Medicare

Medicare is a federal health insurance program.

HHS.gov

Who it is for: Primarily adults aged 65 and older, as well as younger people with specific disabilities or permanent kidney failure. Eligibility is based on age and work history, not income.

Medicare (.gov)

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How it works: It is run uniformly by the federal government across all states.

HHS.gov

Parts of coverage:

Part A: Hospital insurance for inpatient stays and hospice care.

Part B: Medical insurance for doctor visits and outpatient care.

Part C (Medicare Advantage): Private plans that bundle various parts together.

Part D: Prescription drug coverage.

Medicare (.gov)

Medicaid

Medicaid is a joint federal and state assistance program.

Medicare (.gov)

Who it is for: People of any age with limited income and resources, including children, pregnant women, and people with disabilities.

The National Council on Aging (NCOA)

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How it works: It is funded jointly by federal and state governments and run individually by each state, meaning eligibility and benefits vary depending on where you live.

HHS.gov

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Coverage perks: It often covers long-term nursing home care and personal care services that standard Medicare does not fully pay for, usually with very low out-of-pocket costs.

UPMC Health Plan

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Dual Eligibility

Some individuals qualify for dual eligibility, meaning they are enrolled in both programs. In these cases, Medicare acts as the primary payer for medical services, while Medicaid helps cover remaining costs like copayments and deductibles