• Troyer & Good, PC

Difference Between Medicare and Medicaid

Updated: Feb 18, 2019



Medicaid and Medicare both help pay for medical bills, but the two programs are very different. They differ in eligibility requirements, how they operate under federal and state law, and the services they cover.


Eligibility. Your eligibility for Medicare does not depend on your financial status. Medicaid, however, has income and asset based requirements. In most cases, you must have low income and few assets to receive Medicaid. You can participate in both programs if you are eligible. A participant in both Medicaid and Medicare is referred to as “dual eligible.”


Federal and State Operations. Medicare is a federal program run by the Center for Medicare and Medicaid Services. You apply for Medicare at your local Social Security office. In Indiana, Medicare payments are handled by National Government Services. On matters of application, eligibility, or general information, you will usually deal with the Social Security Office. On matters of claims, coverage, and payment, you will often deal with National Government Services.


Medicaid is a federal-state program. In Indiana, the Family and Social Services Administration (FSSA) has ultimate responsibility over this program. You can apply for Medicaid online at the FSSA website. Medicare is basically the same throughout the United States whereas Medicaid varies from state to state.


Services. Medicaid also pays for more services than Medicare. In fact, Medicaid can pay for some of the gaps in Medicare coverage. Medicare has four parts to its services: (1) Part A can help you pay for in-patient care in a hospital and for limited care in a nursing home, hospice, or at home; (2) Part B can help you pay for doctors’ services, out-patient hospital services, and some other medical services and supplies; (3) Part C includes health plan options, such as HMOs or PPOs, approved by Medicare and run by private companies; and (4) Part D is prescription drug coverage.


Medicaid has much broader coverage. It will cover medical expenses such as physician services, nursing home services, prescription drugs, in-patient and out-patient hospital care, assisted living facilities, medical supplies and equipment, dental services, optometric services, and burial assistance.


You can find additional information regarding these two programs in our posts An Overview of Medicaid, Medicaid in Indiana, Planning Ahead for Medicaid, and Medicaid and Medicare: Which Pays for What?


Source: Indiana Laws of Aging by Indiana State Bar Association

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