Medicaid vs Medicare: Everything You Need to Know

Navigating healthcare in the U.S. involves understanding two major federal programs: Medicare and Medicaid. Though their names sound similar, they serve different populations, follow different funding structures, and offer distinct benefits.

Key Differences at a Glance

Medicare serves millions of seniors and disabled individuals, while Medicaid supports low-income people of all ages. Many can qualify for both programs simultaneously, known as being dual eligible.

Medicare: What You Should Know

• Eligibility: 65 or older, or under 65 with certain disabilities or end-stage kidney disease

• Parts:

  • Part A covers hospital, hospice, and nursing facility care

  • Part B includes outpatient services, doctor visits, preventive care (approx. $185/month premium in 2025 with $257 deductible)

  • Part C (Medicare Advantage) bundles A & B benefits through private plans

  • Part D provides prescription drug benefits with annual out-of-pocket caps beginning in 2025 (around $2,000)

Medicaid: Key Features

• Eligibility: Income-based across age groups; guidelines vary by state

• Benefits: Often includes nursing home care, personal care services, and helps cover costs Medicare doesn’t pay

• Cost: Low or no premium; Medicaid may pay Medicare premiums or deductibles for dual-eligible individuals

Dual Eligible: Why It Matters

• Nearly 10 million people qualify for both Medicare and Medicaid

• Medicare pays first for covered services, and Medicaid fills gaps like copays and long-term care costs

• Dual-eligible individuals often qualify for programs like Qualified Medicare Beneficiary (QMB)

• Medicaid may cover services not covered by Medicare, such as dental or eyeglasses

2025 Policy Updates & What to Watch

• New annual cap on Medicare Part D out-of-pocket drug costs (around $2,000) starts in 2025

• Medicaid may face policy changes including work requirements and reduced federal matching

• Medicare Advantage plans continue to expand for dual-eligibles

Frequently Asked Questions

Who qualifies for Medicare vs. Medicaid?
Medicare serves seniors and disabled individuals; Medicaid serves low-income individuals regardless of age.

Can I be on both programs?
Yes. Those eligible for both are called dual-eligibles; Medicare pays first, Medicaid covers additional costs and services.

How much does Medicare cost in 2025?
Standard Part B premiums are around $185/month with a $257 deductible. Part A is usually premium-free if you’ve paid into the system.

What does Medicaid cover that Medicare doesn’t?
Medicaid often covers long-term care, nursing home stays, dental, vision, personal care, and helps with Medicare cost-sharing.

Will healthcare policy changes affect these programs?
Yes. Federal reforms may impact eligibility, benefits, and funding structures for both Medicare and Medicaid.

✅ How to Make the Most of Your Eligibility

• If eligible for Medicare and Medicaid, enroll in both to maximize coverage and minimize costs

• Choose between Original Medicare and Medicare Advantage carefully

• Explore Medicare Savings Programs like QMB or SLMB if you have low income

• Stay informed about local Medicaid rules—each state administers the program differently

✅ Need Help Navigating Medicare vs. Medicaid?

Compare available programs, coverage options, and costs with confidence. Whether you’re approaching Medicare eligibility, applying due to disability, or managing dual coverage — we can help you understand what you qualify for.

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