Orlando Harmon
Medicaid and Medicare are two of the most used healthcare insurance programs in the United States. While both are government-funded programs, they serve different purposes. Medicare is a federal health insurance program for individuals aged 65 and above, as well as younger people with disabilities or end-stage renal disease. On the other hand, Medicaid is a joint federal and state program that provides health coverage for people with limited incomes and resources, regardless of age. The eligibility and benefits offered by Medicaid vary across states, and it often covers services that Medicare does not, such as long-term care and non-emergency medical transportation. As of 2025, about 21% of people nationally reported having Medicaid coverage, with rates varying significantly by state.
| Characteristics | Values |
|---|---|
| Percentage of people with Medicaid nationally | 21% |
| Range of percentage of people with Medicaid by state | 11% (Utah) - 34% (New Mexico) |
| Coverage of births in the US | 41% |
| Coverage of children with special health care needs | Nearly half |
| Coverage of nursing home residents | 5 in 8 |
| Coverage of non-elderly adults with mental illness | 29% |
| Coverage of non-elderly adults with HIV | 40% |
| Type of program | Medicaid: Joint federal and state program; Medicare: Federal health insurance |
| Eligibility | Medicaid: Low-income individuals and families of all ages; Medicare: Age 65 or older, younger people with disabilities, people with End Stage Renal Disease |
| Coverage | Medicaid: Long-term care, emergency ambulance services, non-emergency medical transportation, nursing home care, personal care services; Medicare: Prescription drugs, copayments, coinsurance, deductibles |
| Enrollment based on income level | Medicare: No limit; Medicaid: Limited income |
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What You'll Learn
- Medicaid covers 41% of US births, half of children with special healthcare needs, and nearly half of adults in poverty
- Medicare is federal insurance for those aged 65+ and some younger people with disabilities
- Medicaid eligibility varies by state, depending on income, resources, and residency
- Medicare Part B covers doctors' services, outpatient care, and other services not covered by Part A
- Medicaid covers long-term care, which is not covered by Medicare or most private insurance
Medicaid covers 41% of US births, half of children with special healthcare needs, and nearly half of adults in poverty
Medicaid is a joint federal and state program that provides health coverage for certain individuals and families with low incomes and resources. Eligibility and benefits vary from state to state, with each state running its own program and having its own eligibility criteria. Generally, eligibility is determined based on an individual's age, health condition, and income level.
Medicaid is a crucial source of coverage for specific populations, and in 2023, it covered a significant portion of children and adults in the United States. Notably, Medicaid covered nearly 4 in 10 children, over 8 in 10 children in poverty, and almost half of adults in poverty.
One of the key areas where Medicaid provides essential support is in covering the costs of childbirth. According to a 2022 report, Medicaid finances about 41% of all births in the United States, including nearly 50% of births in rural communities. This coverage ensures that women across the country have access to vital prenatal and postpartum care.
Additionally, Medicaid plays a significant role in supporting children with special healthcare needs. It covers nearly half of these children, providing them with comprehensive benefits known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services. These services offer crucial support for children who require specialized care, ensuring their health and well-being.
Medicaid also covers other vulnerable populations, including individuals with disabilities, the elderly, and those transitioning out of carceral settings. It offers benefits that Medicare does not typically cover, such as long-term care, nursing home care, and personal care services. Medicaid is one of the most cost-efficient forms of coverage, with lower total and per capita costs than Medicare and private health insurance.
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Medicare is federal insurance for those aged 65+ and some younger people with disabilities
Medicare is a federal insurance program that primarily caters to individuals aged 65 and above. It also covers some younger people with disabilities or specific conditions. This includes people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant) and ALS (Lou Gehrig's disease).
Medicare is available to eligible individuals regardless of their income, health status, or prescription drug usage. It consists of multiple parts, with Part A covering inpatient care in hospitals, critical access hospitals, and skilled nursing facilities, as well as hospice care and some home health care. Most people don't pay a monthly premium for Part A. Part B, which covers medical services like doctors' services and outpatient care, requires a monthly premium. Medicare Part D, available since 2006, provides prescription drug coverage. Additionally, Medicare Advantage Plans, also known as Part C or MA Plans, are offered by private companies approved by Medicare and provide another health plan option.
Medicare eligibility typically begins three months before an individual turns 65 and ends three months after they turn 65. However, it is recommended that individuals sign up as soon as they become eligible to avoid gaps in coverage and late enrollment penalties. Some people may even qualify for Medicare earlier than 65 if they meet certain criteria, such as receiving retirement or disability benefits from Social Security. To determine eligibility, individuals can contact the Social Security Administration or visit Medicare.gov.
Medicaid, on the other hand, is a joint federal and state program that provides health coverage for individuals and families with limited incomes and resources. Eligibility and benefits can vary across different states, and it often covers specific populations, including children, adults in poverty, pregnant women, seniors, and people with disabilities. Medicaid offers benefits that Medicare does not typically cover, such as nursing home care and personal care services. It also covers emergency ambulance services and dental services for individuals under the age of 21, with states having the option to extend these benefits to those 21 and older.
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Medicaid eligibility varies by state, depending on income, resources, and residency
Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. While the federal government has general rules that all state Medicaid programs must follow, each state runs its own program. This means that eligibility requirements and benefits can vary from state to state.
Medicaid eligibility is based on income, resources, and residency. Eligibility rules differ among states, and certain eligibility groups do not require a determination of income by the Medicaid agency. For example, children for whom an adoption assistance agreement is in effect under Title IV-E of the Social Security Act are automatically eligible. Young adults who meet the requirements for eligibility as a former foster care recipient are also eligible at any income level.
The Modified Adjusted Gross Income (MAGI) methodology is used to determine financial eligibility for most children, pregnant women, parents, and adults. MAGI considers taxable income and tax filing relationships to determine financial eligibility. However, some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older).
Medicaid eligibility for individuals aged 65 and older or who have blindness or a disability is generally determined using the income methodologies of the Supplemental Security Income (SSI) program administered by the Social Security Administration. Some states, known as 209(b) states, use more restrictive eligibility criteria than SSI but still largely apply SSI methodologies.
In all states, Medicaid gives health coverage to some individuals and families, including children, parents, pregnant women, elderly people with certain incomes, and people with disabilities. Additionally, some states have expanded their Medicaid programs to cover other adults below a certain income level.
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Medicare Part B covers doctors' services, outpatient care, and other services not covered by Part A
Medicaid and Medicare are both federal health insurance programs, but they cater to different demographics. Medicaid is a joint federal and state program that provides health coverage to individuals and families with limited incomes and resources. The percentage of people with Medicaid is 21% nationally, but this ranges from 11% in Utah to 34% in New Mexico. Eligibility and benefits vary from state to state.
Medicare, on the other hand, is available for people aged 65 or older, younger people with disabilities, and people with End Stage Renal Disease. Medicare Part B, in particular, covers medically necessary services, including doctors' services, tests, outpatient care, home health services, durable medical equipment, and other medical services. It also covers preventive services, such as the flu shot, and emergency or observation services. Medicare Part B also covers certain drugs and biologicals that are typically administered by a healthcare provider, such as certain injectable drugs.
It is important to note that Medicare Part B does not typically cover prescription or over-the-counter drugs received in an outpatient setting, as these are considered "self-administered drugs." However, if you have Medicare prescription drug coverage (Part D), these drugs may be covered under certain circumstances. In most cases, you will need to pay out-of-pocket for these drugs and then submit a claim to your drug plan for a refund.
Medicare Part B helps cover the cost of services that are deemed medically necessary to diagnose or treat a medical condition. This includes services that meet the accepted standards of medical practice and are not considered experimental or investigational. It is worth noting that your doctor or healthcare provider may recommend services that are not covered by Medicare, in which case you may have to pay some or all of the costs.
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Medicaid covers long-term care, which is not covered by Medicare or most private insurance
Medicaid is a joint federal and state program that provides health coverage to individuals and families with low incomes and limited resources. It is available in all states, but eligibility and benefits vary, with each state running its own program. This means that rates of Medicaid coverage are higher in states with lower average incomes and lower rates of health insurance provided by employers.
Medicare, on the other hand, is federal health insurance available to those aged 65 and older, younger people with disabilities, and people with End-Stage Renal Disease. It does not cover non-medical long-term care. Medicare Part A helps cover inpatient care in hospitals and skilled nursing facilities, but not custodial or long-term care. Medicare Supplement Insurance Plans, or Medigap, also do not cover most long-term care services.
Medicaid offers benefits that are not usually covered by Medicare or private insurance, including non-emergency medical transportation and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services. It also covers nursing home care and personal care services, with beneficiaries usually not paying anything for covered medical expenses.
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Frequently asked questions
Medicare is federal health insurance for anyone aged 65 and older and some people under 65 with certain disabilities or conditions. Medicare eligibility starts three months before turning 65 and ends three months after turning 65.
Medicaid is a joint federal and state program that provides health coverage to people with limited income and resources. Eligibility and benefits vary from state to state.
Medicare is available for people aged 65 or older, younger people with disabilities, and people with End-Stage Renal Disease. Medicare does not limit enrollment based on income level. On the other hand, Medicaid is designed for people of any age with limited income and resources and is often a program of last resort for those without access to other resources.
Medicaid covers benefits that Medicare doesn't normally cover, including long-term care, non-emergency medical transportation, and comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment (EPSDT) services.
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