Medicaid vs Medicare — What's the Difference?

What Is Medicare?

Medicare is a federal health insurance program primarily for people age 65 and older, as well as younger people with certain disabilities or End-Stage Renal Disease. Medicare is not based on income — you qualify based on age or disability status. Most people who worked and paid Medicare taxes for at least 10 years receive Medicare Part A (hospital insurance) at no cost. Part B (medical insurance) has a monthly premium.

What Is Medicaid?

Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families. Eligibility is based primarily on income and household size. In West Virginia, Medicaid was expanded under the ACA to cover adults with incomes up to 138% of the federal poverty level (about $20,120 for a single person in 2024). Medicaid is administered by the West Virginia Department of Health and Human Resources.

Key Differences Between Medicare and Medicaid

The most important differences:

• Medicare: age-based (65+) or disability-based; not income-based
• Medicaid: income-based; available at any age
• Medicare: federal program with standardized benefits
• Medicaid: joint federal-state program; benefits vary by state
• Medicare: has premiums, deductibles, and cost-sharing
• Medicaid: little or no cost-sharing for most enrollees

Dual Eligibility — Having Both Medicare and Medicaid

Some people qualify for both Medicare and Medicaid — these individuals are called 'dual eligibles.' If you have both Medicare and Medicaid, Medicaid can help pay for Medicare premiums, deductibles, and cost-sharing. There are also special Medicare Advantage plans designed specifically for dual-eligible individuals that coordinate benefits from both programs.

West Virginia Medicaid

West Virginia expanded Medicaid under the ACA, significantly increasing the number of residents eligible for coverage. WV Medicaid covers doctor visits, hospital care, prescription drugs, mental health services, and more. To apply for WV Medicaid, visit dhhr.wv.gov or call the WV DHHR. AG Insurance can help you understand whether you qualify and what coverage is available.

Medicare Savings Programs

If you have Medicare and a limited income, you may qualify for a Medicare Savings Program that helps pay your Medicare premiums and cost-sharing. These programs are administered through Medicaid. There are four levels of Medicare Savings Programs based on income, ranging from paying only the Part B premium to paying all Medicare premiums and cost-sharing.