Medicaid vs. Medicare

What is the difference between Medicare and Medicaid? They may sound similar, but they usually serve separate groups of people.

What is Medicare?

Medicare is a health coverage program for individuals aged 65 and older and younger people with certain disabilities. Medicare is a federal program that offers the same benefits across the entire country no matter your income.

If you have Medicare, you will pay premiums, deductibles and copayments. In addition, low-income individuals may qualify for extra financial help through supplemental plans.

Medicare real-life example

Consider Tim, a 67-year-old retired engineer. Tim qualifies for Medicare due to his age.

Because he is eligible for Medicare, Tim will now have help covering his doctor visits, medical supplies, preventive services, and prescriptions.

What is Medicaid?

Medicaid is a state and federal program that provides health coverage for low-income adults, children, pregnant women and people with specific disabilities. Because Medicaid is run by the state, the rules may differ from state to state, but every state must follow the federal Medicaid guidelines.

Mother reading picture book to daughter on living room floor

Medicaid real-life example

Julia is a 32-year-old single mother with two children. Julia works part-time, but her income does not cover her family's expenses.

Julia qualifies for Medicaid based on her state's rules and will receive health coverage for doctor visits, hospital stays, dental and vision care, transportation, prescriptions and more.

What is Dual Eligibility?

You could also qualify for both Medicare and Medicaid. When this happens you are "dual-eligible" and can be enrolled in a Dual Eligible Special Needs Plan (D-SNP).

Depending on the level of Medicaid you qualify for, the state may cover your premiums, deductibles, coinsurance, copayments and prescription drug costs not covered by Medicare.

Knowing the difference between Medicare and Medicaid is important when choosing health coverage. Priority Health offers a variety of options to help you find the best plan for your needs. Call our Michigan-based customer service team at 888.975.8102 (TTY 711) to learn more.

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The difference between Medicare and Medicaid

What is Medicare?

Medicare real-life example

What is Medicaid?

Medicaid real-life example

What is Dual Eligibility?

Member Resources