Differences Between Medicare and Medicaid Health Plans

Medicare and Medicaid Health Plans

About Medicare

Medicare is a government health insurance program designed for people age 65 and above. Though younger people suffering from an illness like end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) also qualify for Medicare plans. When individuals attain the age of 65 years, Medicare sends information to individuals to sign up for Medicare plans. Individuals have the option to choose between Original Medicare with prescription drug coverage, Medicare Part D, or Medicare Advantage or Medicare Part C plan.

Medicare Part A, Part B, Part C, and Part D Coverage

Medicare Part A or Hospital Coverage

Medicare Part A is a part of Original Medicare, which provides coverage to enrollees upon hospitalization.

Medicare Part B Coverage

Part B is also a part of the Original Medicare that provides coverage for outpatient care like doctor appointments.

Medicare Part C or Advantage Plan

Medicare Part C or Advantage plans are an increasingly popular plan opted by the majority of Medicare beneficiaries. Around one-third of the Medicare beneficiaries have a Medicare Advantage plan, and this number is increasing every year. More than 24 million people are covered under 4,000 types of Medicare Advantage plans. Offered by private health insurance companies, Part C plan provides combine coverage of Original Medicare and Medicare Part D coverage. Besides, it also provides supplemental benefits like dental, vision, and even population health initiatives such as transportation costs to doctors’ appointments.

Medicare Part D or Prescription drug coverage

Unlike Original Medicare, which is a federal government program, Medicare Part D plan is offered by a private health insurance company. Medicare Part D plan can only be obtained by people having Original Medicare, and it can’t be obtained by people enrolled in Medicare Part C or Advantage plan.

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Medigap is also a part of the Medicare plan available to the beneficiaries of Original Medicare. It is a type of supplemental plan that allows beneficiaries to pay for their out-of-pocket Medicare services. The best thing about the Medigap plan is that it may also pay for international health care. If the enrollees of this plan travel to foreign countries and end up needing health care, then their Medicare plan will not cover them, instead, their Medigap plan may pay up to 80% of the healthcare costs.

About Medicaid

Medicaid is a federal or state health insurance program designed for low-income citizens of the U.S. People enrolled in the Medicaid plans have the same coverage as offered by the most employer-sponsored health plans. Medicaid managed care, a type of Medicaid plan, offered by a private insurance company has also become increasingly common. However, people enrolling in a Medicaid plan offered by an insurance company need to sign up through their state. Regardless of the type of Medicaid plan, the federal government requires these plans to provide coverage for hospitalizations, home health care, physician appointments, labs and x-rays, maternity, pediatric and preventive care, and these plans also cover child dental care. Medicaid plan is available to individuals having an income below 100% of the federal poverty level, and the Affordable Care Act has allowed states to expand Medicaid eligibility for up to 138% of the federal poverty level. Around 36 states have expanded Medicaid eligibility. In addition to these, individuals who are disabled, elderly, or a parent or caregiver are also eligible for Medicaid if their income is below 200% of the federal poverty level.

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Difference between Medicare and Medicaid

Medicare and Medicaid are federal health insurance program, which differs in the following ways:


The major difference between Medicare and Medicaid is eligibility. Individuals qualify for Medicare depending upon their age and disability, and they qualify for Medicaid based on income. Individuals could be eligible for both Medicare and Medicaid if they meet income and age requirements for each program.


Individuals enrolled in Medicare plans don’t get coverage for their families, as this plan doesn’t provide family coverage. Thus, individuals who are on Medicare and have dependents can’t get them on their plan. Whereas Medicaid plans provide coverage for dependents. Medicaid and the Children’s Health Insurance Program covers more than 45 million children.

Open Enrollment

Open enrollment period for Medicare is from October 15 to December 7, and changes can also be made in the plan during this period. Individuals have three months after they turn 65 to enroll in the Medicare plan. Medicare has a fixed enrollment period whereas Medicaid doesn’t have an open enrollment period and individuals can sign up for a Medicaid plan upon becoming eligible for the plan during any time of the year.

Plan Options

Medicare plans offer a wealth of choices in terms of health plans and individuals need to narrow down the choice and select the best Medicare plan available to them. Medicare plans vary in terms of premiums, deductibles, and out-of-pocket costs, so individuals need to first broadly compare each plan before deciding on a plan. On the other hand, Medicaid provides one or very few choices. The plan can be obtained through the state, or managed care Medicaid plan can be obtained through a private insurer.

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How Medicaid works with Medicare

Individuals having both Medicare and Medicaid often worry about which plan will pay first. However, they should know that there is a system called coordination of benefits, which decides about the insurer that will pay first. Generally, individuals having both Medicare and Medicaid, Medicare pays for the healthcare first and Medicaid is considered as the secondary payer. Individuals just need to ensure to avail healthcare from the providers who accept both the plans, otherwise, they will have to pay more out-of-network costs, if their provider doesn’t take both the plans.

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