Medicare and Medicaid are both government-sponsored programs that help cover medical costs, but there are some key differences between them. To give you a better understanding of the type of medical coverage that may be available to you, our team at The Gardens at Barry Road senior living community created this comparison guide. Read on to explore what makes Medicare different from Medicaid.
One of the most important differences between Medicare and Medicaid is who administers it. Medicare is a federal program administered by The Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services. Congress passes laws that govern Medicare, and the CMS uses these laws to create coverage rules.
Medicaid is a joint federal and state program, and an agency in each state is responsible for administering the program for its residents. Congress passes laws that all states must adhere to when establishing programs, but some decisions are left up for state lawmakers to decide. As a result, the rules for Medicaid vary from state to state.
Medicare doesn’t have any income requirements. The program helps cover the cost of eligible medical expenses for:
In Missouri, Medicaid helps pays for medical expenses for people who are one of the following:
If you meet the eligibility requirements for the programs, it’s possible to have both Medicare and Medicaid coverage.
Medicare has no income or asset eligibility requirements. If you fall into one of the covered categories, you can apply for Medicare.
To be eligible for Medicaid in Missouri, you must qualify as low income. As of 2023, single people over the age of 65 can earn no more than $1,033 per month, and married seniors can earn a maximum of $1,397 per month.
Missouri also looks at assets for those over 65 when deciding whether to approve their Medicaid application. Assets include property, vehicles and money in investments. To qualify for Medicaid, a single person over the age of 65 must have less than $5,726 in total assets. The maximum total asset level for married seniors is $11,452.
With both Medicare and Medicaid, seniors have some flexibility when choosing health care coverage. Missouri partners with private health insurance companies to provide Medicaid coverage, and seniors can choose the insurer they prefer from its approved list.
There are two main options when it comes to Medicare: Original Medicare and Medicare Advantage. The federal government manages original Medicare, while seniors purchase Medicare Advantage Plans through approved private insurers.
What Medicare and Medicaid cover is also different. Generally, Medicaid will help pay for some things that Medicare typically doesn’t.
Seniors with Original Medicare receive coverage for hospitalization through Medicare Part A, as well as help paying for doctor’s visits, outpatient care, eligible medical equipment and preventive care. Medicare Advantage Plans must cover everything that Original Medicare does and may provide additional benefits, such as vision and dental coverage. Most Medicare Advantage Plans don’t cover long-term care.
Some Medicare Advantage Plans include prescription drug coverage. Seniors enrolled in Original Medicare or a Medicare Advantage Plan that doesn't cover prescription drugs can get coverage by purchasing a Medicare Part D plan.
For seniors, Missouri’s comprehensive Medicaid program covers:
Costs are another area where Medicaid and Medicare differ. Each type of health coverage has different rules for premiums, deductibles and co-pays and coinsurance.
A premium is something you pay each month to receive health care coverage. Seniors typically don’t pay monthly premiums for Medicaid in Missouri. In some cases, Medicaid may help pay for all or some of a senior’s Medicare premiums, deductibles, co-pays and coinsurance.
The costs a person is responsible for paying under Medicare rules depend on their income and the type of Medicare they're enrolled in. The following are the costs as of 2023:
A deductible is an amount you must pay out of pocket before your health coverage will cover the cost of medical expenses. Medicaid doesn’t have deductibles, but Medicare does. Here’s a look at Medicare deductibles as of 2023:
Co-pays are a fee you pay to a health care provider for a service, while coinsurance is a portion of medical expenses you’re responsible for paying out of pocket. Depending on income and other factors, some people enrolled in Missouri’s Medicaid program must pay a co-pay when receiving certain health care services. Co-pays range from $0.50 to $10.
For Medicare, co-pays and coinsurance as of 2023 were:
