What’s the difference between Medicare and Medicaid?

Can you have both Medicare and Medicaid?

Yes. If you're 65 or older and meet your state's income requirements for Medicaid, you can sign up for both Medicare and Medicaid. Together, they offer more comprehensive health coverage at a lower cost.

What is a “Dual Eligible”?

Dual eligibles are people who qualify for both Medicare and Medicaid coverage. If you're enrolling in Medicare at 65 and qualify for Medicaid, you can sign up for Original Medicare or Medicare Advantage as a dual eligible. You get the healthcare coverage you need and help with additional healthcare costs.

If you have Medicare and Medicaid, which is primary?

While Medicare is the primary payer for medical needs, Medicaid can cover costs that Medicare coverage doesn’t. When you visit a provider that takes both Medicare and Medicaid, Medicare pays first for the cost of your care. Medicaid pays second, covering copays and other costs not covered.

If you qualify for both Medicare and Medicaid, you may be eligible for the Qualified Medicare Beneficiary (QMB) program, one of four Medicare Savings programs. With the QMB program, you'll get help with Part A and Part B premiums, coinsurance, and deductibles.

What are the 4 parts of Medicare?

• Medicare Part A and Part B, also known as Original Medicare, cover most inpatient and outpatient medical needs.
• Part C (also known as Medicare Advantage) and Part D (prescription drug coverage) are available through private insurers and provide coverage beyond what is included with Part A and Part B.

What does Medicare Part A cover?

Medicare Part A is your hospitalization insurance. Medicare Part A includes:

• Hospital stays (semi-private rooms)
• Hospital meals
• Nursing services
• Intensive care services
• Drugs, medical supplies, and equipment used on the premises
• Lab tests and X-rays taken while hospitalized
• Surgery and recovery costs
• Rehabilitation and therapy services
• Part-time home nursing care

What does Medicare Part B cover?

Medicare Part B provides for outpatient medical needs. Medicare Part B includes:

• Routine doctor visits
• Tests, screenings, and X-rays
• Flu shots and other vaccinations
• Necessary medical supplies
• Outpatient mental health care
• Medically necessary preventive care

What do Medicare Parts C and D cover?

You can add more coverage to your Original Medicare with Part C and Part D plans, which are offered through private insurers like Wellpoint. Medicare Advantage (Part C) plans provide all-in-one coverage that includes Parts A and B, and most cover prescription drugs as well. They typically have $0 or low monthly premiums, no medical deductibles, and may offer additional benefits including:

• Routine dental care including cleanings, X-rays, and dentures
• Routine vision care including contacts and glasses
• Routine hearing care including hearing aids
• Fitness programs, including exercise classes
• Spending allowances for over-the-counter health items, groceries^1,2, and utilities^1,2

Part D plans only offer prescription drug coverage. These plans are a good option when you just need drug coverage added to your Original Medicare.

Original Medicare covers a lot, but not everything. It doesn’t cover:

• Most prescription drugs
• Routine dental, vision, and hearing care
• 20% of your medical coverage (Part B)
• Out-of-pocket costs
• An annual Part B deductible
• Copays for every day after 60 days in the hospital

If you want additional coverage, you might want to consider Medicare Advantage Part C plans.