If you’re new to Medicare or helping a loved one, it’s easy to mix up Medicare and Medicaid—they sound similar, but they’re very different programs. The good news: once you understand the basics, it becomes much easier to choose coverage confidently and avoid costly mistakes.
Below is a clear breakdown of what each program is, who qualifies, and how they can work together.
What Is Medicare?
Medicare is a federal health insurance program mainly for:
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People age 65+
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Some people under 65 with qualifying disabilities
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People with End-Stage Renal Disease (ESRD) in certain cases
Medicare is generally divided into “parts”:
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Part A (Hospital Insurance): inpatient hospital, skilled nursing (limited), hospice, and some home health
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Part B (Medical Insurance): doctor visits, outpatient care, preventive services, and durable medical equipment
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Part C (Medicare Advantage): private plan alternative to Original Medicare (Part A + Part B), often includes extra benefits
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Part D (Prescription Drug Coverage): helps cover medications through private plans
Key point: Medicare eligibility is mostly based on age or disability, not income.
What Is Medicaid?
Medicaid is a state and federal program that provides health coverage for people with limited income and resources. Because it’s administered by states, benefits and rules can vary depending on where you live.
Medicaid may help cover things like:
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Doctor visits and hospital care
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Long-term services and supports (including nursing home care in many cases)
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Some home and community-based services
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Additional benefits that may differ by state (vision, dental, etc.)
Key point: Medicaid eligibility is largely based on income and financial resources (and sometimes household circumstances).
Medicare vs. Medicaid: The Quick Comparison
Medicare
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Federal program (same basic structure nationwide)
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Based on age/disability
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You typically pay premiums/copays (depending on plan)
Medicaid
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State + federal program (rules vary by state)
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Based on income/resources
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Costs are often lower, and coverage may be broader for long-term care
Can You Have Medicare and Medicaid at the Same Time?
Yes — and it’s more common than many people think.
If you qualify for both programs, you may be considered “dual eligible.” In many cases:
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Medicare pays first
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Medicaid helps cover remaining costs, like premiums, copays, or deductibles (depending on your level of Medicaid)
Some people who qualify for both may also be eligible for programs that help reduce Medicare costs, such as Medicare Savings Programs or Extra Help for prescription drugs.
Why This Matters (Common Mistakes to Avoid)
Here are a few issues I see frequently:
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Assuming Medicare covers long-term care.
Medicare typically does not cover ongoing custodial care in a nursing home. Medicaid is often the program that can help with long-term care when someone qualifies. -
Missing enrollment windows.
Even if you may qualify for Medicaid, Medicare enrollment timing can still matter—especially when avoiding late penalties. -
Overpaying for coverage.
If you qualify for assistance programs, you may be able to reduce premiums and prescription costs significantly.
How an Advisor Can Help
A Medicare advisor can help you:
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Compare Original Medicare vs. Medicare Advantage
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Check whether you may qualify for cost-saving assistance
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Confirm doctors and prescriptions are covered
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Avoid unnecessary penalties and enrollment mistakes
Next Step: Let’s Make This Simple
If you’d like, I can help you review your current coverage, prescriptions, and doctors and explain your options in plain English.
Schedule a consultation or reach out today to get started.
This content is for informational purposes only and does not constitute legal, tax, or medical advice. Program availability and eligibility rules may vary by location.