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Ethete Clinic
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Riverton Clinic

What's the difference between Medicaid and Medicare?

In a nutshell, Medicaid is a federal and state government program that can help cover the cost of health care to anyone as long as they meet the eligibility requirements. And Medicare is health insurance for people 65 and older, people under 65 with certain disabilities, or people of any age with End-Stage Renal Disease (ESRD).

We'll go into more detail about each program in the next section.







What is Medicaid?

Medicaid is a joint federal and state program that helps cover the cost of health care to people who have limited income and resources. Each state has different rules about eligibility and how to apply for Medicaid.


Am I Eligible for Medicaid?


You may be eligible for Medicaid if you have limited income and are any of the following:

  • 65 or older
  • A child under 19
  • Pregnant
  • Living with a disability
  • A parent or adult caring for a child
  • An adult without dependent children (in certain states)
  • An eligible immigrant


When you enroll, you can get the health benefits that you need. Including the following:

  • Doctor visits
  • Hospital stays
  • Long-term services and supports
  • Preventative care, including immunizations, mammograms, colonoscopies, and other needed care
  • Prenatal and maternity care
  • Mental health care
  • Necessary medications
  • Vision and dental care (for children)


What is Medicare?

Medicare is health insurance for:

  • 65 or older
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
  • Medicare has several different parts that cover different thing.


Part A (Hospital Insurance) help cover:

  • Inpatient care in hospitals
  • Skilled nursing facility (SNF) care
  • Hospice care
  • Home health care

There usually isn’t a monthly premium for Part A if you or your spouse paid Medicare taxes while working. This is sometimes referred to as premium-free Part A. If you aren’t eligible for premium-free Part A, you might be able to buy Part A and pay a monthly premium for coverage.

Part B (Medical Insurance) help cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (DME)
  • Some preventative care

Most people pay the standard monthly Part B premium.

Part C (Medicare Advantage):

  • Includes all benefits and services covered under Parts A and B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost

Part D (Medicare prescription drug coverage):

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • Maybe help lower your prescription drug costs and help protect against higher costs in the future