Published: June 2025
Speaking of government health insurance programs in the US, Medicare and Medicaid most of the time are treated as if they are similar, or are used in substitution for one another, but, in fact, they are designed for different purposes.
If you want to learn how to determine the program that you (or a relative) are fit for, this article explains the unique features of Medicare and Medicaid in 2025 very explicitly — such as those who are eligible, the extent of coverage, and how it is possible to get the benefits.
🧾 Quick Overview
| Feature | Medicare | Medicaid |
|---|---|---|
| Who it’s for | People 65+ or younger with disabilities | People of any age with low income |
| Managed by | Federal government | Joint federal and state governments |
| Income-based? | ❌ No | ✅ Yes |
| Covers families? | ❌ No (individual only) | ✅ Yes (includes families, children, etc.) |
| Cost to enrollees | Premiums, deductibles apply | Usually free or low-cost |
🩺 What Is Medicare?
Medicare is a federal health insurance program that primarily caters to:
- People aged 65 and older
- Individuals with specific disabilities who are below 65 years of age
- Patients with End-Stage Renal Disease (ESRD) or ALS
🧠 Medicare Has 4 Parts:
- Part A (Hospital Insurance)
- Covers inpatient hospital stays, hospice, and some home health care.
Part B (Medical Insurance)
- Covers doctor visits, outpatient care, and preventive services.
Part C (Medicare Advantage)
- Combines Parts A and B through private insurance, may include drug/dental/vision coverage.
Part D (Prescription Drugs)
- Covers prescription medications.
While it is mostly the case that people do not have to pay a premium for Part A, the other parts, namely B, C, and D, may be linked with fees to be paid every month.
💳 What Is Medicaid?
Medicaid is a health insurance program run by the state which offers free or low-cost health coverage to:
- Low-income individuals & families
- Children
- Pregnant women
- Seniors
- People with disabilities
Medicaid eligibility varies from state to state and is mainly based on the income and the number of family members.
Key Benefits:
- There are no or very low premiums
- It includes hospital visits, doctor visits, long-term care, and sometimes dental/vision
- It can be used together with Medicare for dual-eligible individuals
Example: A pregnant woman earning less than the state income limit can be one of the examples of several cases to get full maternity coverage under the Medicaid program.
👥 Is it possible for you to be eligible for both?
- You bet! There are those people in this world who may qualify for both Medicare and Medicaid, they are said to have a dual eligibility status.
- Usually, those are the elderly who have little or no income or disabled people. Medicaid could support people in paying their Medicare premiums and cover those services that are not covered by Medicare.
📌 Key Differences at a Glance
| Category | Medicare | Medicaid |
|---|---|---|
| Age Requirement | 65+ (or disability) | No age restriction |
| Income Requirement | No | Yes |
| Managed by | Federal | State + Federal |
| Covers Long-Term Care? | Limited | Yes, often fully |
| Covers Family Members? | No | Yes (pregnant women, children, etc.) |
🧠 Which One Should You Apply For?
| Situation | Recommended Program |
|---|---|
| You’re 68 and retired with decent income | Medicare |
| You’re 29, unemployed, and pregnant | Medicaid |
| You’re 70 and live on Social Security alone | Medicare + Medicaid |
| Your child needs insurance but you don’t work | Medicaid |
📝 How to Apply
✅ For Medicare:
- Sign up for it through ssa.gov/medicare online
- Below you will find one way out of many. It usually begins 3 months prior to your 65th birthday
✅ For Medicaid:
- Visit your state’s Medicaid website
- Use healthcare.gov to check if you qualify