How does Medicare differ from Medicaid?

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With healthcare costs rapidly increasing every year, finding a high-quality, cost-effective health insurance plan is not an easy task. For many people in the United States, the government healthcare programs of Medicare and Medicaid are the best available options to pay for healthcare. While Medicare and Medicaid both serve the same purpose of assisting people with their healthcare coverage, they possess several key differences.

Governmental Involvement

Medicare is a federally run health insurance program. While individual states have multiple social security administration offices, they are run directly through the federal government by the social security administration. To apply, individuals must contact the social security administration directly. Medicaid is run jointly through both the federal and state governments. While the federal government does set general guidelines for qualifications, individual states are directly in charge of running the program and can implement different requirements as long as they do not contradict the overarching federal guidelines. Individuals must apply directly with their state Medicaid office to get coverage.


Medicare is available for individuals starting at 65 years old, as long as they have been an American citizen or legal resident for at least 5 years. Medicare also covers those with disabilities and automatically enrolls individuals in the program who have received Social Security disability or Railroad Retirement disability for 24 months. Medicaid is an option for low-income individuals who need assistance in paying for medical coverage. All qualifying individuals must have an income below the federal poverty level, and must also be a US citizen or legal resident to get coverage. However, non-legal residents can get coverage for emergency care. Also, some states allow individuals with income that is 138% of the federal poverty level to get Medicaid coverage, while other states offer Medicaid coverage for non-legal residents for prenatal care.

Enrollment/Sign-up Period

The initial enrollment period for Medicare recipients is 3 months after they turn 65. Failing to sign up within that timeframe will result in penalties to a person's coverage. Any additional changes to Medicare plans for existing customers must be made during the open enrollment period from October 15 to December 7. Medicaid has no enrollment period or deadlines for signing up. Individuals who are eligible for Medicaid can sign up at any time of the year.

Plan Overview

Medicare plans are broken up into several different sections. Part A covers hospital fees, Part B covers physician fees, and Part D covers prescription drugs. Part C combines Parts A, B, and D into a single plan called a Medicare Advantage Plan and is offered and administrated by a private insurance company. Individuals with certain health conditions such as cancer may benefit from the flexibility offered by a Part C medical plan, although higher out-of-pocket costs are often associated with Part C plans. Medicaid plans vary state by state but are not broken down into separate parts. All plans generally have the same protections, privileges, and coverages found in most employer-provided healthcare plans.

Plan Scope

Medicare provides its customers with several health insurance plans for their different parts. However, Medicare does not provide family coverage, meaning that any dependents of the Medicare recipient cannot get on the specific healthcare plan. Medicaid is more limited in the types of health plans offered. However, it does allow family members to be covered by a specific healthcare plan.

Medicare and Medicaid both provide health insurance coverage to millions of Americans every year. However, they are both different in the types of plans offered and the types of customers they serve.