Medicaid vs Medicare: What’s the Difference?
Many people with disabilities qualify for both Medicaid and Medicare, but the programs are distinct. This guide breaks down eligibility, coverage, costs, and how the two programs can work together.
Key Points
- Medicaid is income-based (needs-tested).
- Medicare is insurance for people 65+ or on SSDI.
- Some people qualify for both (“dual eligibility”).
- Medicaid often covers services Medicare doesn’t, like long-term care.
Medicaid Overview
- Managed by states under federal rules.
- Covers medical, behavioral, and long-term supports.
- No premiums in most cases, but may have small copays.
- Eligibility tied to income/resources (varies by state).
- Key programs include HCBS waivers and Medicaid Buy-In for workers with disabilities.
Medicare Overview
- Federal program for seniors and people with qualifying disabilities.
- Eligibility after 24 months on SSDI (waived for ALS or kidney failure).
- Four parts:
- Part A: Hospital
- Part B: Doctor/outpatient
- Part C: Advantage plans
- Part D: Prescription drugs
- Monthly premiums for Parts B/D; higher incomes pay more.
Dual Eligibility: Getting Both
- Medicaid can pay Medicare premiums, deductibles, and services not covered by Medicare.
- Programs: QMB, SLMB, QI, and QDWI help cover Medicare costs.
- Dual-eligible individuals often have broader coverage and less out-of-pocket cost.
Choosing Providers
Always confirm if your provider accepts both programs. Some services (like long-term supports) may require state-level prior authorization.
FAQs
Do I automatically get Medicaid with SSI?
In most states yes, but some require a separate application.
Can I have both Medicare and Medicaid?
Yes, if you meet both sets of criteria.
What’s better, Medicaid or Medicare?
Neither—it depends on your age, income, and disability status. Many people use both.
Does Medicaid cover dental or vision?
Coverage varies by state; check your state’s Medicaid website.