Understanding Medicare versus Medicaid

On Behalf of | Jan 23, 2023 | Elder Law

Elder law issues are sometimes complex and difficult to understand. If you have entered the later years of your life, or you are an adult child of an elderly parent who resides in Illinois, such issues may be especially relevant. At some point, you may have heard someone use the terms ”Medicare” and ”Medicaid,” as though they are interchangeable. In fact, they are two distinct and separate programs.  

Understanding the difference between Medicare and Medicaid may help ensure that you know which program best fits your needs at this time. On the other hand, if you aren’t sure about these programs, it might cause you to miss out on getting the help you need or in making sure that your loved one’s needs are met, especially if he or she resides in an assisted living facility.  

Medicare is a medical need-based program 

The primary difference between Medicare and Medicaid lies in how eligibility is determined. Both are types of health insurance. If you or your loved one are age 65 or older, you might be eligible for the federal health insurance plan known as Medicare. The U.S. Treasury holds two trust funds which provide coverage to people with certain conditions or disabilities.  

Your eligibility for Medicare is primarily based on your age and whether or not you have one of the conditions included on the approved list. If you have Medicare, you are still responsible for deductibles and monthly premiums. These rates are standardized, so if you relocate to another state, they stay the same. 

Medicaid is an income-based program 

The Medicaid program operates in cooperation at the state and federal levels of government. If you or your parent have limited income that meets the qualification requirements, the program can help cover medical expenses, prescription drug costs and other medical debt.  

Medicaid guidelines vary from state to state. One of its greatest benefits is that it can help cover costs that are not covered under the Medicare program.  

Dual eligibility 

In many cases, it is possible that you might be dually eligible for both the Medicare and Medicaid programs. In other words, if you meet the requirements, you can have both plans at the same time. While you would not have a monthly premium for Medicaid, as you would for Medicare, you might have a co-pay fee for certain things with Medicaid.  

If someone has dual eligibility, Medicare always gets billed first. Medicaid, on the other hand, pays last, after any other existing health coverage or financial assistance. Any number of complications or disputes may arise when navigating these systems, which is why it may be helpful to discuss a specific problem with someone who is well-versed in elder law issues. 


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NELF | National Elder Law Foundation
CAP | Council of Advanced Practitioners | NAELA | National Academy of Elder Law Attorneys, Inc.
Illinois State Bar Association