Medicaid versus Medicare

Medicaid. Medicare. Why is there so much confusion between the two?

Let's help clarify!

Medicaid is managed by the State and the benefits vary based on the individual’s income.  Medicare is managed by the federal government and is mainly based on age. In unique circumstances, such as certain disabilities, younger people can qualify for Medicare.

What is Medicaid?

Medicaid offers health care at lower or no cost at all. It is managed by the State of Hawaii so the eligibility requirements vary from state to state. Hawaii’s Medicaid program is called MED-QUEST and the individual will need to recertify each year.

Medicaid covered the following groups: 

1. Adults: Provides Medicaid eligibility for individuals age nineteen years or older and under age sixty-five years.

2. Children: Provides Medicaid eligibility for infants and children under age nineteen, or under age twenty one years old and in receipt of foster care, kinship guardianship, or adoption assistance.

3. Former Foster Care Children: Provides Medicaid eligibility for certain former beneficiaries of foster care, kinship guardianship, or adoption assistance who are age eighteen years but under age twenty-six years old.

4. Parent and Other Caretaker Relatives: Provides Medicaid eligibility for a parent or other caretaker relative living with a child under age nineteen years.

5. Pregnant Women: Provides Medicaid eligibility for pregnant women to include a pregnant individual under age nineteen years, whose household income exceeds the age-specific income standard for a household of applicable size for participation under Title XIX of the Social Security Act, or under age twenty-one years and in receipt of foster care, kinship guardianship, or adoption assistance.

6. Transitional Medical Assistance: Provides Medicaid eligibility provisions of transitional medical assistance for a pregnant woman, or parent or caretaker relative, to include a qualified non-citizen, living with a child under age nineteen or an individual who is under age twenty-one and in receipt of foster care, kinship guardianship or adoption assistance, who becomes ineligible for medical assistance as a result of increased earned income, or collection or increased collection of spousal support payments under section 1925 of the Social Security Act.

7. Aged, Blind, and Disabled: Provides Medicaid eligibility for aged, blind, and disabled individuals under the provisions of Title XIX of the Social Security Act.


What is Medicare?

Medicare is a national health insurance program run by the federal government. Medicare covers:

1. People age 65 and older.
2. Some people under age 65 who may qualify due to a disability or another special situation.

Medicare helps millions of American seniors and disabled individuals cover some of their health care costs.

There are 4 different parts to Medicare. 

Medicare Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

Medicare Part B (Medical Insurance) covers, including doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services.

Medicaid Part C combines Part A (hospital insurance) and Part B (medical insurance) in one plan that often includes prescription drug coverage too.

Part D covers prescription drug coverage.

Can one qualify Medicaid and Medicare?

Yes! Some may quality for both Medicaid and Medicare if they meet all of these requirements: 

1. They meet the age requirement of 65 years or older -or- they have a disability
2. They meet the Medicaid requirements for the state. 

You or your aging loved one can be  “dual eligible” because they meet both Medicaid and Medicare requirements. Dual health plans combine hospital, medical and prescription drug coverage. You or your loved one will keep all your Medicaid benefits and could get more benefits than with original Medicare. The best part is that it could all be for a $0 plan premium.

For more information or to see if you qualify, please contact your healthcare provider and/or visit

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