Difference Between Similar Terms and Objects

Difference Between Medicare and Medicaid

Difference between Medicare and Medicaid

These are two separate health insurance programs designed for different groups of people having health issues. Medicare Health Insurance is for people over age sixty-five or people with some disabilities.

Medicaid Health Insurance Program which is for low-income people, offer some more medical and medication services that Medicare doesn’t offer, such as food stamps and a prolonged and long-term medical care.

To be more precise, Medicare Health Insurance Program helps U. S’s elders and people with disabilities, and Medicaid Health Insurance Program helps people with low incomes.


Medicare and Medicaid, primary components of the United States healthcare system, share similarities in their roles as government-sponsored programs aimed at expanding access to healthcare services. Medicare, a federal initiative, primarily focuses on the health needs of individuals aged 65 and older, as well as certain younger individuals with disabilities.

On the other hand, Medicaid functions as a collaborative effort between federal and state governments, targeting eligible low-income individuals and families, such as a diverse demographic, including pregnant women, children, elderly adults, and those with disabilities.

Both programs play important roles in promoting healthcare inclusivity, offering coverage to segments of the population that might face challenges in accessing private health insurance. Despite their eligibility criteria and administrative structures, both Medicare and Medicaid focuses on enhancing healthcare accessibility for different demographic groups within the nation.


Medicare is a federally funded health insurance program in the United States designed for individuals aged 65 and older, providing essential coverage for hospital stays, outpatient care, preventive services, and more.

Established in 1965, it also targets to certain younger individuals with disabilities or specific medical conditions. It contains various parts, including Hospital Insurance (Part A), Medical Insurance (Part B), and Medicare Advantage (Part C), and this program make sure a range of healthcare services to promote the well-being of older Americans and individuals with qualifying health needs. Through this approach, Medicare plays a important role in offering accessible and comprehensive healthcare coverage to diverse population across the nation.


Medicaid is a joint federal and state health insurance program in the United States, cover for eligible low-income individuals and families. Established alongside Medicare in 1965, Medicaid operates as a partnership between the federal government and individual states, allowing states flexibility in program design and administration while following to federal guidelines. The program focus on a diverse demographic, including pregnant women, children, elderly adults, and people with disabilities.

Medicaid offers a broad range of health services, such as hospital and doctor visits, prescription medications, preventive care, and long-term care. Eligibility criteria vary by state and consider factors such as income, family size, and specific health needs. Medicaid plays a important role in promoting healthcare access for vulnerable populations, serving as a safety net to make sure that individuals and families with limited financial resources can receive appropriate medical care.

Difference between Medicare and Medicaid

1.      Definition


Medicare is a U.S federal government health insurance program that subsidizes health care services. The program covers those over age 65, others who meet specific eligibility criteria, and individuals with certain diseases.


It is for low-income individuals and families. It is paid for by Federal, State and Local Taxes.

2.      Enrollment


October 15th – December 7th or 3 months following 65th birthday


Available at any time

  1. What do participants pay?


Participants pay deductibles and for part of coverage


Participants pay very little or no part of coverage

  1. Eligible people


  • Seniors (65+)
  • People with permanent disabilities
  • People with any age End-Stage Renal Disease (ESRD)



  • Low-income families and children
  • People with disabilities
  • Pregnant women
  • Seniors (65+)
  1. Regulation


Regulated by Federal Government


Regulated by State Government

  1. Quality


Home Health Quality Reporting Program, drawing on OASIS and claims data


No national standards. State reporting requirements vary by programs and services

  1. What doe these Health Insurance Programs cover?


Home Health Quality Reporting Program, drawing on OASIS and claims data



  • Inpatient and outpatient hospital services
  • Lab and X-ray facilities
  • Nursing facility
  • Family planning services
  • Health screening
  • Surgical dental services for adults

Comparison Table Medicare vs Medicaid

The points of difference between Medicare & Medicaid have been summarized as below:

Feature Medicare Medicaid
Administering Authority Federal government Joint federal and state partnership
Eligibility Criteria Primarily individuals aged 65 and older; certain disabilities Low-income individuals and families; pregnant women, children, elderly adults, and people with disabilities
Coverage Part A: Hospital Insurance; Part B: Medical Insurance; Part C: Medicare Advantage; Part D: Prescription Drugs Varied and comprehensive, including hospital and doctor visits, prescription drugs, preventive care, and long-term care
Funding Funded through payroll taxes, premiums, and general revenues Jointly funded by federal and state governments
Enrollment Process Automatic enrollment for most individuals turning 65; others may need to apply Application process through state Medicaid offices based on income and other eligibility criteria
Premiums Part A may have no premiums for those with sufficient work credits; Part B and Part D may have premiums based on income Premiums vary by state, and some individuals may have nominal or no premiums
Cost-Sharing Deductibles, copayments, and coinsurance apply Varied cost-sharing structures, often nominal for low-income individuals
Scope of Coverage Broad coverage for seniors and certain disabled individuals Comprehensive coverage for low-income individuals and families
Long-Term Care Limited coverage for skilled nursing facility care Extensive coverage for long-term care services
Flexibility in Program Design Standardized across the country States have flexibility in program design and administration


What is the difference between US Medicare and Medicaid?

Medicare is a federal program (the federal government establishes uniform rules for Medicare at the national level) that offers health coverage if you are sixty-five plus or under sixty-five and have a disability, no matter your income. Medicaid is a state (each state manages its own Medicaid assistance program) and federal program that offers health coverage if you have a very low income.

 What is the highest income to qualify for Medicaid?

A person with an income of up to 77,280 USD and a family of 4 who earn up to 159,000 USD can receive subsidies of the state to reduce the costs of health coverage.

What is the income limit for Medicaid in Colorado?


Family Size Approximate Monthly Family Income to Qualify for Health First Colorado
Adults 19 – 65 Children 0 – 18
1 Up to 1,507 USD Up to 1,609 USD
2 Up to 2,030 USD Up to 2,167 USD
3 Up to 2,553 USD Up to 2,726 USD


What are the disadvantages of Medicaid?

  • Choice of providers is restricted to a single network in some states
  • A reduced financial ability to choose for elective treatments
  • Inability to purchase top-brands or superior brand medications or other medical aid

Who is not eligible for Medicare?

You are not eligible for Medicare if:

  • Done not have forty quarters in Medicare-covered job
  • Did not work or have job covered by Medicare
  • Do not qualify for eligibility for Medicare through the employment history of a current, former, or no more or deceased spouse

What are the 3 requirements for Medicare?

The 3 requirements for Medicare include:

  • Sixty-five years age or older
  • Mandatory to be a United States resident
  • Be a United States citizen
  • Be an alien who has been lawfully eligible for permanent residence in the country and has been residing in the U.S for five continuous years before the month of applying for Medicare.


Do you have to pay for Medicare?

One will usually pay 20 percent of the price for each Medicare-covered medical service or medication/drugs after one pays one’s deductible. If the person has limited resources and income, he or she may receive any help and support from the person’s state to pay the federal government program premiums and other costs, like deductibles, coinsurance (the percentage of costs of a covered health care service you pay), and copays (the money that a patient with health insurance pays for each medical/healthcare service).


Do you have to work to get Medicare?

Nobody is obliged to enroll in Medicare.

Sharing is caring!

Search DifferenceBetween.net :

Email This Post Email This Post : If you like this article or our site. Please spread the word. Share it with your friends/family.

1 Comment


  1. Difference Between HCPCS and CPT | Difference Between | HCPCS vs CPT

Leave a Response

Please note: comment moderation is enabled and may delay your comment. There is no need to resubmit your comment.

References :

[0]Altman, D., & Frist, W. H. (2015). Medicare and Medicaid at 50 years: perspectives of beneficiaries, health care professionals and institutions, and policy makers. Jama, 314(4), 384-395.

[1]Berwick, D. M., & Gilfillan, R. (2021). Reinventing the center for Medicare and Medicaid innovation. JAMA, 325(13), 1247-1248.

[2]Hennessy, S., Leonard, C. E., Palumbo, C. M., Newcomb, C., & Bilker, W. B. (2007). Quality of Medicaid and Medicare data obtained through Centers for Medicare and Medicaid Services (CMS). Medical care, 45(12), 1216-1220.

[3]Harrington, C., & Kitchener, M. (2010). Medicare and Medicaid in long-term care. Health Affairs, 29(1), 22-28.

Articles on DifferenceBetween.net are general information, and are not intended to substitute for professional advice. The information is "AS IS", "WITH ALL FAULTS". User assumes all risk of use, damage, or injury. You agree that we have no liability for any damages.

See more about : , , ,
Protected by Copyscape Plagiarism Finder