regular basis, you know how quickly those costs can add up. Medicare Part D covers the cost of most prescription drugs, vaccines, and shots.

Medicare Advantage

Also called Medicare Part C, this is offered by private companies. It provides both Part A and Part B coverage and sometimes covers additional costs like vision and dental plans. Most Medicare Advantage plans also include Part D coverage for prescriptions.

For additional resources and helpful information about Medicare, visit

Medicare Eligibility Requirements

As you can see, Medicare provides comprehensive health insurance coverage through its four parts. However, it’s not available to everyone. You qualify for Medicare if you meet the following qualifications:

  • You’re 65 or older and you or your spouse paid Medicare taxes for at least 10 years
  • You’re 65 or older and you receive (or are eligible to receive) Social Security benefits
  • You’re 65 or older and you receive (or are eligible to receive) benefits from the Railroad Retirement Board
  • You have permanent kidney failure and require dialysis or a kidney transplant
  • You have amyotrophic lateral sclerosis (ALS), also known as Lou Gherig’s disease

If you’re not sure if you meet the above requirements, you can check your eligibility using Medicare’s online tool.

Average Medicare Costs

Even though Medicare is a federally funded program, there are still some associated costs to expect. The amount you’ll have to pay depends on a few factors like your eligibility and income levels.

Medicare Part A Costs

In most cases, you won’t have to pay a monthly premium for Part A coverage. However, it depends on your eligibility. If you do have to pay a premium, the maximum amount you’ll owe each month is $458.

Medicare Part B Costs

Part B premium costs are dependent on your income level. At a minimum, you’ll have to pay $144.60, but that cost could be higher if you have a higher income level.

Medicare Part D Costs

Like Part B, your monthly premium for Part D coverage varies by your income level. The total amount you pay is also based on the plan you choose to cover your prescription costs.

Medicare Advantage Costs

Because Part C plans are offered by private companies, the costs vary by plan. You’ll want to research a few plans to see which one makes the most sense for your specific circumstances.

What Is Medicaid?

Similar to Medicare, Medicaid is a federal and state health insurance program, also established in 1965. It was created to help low-income adults, children, and families afford health insurance.

Medicaid coverage varies by state, but it also must meet certain federal requirements.  Medicaid works hand-in-hand with the Children’s Health Insurance Program (CHIP), to help provide coverage for all members of the family.

In some cases, you may qualify for both Medicare and Medicaid coverage together.

Medicaid Eligibility Requirements

Medicaid eligibility is based on both your income and the size of your family. However, the specific qualifications vary by state.

In some states, all adults below a certain income level qualify for coverage, while in other states, only some low-income people qualify.

Depending on the state in which you live, the following people may qualify for Medicaid coverage:

  • Low-income adults
  • Low-income families and children
  • Pregnant people
  • Elderly people
  • Those with certain disabilities

You can see an overview of coverage details on a state-by-state basis by visiting the Medicaid website.

Average Medicaid Costs

Because Medicaid is a state program, costs also vary depending on the state in which you live. However, there are some general things you should know.

Even if you qualify for Medicaid coverage, you’ll likely have to pay more for health services if you’re at the higher end of the income level requirements.

For prescription drugs, you can also expect to pay a percentage of the costs. And, if you visit the emergency room when it’s not a true emergency situation, you may end up having to pay the full price for the visit.

In most cases, you won’t have to pay a monthly premium for coverage, but if you’re a higher earner, you should be prepared to pay. In some cases, you may have to pay a set amount per month, per child in your family.

Medicare vs Medicaid: Know Your Options

Not having health insurance coverage is stressful and scary. After reading through this Medicare vs Medicaid guide, you have a better idea of your options and if you qualify for one of these federal programs. This is the first step towards peace of mind.

Before you go, don’t forget to look through some of our other health articles to help you learn more about living your best life.

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