Medicare and Medicaid: How It Works

When it comes to healthcare coverage in the United States, two programs often get confused: Medicare and Medicaid. Both help people pay for medical care, but they serve different groups and work in very different ways. Understanding the differences (and how they can sometimes work together) is key to making sure you or your loved ones are fully covered.

Medicare and Medicaid both provide health coverage—but they serve very different needs.

What Is Medicare?

Medicare is a federal health insurance program primarily for:

• People age 65 and older

• Certain younger individuals with disabilities

• People with End-Stage Renal Disease (ESRD) or ALS

Medicare is made up of several parts:

• Part A: Hospital insurance (inpatient care, skilled nursing, hospice)

• Part B: Medical insurance (doctor visits, preventive care, outpatient services)

• Part C (Medicare Advantage): Private plans that combine Parts A & B, often with extra benefits and sometimes include Part D

• Part D: Prescription drug coverage

💡 Medicare helps older adults and some disabled individuals get affordable health coverage, but it doesn’t cover everything.

What Is Medicaid?

Medicaid is a joint federal and state program that provides health coverage for people with low income and limited resources. Unlike Medicare, eligibility is based on financial need and varies by state.

Medicaid covers:

• Doctor visits, hospital stays, and preventive care

• Long-term care (like nursing homes or home health services)

• Prescription drugs (depending on the state)

• Some services Medicare does not cover, such as extended custodial care

💡 Medicaid is often a lifeline for individuals and families who can’t afford private insurance or who need long-term care.

Some people qualify for both Medicare and Medicaid—called ‘dual eligible’—for even more coverage.

Can You Have Both Medicare and Medicaid?

Yes—you can! People who qualify for both programs are known as “dual eligible.”

Here’s how it works:

• Medicare pays first for covered services

• Medicaid may help cover costs that Medicare does not, like premiums, deductibles, and copayments

• Many states also offer Special Needs Plans (SNPs) designed specifically for people who have both Medicare and Medicaid

This combination can significantly reduce out-of-pocket costs and provide more comprehensive coverage.

Key Differences Between Medicare and Medicaid

Feature	Medicare	Medicaid
Who it helps	People 65+ or disabled	People with low income/resources
Run by	Federal government	State & federal governments
Coverage	Hospital, medical, prescription drugs	Varies by state, includes long-term care
Cost	Premiums, deductibles, copays	Usually free or very low cost

Why Understanding Both Matters

Navigating healthcare coverage can feel overwhelming. Many people assume Medicare will cover all of their needs, only to realize later that there are gaps—especially in long-term care. Others may qualify for Medicaid but don’t realize they’re eligible.

By understanding how these two programs work (and how they can work together), you can:

• Save money on healthcare expenses

• Gain access to more services and care options

• Protect your savings and retirement income

Let’s Simplify It for You

Whether you’re nearing retirement, caring for a loved one, or exploring your eligibility for Medicaid, you don’t have to figure it all out on your own. At Mountaineer Health & Life Insurance, we’ll walk you through your options and help you find the right coverage for your situation.

📞 Call or Text - 304-989-5809

📧 Email us - info@mountaineerhealthandlife.com

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