Medicare & Medicaid Working Together

Medicare and Medicaid might sound and act similarly, but in fact they are vastly different. While Medicare is the federal health care program for typically aged individuals and those on disability, Medicaid is for the population on a very low income. Medicaid is the federal and state program that provides health coverage to those who cannot afford it for themselves. When someone who lives on a very low income goes onto Medicare, they become dual eligible for both programs, at the same time. There are special plans that have been created specifically to meet the needs of people who receive both Medicare and Medicaid!

Medicare  Medicaid
What is it?
A federal health insurance program for people who are:
  • 65 or older
  • Under 65 with certain disabilities
  • Of any age and have End Stage Renal Disease (ESRD) or ALS
What is it?
A joint federal and state program that helps pay health care costs for certain people and families with limited income and resources. Different programs under the Medicaid umbrella are designed to help specific populations.

Medicaid is a federal and state program designed to pay the health care costs for individuals and families with very limited income and resources. There are many different programs for Medicaid, designed to help specific people.
Who governs it?
Federal government
Who governs it?
State governments
What does it cover?
Depends on the coverage you choose and may include:
  • Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
  • Doctor visits, care and services received as an outpatient, and some preventive care (Part B)
  • Prescription drugs (Part D)

Note: Medicare Advantage plans (Part C) combine Part A and Part B coverage, and often include drug coverage (Part D) as well - all in one plan.

What does it cover?
Every state has its own Medicaid programs, and so the coverage varies, dependent upon where you reside, but there are federal guidelines that require certain benefits be mandatory. Many states also opt in to offering additional and optional benefits as well.
  • Care and services received in a hospital or skilled nursing facility
  • Care and services received in a federally-qualified health centers, rural health clinic or freestanding birth center (licensed or recognized by your state)
  • Doctor, nurse midwife, and certified pediatric and family nurse practitioner services
  • And more
What does it cost?
It depends on the coverage you choose. Costs may include premiums, deductibles, copays and coinsurance. 
What does it cost?
It depends on your income and the rules in your state. Costs may include premiums, deductibles, copays and coinsurance. Certain groups are exempt from most out-of-pocket costs. 
How do I get it?
Many people are enrolled in Parts A and B automatically when they turn 65. You can also contact your local Social Security office to see if you are eligible. 
How do I get it?
Since each state governs its own Medicaid programs, the eligibility to get onto Medicaid varies. Most states do offer an online electronic application process for applying for Medicaid and have phone lines you can call to speak with a live person about Medicaid and how you may qualify.
  How does my Medicaid work with my Medicare?
There are different levels of Medicaid, which provide varying levels of financial assistance for your health care. Speak to your local Essential Solutions Medicare representative to learn what level of Medicaid you receive and how your specific Medicaid level financially assists with your Medicare health care costs.

We do not offer every plan available in your area. Currently, we represent 10 organizations that offer 115 products in your area.
Please contact, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options.