Understanding the difference between Medicare vs. Medicaid can be confusing, especially since both programs provide health coverage but serve different people. While Medicare provides coverage for older individuals and those with disabilities, Medicaid addresses benefits for low-income individuals and families.
At A.R. Pike Law, we focus on helping families, individuals, and small business owners in Virginia plan for their futures. Our work includes estate planning, elder law, Medicaid planning, long-term care strategies, and probate. If you need help understanding or planning for Medicare or Medicaid, reach out today.
What Is Medicare?
Medicare is a federal health insurance program covering people:
- Age 65 or older,
- Younger than 65 following 24 months of receiving Social Security Disability Insurance (SSDI) benefits, and
- People with end-stage renal disease or ALS.
The government organizes Medicare into several parts, including:
- Part A (hospital insurance)—inpatient hospital stays, skilled nursing facilities (up to 100 days), hospice care, and some home health services;
- Part B (medical insurance)—outpatient services such as doctor visits, lab tests, preventive checkups, and medical equipment;
- Part C (Medicare Advantage plans)—private plans combining Parts A and B, often including prescription drug coverage and additional benefits; and
- Part D (prescription drug coverage)—cost of medications.
Most people on Medicare pay:
- Premiums—monthly fees,
- Deductibles—what you must pay before Medicare begins covering costs, and
- Coinsurance—a percentage of costs you continue to pay after meeting the deductible.
The federal government does not base Medicare eligibility on the applicant’s resources.
What Is Medicaid?
Medicaid is health insurance for those with limited means. It is a joint federal and state program, with the federal government setting guidelines and the states administering it.
Medicaid has several programs, including:
- Regular Medicaid;
- Coverage for seniors (65+), persons who are aged, blind, or disabled (ABD); and
- Long-term care coverage.
A qualifying disability generally means a condition that prevents a person from working at a substantial level for at least 12 months or one expected to result in death.
Virginia Medicaid sets strict eligibility limits, which vary by program. Not all assets count against you for purposes of qualifying for Medicaid. For example, a family home, personal belongings, and one vehicle may be exempt.
Medicare vs. Medicaid Coverage Differences
Although both programs provide health coverage, key differences between Medicaid and Medicare distinguish them.
| Medicare | Medicaid | |
| Eligibility | Based on age (65+) or certain disabilities. | Must have limited income and assets. |
| Administration | Run entirely by the federal government. | Run jointly by the federal and Virginia governments, with rules set by Virginia within federal guidelines. |
| Coverage | Primarily covers hospital care, outpatient care, and prescription drugs. | Provides broader services, including long-term nursing home care and in-home assistance. |
| Costs | Requires premiums, deductibles, and coinsurance. | Usually free or very low cost, with small copayments in some cases. |
| Long-Term Care | Only short-term nursing care—up to 100 days in limited circumstances. | Often pays for extended nursing home care or ongoing support at home. |
| Disability | Available to people under 65 after receiving SSDI benefits for 24 months or immediately with ALS or end-stage renal disease. | Covers many people with disabilities who meet strict income and asset limits. |
For those above 65, the most significant difference between Medicaid and Medicare is that Medicaid has asset and income limits. Yet, the differences in Medicare vs. Medicaid coverage can be substantial as well, especially when it comes to long-term care. Finally, disability coverage varies, with Medicaid generally covering a broader group.
Guiding You Through Medicare vs. Medicaid in Virginia
At A.R. Pike Law, we know how confusing understanding Medicare and Medicaid can be. With years of combined experience in estate planning, elder law, and Medicaid and long-term care planning, our team helps Virginia families plan for the future.
Whether you need guidance on Medicaid eligibility, practical strategies to preserve property, or help aligning your Medicare benefits with long-term care planning, we are here to help.
If you are ready to discuss your options for healthcare, estate planning, or long-term care in Virginia, contact A.R. Pike Law today.
Resources:
- Medicare.gov, Get started with Medicare, link.
- Medicare.gov, Skilled nursing facility care, link.
- VA Department of Medical Assistance Services, Adults 19-64 Years Old, link.
- VA Department of Medical Assistance Services, Long-Term Services & Supports, link.
VA Department of Medical Assistance Services, Medicare, link.
