What’s the difference between medicare and medicaid?

WHAT DOES MEDICAID COVER? Low-income Americans of any age with Medicaid receive comprehensive health care, including doctor services, home health care, inpatient and outpatient hospital

care, lab tests and X-rays, and rural health clinic services. People who meet additional requirements can qualify for nursing home care. Other coverage varies by state. Some state Medicaid

programs also cover dentistry, physical and occupational therapy, prescription drugs, vision services and some personal care services such as help with bathing and dressing. Some state

Medicaid programs also offer home- and community-based service (HCBS) waiver programs that let you receive care at home or in an assisted living facility rather than in a nursing home.

Waiver programs vary significantly by state. To qualify, you must meet income and asset levels. Medicaid waiver programs may also have separate requirements for different coverage levels,

based on help you need to care for yourself. WHO IS ELIGIBLE FOR MEDICAID? Each state has different rules for Medicaid eligibility, but it’s usually based on your household income, age,

disability, family size and sometimes assets. You can get a quick estimate of Medicaid eligibility in your state using the eligibility tool at HealthCare.gov. If you don’t qualify for

Medicaid based on your income, you could be eligible if you have children, have a disability or are pregnant. Contact your state Medicaid office for more information. Those 65 or older,

blind or disabled have different requirements. Eligibility is based on income and assets; you can keep up to $2,000 in countable assets to qualify. Some states allow you to keep more. HOW

MUCH DOES MEDICAID COST? Federal regulations allow states to pass along small charges as copayments, coinsurance, deductibles and sometimes premiums. But the government limits those charges

based on your income. HOW DO I SIGN UP FOR MEDICAID? Unlike Medicare, which has limited enrollment periods, you can apply for Medicaid any time, either through your state Medicaid agency or

by submitting a form through HealthCare.gov. If the marketplace determines that you or someone in your household qualifies for Medicaid, it will forward the information to your state agency.

KEEP IN MIND Nearly 13 million people called “dual eligibles” qualify for both Medicare and Medicaid at the same time. If you qualify for both programs, Medicare pays covered expenses

first. Then Medicaid fills in some gaps, such as Medicare Part A and Part B deductibles, copayments and coinsurance. If you qualify for Medicaid, you’re automatically enrolled in the Extra

Help program that helps pay Part D premiums, deductibles and copays for prescriptions. Medicaid can also pay expenses that Medicare doesn’t cover, like nursing home care and other long-term

care expenses. In some states, Medicaid covers dental care, glasses, physical therapy, transportation to and from doctor visits and other services. If you don’t qualify for Medicaid, you

could be eligible for help with Medicare’s out-of-pocket costs from a Medicare Savings Program (MSP), which has higher income cutoffs that also vary by state. For more information about

eligibility and coverage for Medicare, Medicaid and Medicare Savings Programs in your state, contact your State Health Insurance Assistance Program (SHIP). Return to Medicare Q&A main

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