Medicare is a Federal health program for those 65 and older, disabled, and those with end-stage renal disease (ESRD). As long as one of these requirements are met, people are eligible regardless of income.

Medicaid is a combined federal/state program for the poor, aged, disabled, and some children. Children not eligible for Medicaid are often eligible for the Child Health Insurance Program (CHIP), a part of the Federal social safety net. Eligibility for Medicaid and CHIP is dependent on household income and resources.

Requirements for Medicare are uniform across all states. Eligibility, benefits, co-payments, deductibles, and other factors for Medicaid vary from state to state.

What Impact Did the Affordable Care Act (ACA, “Obamacare”) Have?

The ACA gave additional money to states to expand Medicaid to include people with incomes up to 133% of the Federal poverty level, or $35,245 for a family of four. As of 2021, all but twelve states have taken the Federal government up on this offer.

Medicare is funded by the Federal Medicare tax and general revenues. Medicaid is funded by a mix of Federal and state funds, with the ratio determined by the ratio of the state’s income level to the national income level, and varies from 50 to 78 percent. States that have expanded Medicaid get up to 90% for the population covered by the expansion.

What Are Some Other Differences?

Besides eligibility, one of the biggest differences is coverage. Medicare has strict limits on long-term care, covering it for only a limited number of days after an acute hospitalization. Long-term custodial care in the US is largely covered by Medicaid. Medicare will not seize property to pay for long-term care after the recipient dies. Depending on state policies, Medicaid can. Medicaid has protection for spouses who continue to live independently when their partner is in a nursing home; this is called “spousal impoverishment protection.” Medicare has no such protection. Medicaid accounts for 43% of national spending on long-term care. For in-home care, Medicare accounts for 32% and Medicaid for 23%.

Can One Receive Both Medicare and Medicaid?

Yes. People who are enrolled in both programs are called “dual-eligible.” Medicare Advantage D-SNPs are available to all dual-eligible. To learn more about the differences between Medicare and Medicaid and if you might be dual eligible, give The Coleman Agency a call today!