Medicare and Medicaid are both government healthcare programs in the United States, but they
serve different populations and have distinct purposes. Here are the key differences between
Medicare and Medicaid:
Eligibility:
- Medicare: Medicare primarily serves individuals aged 65 and older, as well as some younger individuals with disabilities and those with end-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Eligibility for Medicare is not based on income.
- Medicaid: Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families, including pregnant women, children, adults, and people with disabilities. Eligibility for Medicaid is based on income, with specific income limits set by each state.
Funding:
- Medicare: Medicare is primarily funded through payroll taxes paid by workers and their employers. It also receives some funding from the federal government and beneficiary premiums for certain parts of the program.
- Medicaid: Medicaid is jointly funded by the federal government and individual state governments. States have flexibility in designing and administering their Medicaid programs, but they must meet federal guidelines.
Coverage:
- Medicare: Medicare consists of several parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). It primarily covers medical services for seniors and certain disabled individuals.
- Medicaid: Medicaid provides a wide range of healthcare services, including doctor visits, hospital care, prescription drugs, preventive care, and more. The specific benefits and coverage can vary by state and are designed to meet the needs of low-income individuals and families.
Administration:
- Medicare: Medicare is administered by the federal government, specifically the Centers for Medicare & Medicaid Services (CMS).
- Medicaid: Medicaid programs are administered by individual state governments, which have the authority to establish eligibility criteria, benefits, and provider reimbursement rates within federal guidelines.
Enrollment:
- Medicare: Most people become eligible for Medicare at age 65 and are typically automatically enrolled if they're receiving Social Security benefits. Others can apply during specific enrollment periods.
- Medicaid: Eligibility and enrollment processes vary by state, and individuals who qualify for Medicaid must apply directly through their state's Medicaid program.
Medicare official website
Need Extra Help with Prescription Drugs Cost?
Starting January 1, 2024, people with limited resources can qualify for even more savings on
Medicare drug costs (Part D). Find out if you qualify and how much you can save.
2024 Medicare Advantage and Part D Star Ratings
The Star Ratings system helps Medicare consumers compare the quality of Medicare health
and drug plans being offered so they are empowered to make the best health care decisions for
them. An important component of this effort is to provide Medicare consumers and their
caregivers with meaningful information about quality alongside information about benefits and
costs to assist them in being informed and active health care consumers.
