Difference between Medicare and Medicaid

In this article let us learn about what is the difference between medicare and medicaid insurances.

These are the insurance policies handled by the Federal Agency or the Government for the citizens in the US. The main ones are as follows:


  • CMS administers Medicare and it a nationwide largest insurance program.
  • Medicare ID’s are called as HIC# Number (Health Insurance claim)
  • HIC – Format is 10 characters, 9 digits followed by alpha (Example:123-45-6789A)

This is a type of Federal Policy and is sub-divided into:

  • Medicare Part A: To become a member under this policy the patient has to either be above 65 years of age or should be ESRD (End Stage Renal Disease) patient or be a physically challenged person. In addition, its main features are that they are premium free, covers for technical components and the insurance pays 80% of the allowed amount and the balance 20 % is patients’ responsibility as co-insurance.
  • Medicare Part B: This is a premium-based policy available to all the citizens of US and they cover mostly the professional components.
  • Medicare Part C: Patients who have both Part A & Part B coverage of Medicare are eligible for Part C coverage. This is also known as Comprehensive Coverage and Medicare HMO.
  • Medicare Part D: This is also a premium-based policy and pays for prescription drugs.


This is another Federal policy, which covers the medical bills of those patients who are below the poverty line.

Main features are:

  • They are premium free.
  • No patients’ responsibility.

Note on Medicaid: This policy has to be renewed on a monthly basis and if the patients’ income is above the limit that the government has set for a particular month then the patient has to pay that additional amount towards his medical bills, if he has any for that particular month. The payment of that amount towards his medical bills is known as SPENDOFF.


Difference between Medicare and  Medicaid

Medicare Part A

  • Part A received automatically
  • Yearly deductible for Patient to pay in 2009 is $1068
  • Need not purchase
  • Covers inpatient hospital expenses
  • Pays for Hospital, SNF and Hospice

Medicare Part B

  • Need to Purchase
  • Yearly deductible for patient to pay in 2009 is $135
  • Covers outpatient
  • To purchase part B one should have part A
  • Pays for consultation, outpatient Hospital services and for Durable medical equipment


  • It is a Federal Insurance
  • Each state operates its own Medicaid programs with certain federal guidelines.
  • Covers individuals and families with low income and resource.
  • There is no Patient responsibility in most cases.
  • In some cases “SPEND DOWN CHARGES AND COPAY” is applied.
  • It is also called as “LAST PAYER”.

Leave a Reply

Your email address will not be published. Required fields are marked *