Medicare and Medicaid: Breaking Down the Basics

There is more talk about the U.S. healthcare system than ever before, as reforms have put two of the most important programs, Medicare and Medicaid, in the spotlight for millions of Americans. Considering that these names sound similar, it is easy to mix up what these public benefits provide. Recent surveys report that at least a third of Americans are unsure about how these programs work or what each one covers. In hopes of clearing up confusion, this blog will explain what Medicare and Medicaid are, how they differ, and why it matters. 

What Is Medicare?

Medicare is generally provided under two circumstances: 

1. An individual reaches 65 years old

2.  An individual has a qualifying condition like End-Stage Renal Disease (permanent kidney failure) or Amyotrophic Lateral Sclerosis (progressive muscle weakness)

The federal government handles Medicare. This means that the same guidelines and benefits apply to all eligible Americans.

The program itself is split into four sections. Each part correlates to a specific aspect of medical expenses.

Part A is hospital insurance. It covers costs to be admitted to the hospital, spend time in a rehab or nursing facility, receive hospice services, or get certain types of home health care after a hospital stay.

Part B is medical insurance. This includes most routine health care needs outside the hospital. It offsets expenses for doctor appointments, lab work, routine checkups, and equipment like wheelchairs or walkers.

Part C is widely known as Medicare Advantage. This option allows you to pick a private insurance company to cover your Medicare, rather than getting it directly from the government. These plans include everything regular Medicare covers, with extra perks like dental, vision, and sometimes prescription drug coverage to make the offer even more appealing.

Part D is prescription drugs. It helps cover the cost of medications your doctor prescribes. This can be supplementary to regular Medicare or as part of a Medicare Advantage plan.

What Is Medicaid?

Medicaid is targeted towards low-income people, children, pregnant women, and disabled individuals. It is a joint federal-state partnership, so the program can look different depending on the state you live in. A wide range of health services are covered under Medicaid, including doctor visits, hospital care, prescription drugs, and preventive care. This welfare system supports around 80 million Americans, making it the largest payer for long-term care in the US. Medicaid functions as an entitlement program, so every qualifying individual is guaranteed to receive the benefits. Enrollment is typically free or at a very low cost. 

Key Differences

Feature	Medicare	Medicaid
Who qualifies	People 65+; younger with certain disabilities	Low-income individuals: children, pregnant people, some seniors, people with disabilities
Who manages it	Federal government	Joint federal and state management
Cost to patients	Premiums, deductibles, copays	Usually free or very low cost
What’s covered	Hospital, doctor visits, outpatient, preventive, some drugs	Broad services: hospital, doctor, long-term care, dental, vision, behavioral health
Long-term care	Very limited; short-term skilled nursing only	Extensive; covers long-term care like nursing homes and home care
Short-term care	Yes; hospital stays, rehab, skilled nursing (up to 100 days)	Yes; hospital, rehab, and more, depending on state
Network restrictions	Generally none; any provider accepting Medicare	Often state-approved networks/providers
Coverage varies by state	No; same nationwide	Yes; eligibility and benefits differ by state
Prescription drugs	Part D (separate plan)	Usually included
Extra benefits	Limited; some preventive extras	Often includes dental, vision, transportation

Why Does This Matter?

At Rise4Health, we serve people at free community clinics who are not covered by either of these federal programs. Their medical needs are still the same. That is why we create kits: to provide basic essentials that may be hard for them to obtain otherwise.

Final Takeaway

Medicare serves seniors and people with qualifying disabilities.

Medicaid serves low income individuals.

Both are lifelines, but they reach different groups and fill different gaps in our healthcare system. Sadly, there is a vulnerable, growing population covered by neither. If you or someone you might qualify for one of these programs but are unsure, there are free experts called “navigators” in every state who can help. And of course, Rise4Health is always here to answer your questions or connect you with resources.

Have more questions? Reach out anytime. We’re always happy to help however we can.