Medicare vs Medicaid: Which One Are You Eligible For?

Understanding Medicaid and Medicare  

There is a misconception around how either of the programs work, and more than often they are confused with each other for their eligibility and benefits. We have simplified how Medicaid and Medicare work and the health services they cover.  

What is Medicare? 

Medicare is a Federal Health Insurance Program that is primarily for people aged 65 or older. It is available for seniors regardless of the income level although premiums and cost-sharing could differ.  

It is administered at a federal level by Centers for Medicare and Medicaid Services, and the rules and benefits are the same nationwide. It is equivalent to health insurance and not long-term care insurance.  

Health Services Covered by Medicaid 

Part A: As a hospital insurance, it covers inpatient hospital care, short-term nursing facilities, hospice care 

Part B: This works like medical insurance and covers doctor visits, outpatient care, preventive care, and durable medical equipment.  

Part C: Also called the Medicare Advantage, this combines the coverage of Part A and Part B. It can include dental and vision insurance but is often limited.  

Part D: Prescription drugs are covered in this part 

What Does Medicare Not Cover?

Since it is not long-term care insurance, long-term care and personal care services are not covered. Most non-medical home care services like self-directed care programs are not covered by Medicare.  

Medically necessary home care could be covered but has very specific criteria and rules about how long the care is for and who cares for you.  

What is Medicaid? 

Medicaid is focused on individuals and families with limited income and resources. It is a health insurance program. This is a federal and state assistance program, so it is funded by the federal and state government, but the programs and benefits depend on the state. 

It serves different population categories like low-income adults, children, pregnant individuals, seniors, and people with disabilities.   

Health Services Covered by Medicaid

Medicaid covers medical care as well as long-term services.  

Common services: Doctor visits, hospital care, and preventive care are covered. As needed, mental health and substance use treatment are also covered by Medicaid. For pregnant persons, prenatal and post-partum care are covered.  

Long-Term Care and Home Care: Personal care services and home health aides can be paid for by Medicaid. There are home and community-based services that are covered. An important Medicaid program all states have is the self-directed care program under different names like the CDPAP in New York, CDS in Missouri, PCS in Nevada, Home Help Program in Michigan, and ALTCS in Arizona.

Being on Medicaid, gives you access to other benefits and discounts given by organizations and corporations that you can use,

Eligibility Criteria for Medicare and Medicaid

Often confused to be the same or for the other, both insurances are for different populations and focus on different goals for the health of their respective eligible population.  

Medicare Eligibility

Medicare is primarily based on age and/or disability and not income. You could be eligible for Medicare insurance if some of the below criteria apply to you.

1. Age-based eligibility: 

   1. 65 years of age or older 

   2. US citizen or lawfully permanent resident 

   3. Worked and paid Medicare taxes for at least 10 years 

      
      

2. Disability-based eligibility 

   1. Under 65 years of age 

   2. Have received Social Security Disability Insurance (SSDI) for 24 months 

   3. Diagnosed with End-Stage Renal Disease or ASL

There are different enrollment periods for age-related enrollment. If you are receiving Social Security benefits, you are automatically enrolled in Medicare. You can find specific details on each criterion on the official Centers for Medicare & Medicaid Services website.

Medicaid Eligibility

Often misunderstood as an age-related insurance, Medicaid eligibility is focused on income and based on other criteria of household size, assets, and category. Below are the core eligibility factors and categories; however, the specific limits, rules, and benefits could vary by state.  

When applying for Medicaid, your eligibility will be assessed on the basis of income and asset limits, state residency, and citizenship or your immigration status. The eligible population criteria are:

1. Low-income adults: If you are an adult aged 19 - 64 and have a low income, you could be eligible. The income limit is set by the state, so when you are applying for Medicaid, you can check the specific rules on official websites.  

   
   

2. Pregnant persons and Children: The income limit is higher than for adult's category. This covers prenatal, labor, and postpartum care, and often the newborn care is covered too.   

   
   

3. Seniors: If you are 65 years and older, you could be eligible based on your income and asset limits which differ for every state.  

   
   

4. People with disabilities: There could be income and asset limits, but it is required you meet the Social Security disability criteria.

If you are eligible, you can learn how to apply for Medicaid in your state of residence on our website. Some individuals could be eligible for both Medicare due to age or disability and Medicaid due to low income. In which case, they receive benefits from both programs. You can find state specific eligibility criteria here: State-wise income limit chart

Understanding State and Federal Rules

As of January 2025, these are the rules and benefits for Medicare and Medicaid. The policies can be changed sometimes, and it is important to be informed. You can follow pages to stay up to date and join online communities when you get enrolled in any of the program.

BURD Home Health is here to help! If you are looking to be enrolled in Medicaid, you can contact us on 833-447-3326 and we will be happy to guide you through the process or find more information on our website.