Difference Between Medicare, Medicaid and MassHealth

Government programs are often mistaken for one another, which is understandable since they all tend to be equally confusing. When it comes to healthcare, it’s important to distinguish between the programs to understand what they cover, or more importantly, what they do not cover. Here’s what you should know about the difference between medicare, medicaid and MassHealth.


Medicare is a federal health insurance program offered solely to seniors (over age 65). There are several different plans available, some of which are offered through private insurance companies in the state.

  • Medicare Part A – Coinsurance for hospital care, nursing care, hospice, and home health services.
  • Medicare Part B – Covers preventative care, treatments for medical conditions, hospitalization and supplies. Offers limited drug coverage.
  • Medicare Part C – Health Insurance through private companies. Covers what is normally offered in Part A and Part B but possibly with added benefits such as vision, dental, and prescriptions.
  • Medicare Part D – Prescription drug coverage.
  • Medicare Supplement – Covers gaps in coverage from the above, such as copays and deductibles.

Medicaid & MassHealth

Medicaid and MassHealth actually refer to the same program. Unlike Medicare, it’s income and/or asset based (depending on the particular program) rather than age based. It is a joint federal and state program designed for low to moderate income residents. Coverage options vary based on age and medical conditions. You must apply and demonstrate that you meet qualification criteria.

Important Difference Between Medicare, Medicaid and MassHealth

As you can see, the options and coverages can vary but are typically quite extensive. So, what is the most important difference between Medicare, Medicaid and MassHealth? Some things you should evaluate are copays, deductibles, and caps/limitations for these programs. For instance, Medicare will cover a stay in a rehabilitation center  for up to 100 days whereas Medicaid would cover long term care if you meet the eligibility requirements. Some pre-planning may be required to improve your chances of qualifying for Medicaid. Contact us to learn more about Massachusetts Medicaid Planning.