Medicare vs Medicaid: Coverage Options for Older Adults
| Feature | Medicare | Medicaid |
|---|---|---|
| Who it serves | Primarily people age 65+ and some younger people with qualifying disabilities or certain illnesses. | Low-income individuals and families; many states also cover older adults, people with disabilities, and other qualifying groups. |
| Who runs it | Federal program with uniform national rules. | Joint federal–state program; each state sets eligibility and many benefit details within federal guidelines. |
| Main coverage | Hospital care, doctor visits, preventive care, and prescription drugs through different parts (A, B, C, D). | Comprehensive medical coverage that often includes hospital care, doctor visits, prescriptions, and in many states long-term services and supports. |
| Prescription drugs | Usually covered through Part D or some Medicare Advantage plans; plans vary by cost and formulary. | Typically covered, but specific rules, co-pays, and preferred drug lists vary by state. |
| Long-term care | Very limited; generally does not cover custodial long-term care in nursing homes or at home. | Major payer for nursing home care and home- and community-based services for eligible people; rules vary by state. |
| Home health care | Covers some medically necessary home health services under specific conditions. | Can cover home health and other in-home support services, depending on eligibility and state program design. |
| Out-of-pocket costs | Can include premiums, deductibles, and coinsurance; amounts vary by part and plan. | Usually low or no premiums, with small co-pays in some cases; many beneficiaries pay little or nothing. |
| Dual coverage | Some people qualify for both; Medicaid can help pay Medicare premiums and cost sharing. | Same as left; “dual eligibles” often have Medicare as primary and Medicaid as secondary payer. |
