Medicare vs. Medicaid: Why They’re Different (And Why It Matters)

Many people in Delray Beach — and across Florida — use the terms Medicare and Medicaid interchangeably. They sound similar, but they are very different programs. Confusing the two can lead to missed benefits, enrollment mistakes, or unnecessary stress.

Let’s clarify the difference.

What Is Medicare?

Medicare is a federal health insurance program primarily for:

    •    Adults age 65 and older

    •    Certain younger individuals with disabilities

    •    People with specific qualifying medical conditions

Medicare eligibility is generally based on age or disability status — not income.

Coverage typically includes:

    •    Hospital insurance (Part A)

    •    Medical insurance (Part B)

    •    Optional prescription drug coverage (Part D)

    •    Or a Medicare Advantage plan

Medicare does not automatically cover everything, and costs vary depending on your plan choices.

What Is Medicaid?

Medicaid is a joint federal and state program that provides health coverage based primarily on income level.

Eligibility depends on:

    •    Income

    •    Assets

    •    Household size

    •    State guidelines

In Florida, Medicaid helps low-income individuals, families, and some seniors who qualify financially.

When Someone Has Both

Some individuals qualify for both Medicare and Medicaid. These are often called “dual eligible” beneficiaries.

In these cases:

    •    Medicare is usually the primary coverage

    •    Medicaid may help cover premiums, copays, or additional services

But eligibility rules are specific and vary from person to person.

Common Myths People Hear

You may have heard:

    •    “If you’re on Medicare, you automatically qualify for Medicaid.”

    •    “Medicaid replaces Medicare.”

    •    “Everyone over 65 is on Medicaid.”

These statements are not accurate. The programs serve different purposes.

Why This Difference Matters

Understanding whether you have Medicare, Medicaid, or both affects:

    •    What you pay

    •    What services are covered

    •    Which plans you can enroll in

    •    Whether you qualify for cost assistance

Because eligibility depends on both age and income, no two situations are identical.

What applies to your neighbor may not apply to you.

If You’re Unsure Which Applies to You

If you live in Delray Beach and feel uncertain about your coverage — or whether you may qualify for additional assistance — it’s worth clarifying.

Medicare decisions are personal. Income, assets, and health needs all play a role.

If you’d like to review your situation and understand which program applies to you, Medicare Plan Assistance is available to answer your questions.

A short conversation can provide clarity and help you move forward with confidence.

Call now! (561) 808-9410.