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Medicare vs. Medicaid



Who Administers it?

Federal Government

The Federal Government establishes uniform rules for Medicare at a national level

State Specific Programs

The Federal Government establishes uniform rules for Medicare at a national level

Who is Eligible?

Ages 65+


Eligible Disability/Illness

Anybody who meets the age and eligibility requirements, regardless of income.

Low Income

Anyone who meets the income requirements, regardless of age.

How much does it cost?

Standardized Premiums

Premiums are set at a federal level for Original Medicare. There are annual deductibles and coinsurance.

Generally Free

Generally free, although some states charge small fees for certain services. Medicaid may also pay OOP Medicare costs for eligible individuals.

What does it cover?


Covers medical services and hospital care, specific medical equipment and prescription drug coverage under Part D

Basic Health Care

Covers basic health care and prescription drug costs, long-term care, medical equipment, prescription eyeglasses, dental care and health services.


Date/Time Specific

Always Open

You are able to enroll in medicaid throughout the year, as it is always open.

Medicare & Medicaid Together

These requirements allow people to receive both Medicare and Medicaid at once. Both plans will put money towards your healthcare costs and greatly reduce your out-of-pocket costs.

Medicare will put money towards costs first, then Medicaid will pay its remaining share. The amount of money Medicaid will put towards costs is dependent on your coverage status. 

If you are fully eligible for both forms of coverage, all of your costs will be covered. If you are partially dually eligible, you may still have some out-of-pocket costs. There are different dual-eligibility programs that determine this:

  • QMB program: This program supports the payment of Medicare Part A and B premiums for individuals with an income 100% on the Federal Poverty Level (FPL). QMB Plus includes the benefits of QMB as well as full Medicaid benefits.

  • Specified Low-Income Medicare Beneficiary (SLMB) program: Pays the Part B premiums for individuals with an income >100 percent FPL but <120 FPL. SLMB Plus includes benefits from the SLMB program as well as full Medicaid benefits.

  • Qualified Disabled Working Individual (QDWI) program: If you return to work and lose your Medicare Part A coverage, you can buy back these benefits if you have an income up to 200% of the FPL.

  • Qualifying Individual (QI) program: Receives Medicare Part A benefits and has an income 120% of the FPL <135% of the FPL with no cap on the money given annually.

  • Pharmacy duals: Covers Medicare Part D premiums, deductibles, and other cost sharing for prescription drugs.

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