Medicare vs. Medicaid:
What’s the Difference?

Depending on the Medicare coverage you choose, it may include:

• Care and services (inpatient) in a hospital or skilled nursing facility (Part A)
• Doctor visits, care and services (outpatient), and possible preventative care (Part B)
• Prescription Drugs (Part D)

• Medicare Advantage (Part C) plans will combine both Medicare Part A and Part B, and often include prescription drug (Part D) coverage as well – all together in one plan. Medicare Advantage Plans generally include additional benefits as well, such as:

• Vision
• Dental
• Hearing
• Over-the-Counter Benefits
• Transportation
• Fitness Benefits

Once you turn 65 years old, you are most likely eligible for Medicare. To confirm that you are eligible for Medicare, contact your local Social Security office for more information.

If you haven’t paid into Social Security for 40 quarters, you may have higher Medicare costs, but you are still eligible to enroll.

People who qualify for both Medicaid (supports low-income individuals and families) and Medicare Part A/Part B are known as dual eligible. What does this mean? It means that you may qualify for benefits that are run through the state called “Medicare Savings Programs.” These programs provide coverage for certain premiums, copays, and deductibles. The benefits ultimately depend on an individual’s income level and Medicare Savings Program, but sometimes Medicaid can cover all out-of-pocket expenses. Individuals who qualify for the Qualified Medicare Beneficiary (QMB) Program may automatically qualify for the Extra Help Prescription Drug Program.
When dual eligible individuals receive Medicare and Medicaid benefits, some can vary by state.

Dual eligibility can also be categorized as “full-benefit” or “partial-benefit.” Full benefits mean that the individual would receive full coverage of Medicaid benefits. However, those with partial benefits do not receive the full Medicaid services, but Medicaid will cover their Medicare premiums.

If you are enrolled in both Medicare and Medicaid, you’re eligible for a specific type of Medicare Advantage Plan called a Dual-Eligible Special Needs Plan (D-SNP). These plans coordinate the combined benefits of Medicare and Medicaid to help you get the care and resources you need. Some plans may offer $0 premiums and additional benefits.