Medicaid vs. Medicare: What is the difference, and which one is right for me?
According to the most recent data from CMS (Centers for Medicare & Medicaid Services), in 2025 more than 90 million people will depend on this coverage in the U.S.
Health center during a vaccination campaign in California.
When it comes to health insurance in the country, Medicaid and Medicare are the two most important government programs, but they are often confused. Understanding the differences between Medicare and Medicaid, as well as their eligibility requirements, is critical to knowing which one covers you and how to successfully complete your application.
What is Medicaid, and who can qualify for this program?
Medicaid is a health care program jointly funded by the states and the federal government. It is designed for low-income individuals and families who meet certain specific criteria. Because each state administers its own plan, requirements may vary, but generally the eligibility profile includes:
- Families with limited income: especially those with young children or pregnant women.
- People with disabilities: individuals who require ongoing medical assistance.
- Seniors: senior citizens with special financial needs.
- Income criteria: based on the Federal Poverty Level (FPL).
According to the most recent data from the CMS (Centers for Medicare & Medicaid Services), in 2025 more than 80 million people depend on this coverage in the U.S.
Medicare requirements: Age and health conditions
Unlike the previous program, Medicare is federal health insurance designed primarily for people aged 65 and older. However, it also offers coverage to younger citizens under specific conditions:
- People with Social Security-qualified disabilities.
- Patients with end-stage renal disease (ESRD) or ELA.
The four parts of Medicare coverage:
- Part A (Hospital Insurance): covers hospitalization and nursing care.
- Part B (Physician Insurance): includes doctor visits, outpatient services and medical equipment.
- Part C (Medicare Advantage): private plans that combine Parts A and B, and often D.
- Part D (Prescription Drugs): helps cover the cost of prescription drugs.
The Social Security Administration (SSA) recommends starting the enrollment process three months before your 65th birthday to avoid penalties for late enrollment.
Dual eligibility: Can I have Medicare and Medicaid at the same time?
It is possible to qualify for both programs simultaneously; these beneficiaries are known as "dual eligible." This situation occurs when the applicant:
- Meets the age or disability requirements for Medicare.
- Has limited income and assets that allow him/her to qualify for Medicaid in his/her state.
What's the advantage? Having both programs allows Medicaid to cover most out-of-pocket costs, such as co-payments, deductibles and additional services that Medicare does not fully cover, such as long-term care.
How to apply for Medicare and Medicaid in Spanish
The application process can be done entirely in your language to avoid errors in documentation:
- To apply for Medicaid: you must go to your state health agency or to the official Medicaid.gov site. Most states have forms and telephone assistance in Spanish.
- To apply for Medicare: you can apply online through the SSA (Social Security Administration) portal or go to a local office.
Basic documentation required:
- Proof of identity (passport, state ID).
- Proof of immigration status or citizenship.
- Proof of income (W-2, tax returns).
- Proof of residency in the U.S.
Just The News
HHS report finds Medicaid paid over $200 million in incorrect payments for deceased recipients
Misty Severi
Secure your health coverage
Knowing the difference between Medicaid and Medicare is essential to protecting your well-being and finances. If you qualify for both, you could maximize your benefits and drastically reduce your medical expenses.
Applying on time and using the resources available in Spanish makes it easier to access the U.S. health care system and avoid disruptions in your medical care.
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