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Medicare vs Medicaid

Medicare and Medicaid might be two government-funded programs who assist individuals with valuable coverage, but they do have their differences.


Medicare was created to assist individuals with medical costs. Those eligible for the program include individuals 65 and older, or individuals under 65 with a disability.

The coverage for Medicare is divided into four parts: A, B, C, and D. Parts A and B (Original Medicare) are the hospital and medical insurance of the program, which covers inpatient and outpatient services. A Medicare Supplement Plan can be bought in addition to Original Medicare to cover out-of-pocket expenses.

Part C (Medicare Advantage) has the same coverage as Original Medicare, but does not allow for Medicare Supplements. However, Medicare Advantage Plans provide extra coverage, such as vision, hearing, and dental coverage.

Part D is the Medicare prescription drug coverage plan, which can be included in a Part C plan as an added benefit, or purchased as a standalone plan with Original Medicare.

Medicare beneficiaries typically have to pay premiums, deductibles, coinsurance, and copayments.


Medicaid provides coverage for those with a very low income, but the benefits vary among each state. However, the mandatory benefits include:

  • X-rays
  • Lab services
  • Home health services
  • Physician services
  • Inpatient/outpatient services
  • Pediatric services
  • Nursing services
  • Family planning/midwife services
  • Family nurse practitioner services

Optional benefits include:

  • Physical therapy
  • Occupational therapy
  • Prescription drug coverage
  • Optometrist and dental services
  • Prosthetic services
  • Medical transportation

Medicaid beneficiaries typically do not pay anything for covered medical expenses, but a small copayment may be required.

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If you are eligible for both Medicare and Medicaid then you are dual-eligible. To enroll in a D-SNP (Dual-eligible Special Needs Plan), you must be enrolled in Original Medicare and receive full Medicaid benefits. If you don’t receive full Medicaid benefits, you may be considered partially dual-eligible.

To learn more about your eligibility for Medicare and Medicaid, give Rothrock Insurance Solutions a call today!