Medicare vs. Medicaid

You generally qualify for Medicare at 65, as a US citizen or permanent resident. Some people under 65 also qualify earlier, including those with end-stage renal disease (ESRD), ALS (Lou Gehrig's disease), or a qualifying disability.

Medicaid works differently. Eligibility is based on your income, household size, and usually a category, such as being a child, pregnant, a parent of a dependent child, age 65 or older, or having a qualifying disability. Because Medicaid is run jointly by the federal government and each state, both the income limits and the categories that qualify vary by state. Texas has not expanded Medicaid under the ACA, so low income alone does not guarantee coverage here. An adult without children or a qualifying disability may not qualify for Texas Medicaid regardless of how little they earn.

Medicare has several parts that cover different types of care. Part A covers hospital stays, skilled nursing care, and home health care. Part B covers physician services, outpatient care, and other medical services. Part C, run by private insurance companies, combines Part A and Part B and often adds extra benefits like dental, vision, or drug coverage. Part D covers prescription drugs.

Medicaid benefits vary by state, but every state's program covers at least:

• Inpatient and outpatient hospital services
• X-ray and lab services
• Surgical dental services for adults
• Applicable medical treatments for children
• Family planning services, such as nurse and midwife birth control services
• Nursing facility services for adults

Medicare beneficiaries pay premiums, deductibles, and coinsurance for their coverage. Original Medicare has no yearly limit on combined Part A and Part B out-of-pocket costs, which is one reason many people add a Medicare Supplement or Medicare Advantage plan.

Medicaid works differently. Having Medicaid does not always mean $0 cost for the care you receive. Most Medicaid cost sharing is limited to small, nominal amounts, such as a few dollars per visit or prescription, and the exact amount depends on your income and the state you live in.

Yes. Some people qualify for both Medicare and Medicaid at the same time, often called being dual eligible. In that case, Medicaid can help pay Medicare premiums, deductibles, and other costs Medicare doesn't cover. If you think you might fall into this group, it's worth having a licensed advisor check your specific situation.