What's The Difference Between Medicare & Medicaid? Find Out If You're Eligible

From Blue Cross NC By Brian Edmonds
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I admit that I didn’t fully understand the difference between Medicare and Medicaid before I started working in health care. I know I’m not alone. It’s confusing, and I’ve come to realize that many people are unfamiliar with how each one works.

It’s important that we understand the options and benefits each program provides, as well as recent changes and enhancements that will offer not only increased access to health care, but better value for North Carolinians.

But first, let’s begin with the basic questions. What is Medicare? What is Medicaid?


Medicare, which is run by the Centers for Medicare & Medicaid Services, is:

  • A federal insurance program

  • Serves people primarily over the age of 65 regardless of income

  • Serves younger disabled people and dialysis patients

Patients pay part of costs through deductibles for hospitals and other services as well as a small premium for their non-hospital coverage.


Medicaid is a federal-state assistance program that:

  • Serves low-income people of every age

  • Varies from state to state

Patients usually pay no part of costs for covered medical expenses though a small co-payment is sometimes required. Medicaid is run by state and local governments within federal guidelines.

Community Impact

As we work to transform health care, it’s critical that we provide the help and tools necessary to give every person access to quality health care that’s simpler, better and more affordable.

Women and children represent a large segment of Medicaid enrollees. Access to health care at an early age certainly has an impact on how a child grows up to impact the communities in which they live.  For some children, this program gets them off to a healthy start, whereas Medicare, which will hopefully benefit everyone of us at some point in life, will be there for us at the finish line.

Similar logic can be applied for seniors who reach Medicare eligibility. Having access to quality health care is an important factor in not only extending life but also their quality of life. Healthier communities are better communities.

With much talk around how to reign in increasing health care costs in the U.S., it’s important to be aware of changes that are happening with Medicare and Medicaid, specifically the ones targeted towards underserved North Carolinians.

Healthy Blue + Medicare

Affordable, quality health care for low income Medicare beneficiaries shouldn’t be a burden. Last fall, Blue Cross NC offered $0 premium plans again for Medicare beneficiaries in its Blue Medicare Advantage service area along with drug coverage and enhanced benefits for its 2021 Medicare Advantage (MA) plans.

Blue Cross NC’s Medicare Advantage plans are a great option for the Medicare eligible. But we recognized that more could be done for those who were also eligible for Medicaid. That led Blue Cross NC to launch Healthy Blue + Medicare, a Dual-Eligible Special Needs Plan (D-SNP) that provides a new option for individuals eligible for both Medicare and Medicaid.

Healthy Blue + Medicare will make care more accessible and more affordable. Beyond the $0 premium for eligible enrollees, it provides enhanced benefits such as access to nutritious food, dental services and eyewear, and $0 primary copays. This plan moves us forward in the right direction as we work to provide essential, valuable healthcare benefits for the people who really need it.

Last week Blue Cross NC enrolled its first members in Healthy Blue, our Medicaid plan, with more than 48,000 medical professionals across North Carolina.

Medicaid Transformation

While our Healthy Blue + Medicare plan addresses needs for our dual eligible population, that still leaves out a large segment of people who aren’t eligible for Medicare who need access to better health care.  Significant transformation is underway, and it’s going to change the way people in North Carolina receive Medicaid services. It will impact the health care of more than 1.6 million North Carolinians.

There is a new way to get Medicaid health care in our state.

North Carolina Medicaid is transitioning from fee-for-service to managed care, which will lead to better health outcomes for North Carolinians. Medicaid transformation launching July 1st means more choices for them.

With Medicaid transformation happening, people will get the same Medicaid services that they do today. But for the first time ever, they now have the power to choose a health plan offered by health care companies to manage their care.

As Blue Cross NC continues in its mission of improving the health and well-being of our customers and communities, we have launched Healthy Blue, our Medicaid managed care offering.


Having quality, affordable health care is a must, especially in underserved communities where health disparities are a serious, growing problem that must be urgently addressed.  These issues have been brought to the forefront during the COVID-19 pandemic as it further exposed a health system that has failed not only too many North Carolinians, but many Americans across our country.

Whether it is children, seniors, or those who are disabled, access to care is vital in making our communities healthier.  Blue Cross NC remains committed to providing quality care to people who’ll benefit from increased access due to recent changes in our state health care landscape.

We’re hopeful these impactful changes will lead to a better, healthier North Carolina.

Interested in learning more about health insurance? Reach out to the agent on this webpage.

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