Medicare vs. Medicaid: What you need to know

UnitedHealthcare is proud to serve our members by providing coverage for care and working to improve the health of their communities through our government programs, Medicare and Medicaid. As the nation’s largest provider of these government programs, we have deep experience with both programs and the distinctions in the valuable coverage for care they both offer. There are important differences to understand as you think about the coverage you may need. Let’s take a look at how they differ.  

Medicare is individual health insurance from the federal government, available for people who are 65 or older. People under the age of 65 may also be covered by Medicare if they have a qualifying disability or other special situation. To be eligible, you must also be a U.S. citizen.

Medicare is made up of several parts:

• Medicare Part A: This covers health care expenses associated with hospital stays and in-patient care.
• Medicare Part B: This covers costs associated with visits to the doctor, as well as outpatient care. Together, Medicare Part A and Part B are referred to as Original Medicare.
• Medicare Part C: Also called Medicare Advantage, Medicare Part C is an alternate way to receive Medicare Part A and Medicare Part B coverage. It is offered by private insurance companies and includes all the Part A and Part B benefits, along with additional coverage that may include dental, vision, prescription drugs and more.
• Medicare Part D: Also called Medicare prescription drug coverage, Medicare Part D covers some prescription drugs, excluding those that Medicare Part A and Part B already cover. Medicare Part D is available as a stand-alone plan or may be part of Medicare Advantage plan. It is administered by a private insurance company and has recently undergone several significant updates. 

Medicaid is health insurance for people who have a limited or low income, including:

• Women who are pregnant
• Children in low-income families or in foster care
• Seniors
• Parents or caregivers
• People with disabilities

Each state runs their own Medicaid program but complies with federal and government rules and regulations. Because of this, each state can determine their own eligibility requirements, and the benefits offered outside of those that are mandatory, per the law. Mandatory benefits include, but are not limited to:

• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic and treatment services (EPSDT)
• Home health services
• Physician services
• Federally qualified health center services
• Laboratory and x-ray services
• Family planning services

Optional Medicaid benefits that states may choose to cover include:

• Prescription drugs
• Clinic services
• Dental services and dentures
• Podiatry services
• Optometry services
• Chiropractic services
• Case management

Medicaid also provides coverage for Home- and Community-Based Services (HCBS). HCBS benefits are designed for people living at home that require additional support, such as personal care, transportation, physical therapy and more.

Low-cost insurance for infants and children is also available from Medicaid, through the Children’s Health Insurance Program (CHIP). CHIP covers services including:

• Well-visits
• Vaccinations
• Hospital care
• Dental care
• Vision care
• Prescription drugs

The CHIP program is managed on a state-by-state basis, and each state determines who is eligible and the specific benefits offered. 

It is also possible that someone can qualify for both Medicare and Medicaid. In this case, they are eligible for a Dual Eligible Special Needs Plan, also known as D-SNP.

People who qualify for a D-SNP plan often have additional health care needs, such as a mental disorder or a condition that requires in-home support. Along with the coverage available through Medicare and Medicaid, D-SNP plans offer extra benefits that include transportation to appointments and credits that can be used toward health care products.

Medicare, Medicaid and D-SNP are just a few examples of the health insurance a person can have. Health insurance is also frequently available through plans offered by your employer or can be purchased under the Affordable Care Act (ACA).

Regardless of the type of insurance you choose, it’s important to know your coverage to help you stay prepared, protected and healthier.