Medicare vs. Medicaid: Differences, Eligibility & Coverage | TAXtical

Navigating the U.S. healthcare system can be overwhelming—especially when trying to understand the difference between Medicare and Medicaid. Both are government-funded programs that help cover healthcare costs, but they serve different groups, have separate eligibility criteria, and offer distinct benefits.

In this guide, the experts at TAXtical LLC break down everything you need to know about Medicare vs. Medicaid—so you can choose the program that best fits your health and financial situation.

What Is Medicare?

Medicare is a federal health insurance program for:

• Adults age 65 or older

• Individuals under 65 with qualifying disabilities

• People diagnosed with End-Stage Renal Disease (ESRD) or ALS

Medicare Coverage: What’s Included?

Medicare is divided into four parts:

• Part A (Hospital Insurance) – Covers inpatient care, skilled nursing facilities, hospice, and limited home health services.

• Part B (Medical Insurance) – Covers outpatient services like doctor visits, preventive care, and medical supplies.

• Part C (Medicare Advantage) – An all-in-one plan offered by private insurers that includes Parts A & B, and often dental, vision, and wellness benefits.

• Part D (Prescription Drug Coverage) – Helps pay for prescription medications.

Who Pays for Medicare?

• Part A is usually free if you’ve worked and paid Medicare taxes for at least 10 years.

• Parts B, C, and D require monthly premiums, which vary based on income and plan type.

What Is Medicaid?

Medicaid is a joint federal and state program that provides free or low-cost healthcare to low-income individuals and families.

Eligibility varies by state but generally includes:

• Low-income adults and children

• Pregnant women

• Seniors needing long-term care

• People with disabilities

Medicaid Coverage: What’s Included?

While coverage varies by state, Medicaid typically includes:

• Hospital stays and doctor visits

• Long-term care and nursing home services

• Mental health and behavioral therapy

• Dental and vision care

• Prescription drugs

Who Pays for Medicaid?

Medicaid is funded by both federal and state governments. Most enrollees pay little to no out-of-pocket costs, making it a lifeline for many Americans.

Medicare vs. Medicaid: Side-by-Side Comparison

Which Program Do You Qualify For?

• If you're 65 or older or have a qualifying disability → Medicare

• If you're a low-income individual or family → Medicaid

• If you qualify for both → You're “dual eligible” and may receive enhanced benefits and reduced out-of-pocket costs

Get Expert Help Navigating Medicare & Medicaid

Understanding the U.S. healthcare system doesn’t have to be difficult. At TAXtical LLC, we help individuals and families:

• Determine their eligibility

• Apply for benefits

• Plan for healthcare-related expenses

• Maximize coverage while minimizing out-of-pocket costs

📞 Contact us today for a personalized consultation on Medicare, Medicaid, and your healthcare financial strategy.