Medicare vs. Medicaid

Medicare and Medicaid are both government-sponsored health insurance programs that assist Americans in need of healthcare support. However, the health insurance plans are different and are designed to cover the healthcare bills of two distinctive groups of Americans. Medicare primarily offers coverage to adults 65 and over, while Medicaid covers low-income people of any age.

Medicaid is funded by the states, so qualification for the insurance program varies. In contrast, Medicare eligibility is the same across the nation. As you consider these programs, Avila Medicare Solutions wants to help you understand the significant differences between Medicare and Medicaid.


To be eligible for Medicare, you must be age 65 or older and be a citizen or permanent resident of the United States. Medicare can also be extended to Americans with qualifying disabilities and diseases such as ALS or ESRD.

However, while Medicaid eligibility varies from state to state, it primarily depends on income, family size, or disability. The people who may be eligible for Medicaid include low-income individuals or families, teenagers living alone, pregnant women, disabled people, and those with high medical costs.


Both Medicaid and Medicare plans may include deductibles, premiums, coinsurance, and copays. However, when it comes to Medicare, the amount you will pay is based on when you sign up, the coverage options you choose, and the health items and services you use throughout the year. There are four different Medicare Savings Programs (MSP) designed to help people with the costs of Medicare. So, if you qualify for an MSP, you could get help paying for your premiums, coinsurance, deductibles, and copayments.

As for Medicaid, what you pay for the insurance plan depends on your income level and the rules in your state. Moreover, certain groups under the Medicaid program are exempt from a lot of out-of-pocket costs.


There are several different aspects of Medicare that provide coverage for different parts of medical care. Medicare Part A offers hospital and inpatient coverage, and Medicare Part B covers medically required services and equipment. Medicare Part D provides prescription drug coverage. Medicare Part C, also known as Medicare Advantage, is a Medicare coverage option that combines Medicare Part A and B coverage with additional benefits.

Some of the additional benefits from Part C can include coverage for prescription drugs, vision, dental, hearing, and more. The benefits provided by Medicaid vary from state to state, but the benefits included in every Medicaid plan include:

  • Inpatient and outpatient hospital services
  • Lab and X-ray services
  • Family planning services
  • Nursing facility services for adults
  • Applicable medical treatments and health screenings for children
  • Dental and surgical services for adults

For more information on the differences between Medicare and Medicaid, contact Avila Medicare Solutions in Austin, Texas. Our health insurance experts can help you assess your situation and help you apply.

Don’t wait. Give us a call now at 855-GO-AVILA, and we will answer any questions you may have.