For over a decade, Burial Senior Insurance has helped seniors and families nationwide plan ahead with honest, affordable final expense coverage — no medical exams, no waiting periods, and no pressure. Our licensed agents guide you to the plan that fits your budget and your family’s needs.
Last Updated on: October 15th, 2026
Reviewed by Kyle Wilson
In 2026, the standard Medicare Part B premium is $202.90 a month, Medicaid’s expansion limit for a single adult is about $22,025 a year, and private insurers pay doctors roughly 143% of what Medicare pays. Those three numbers capture the basic differences between America’s three main ways to pay for health care. This guide compares Medicare, Medicaid, and private insurance side by side, covering who qualifies, what each costs, which doctors accept it, and the expenses none of them cover.
Quick answer: Medicare is federal insurance for people 65 and older or with certain disabilities. Medicaid is joint federal-state coverage for people with low income and few assets. Private insurance is coverage bought through an employer or the ACA Marketplace. Many seniors qualify for both Medicare and Medicaid, but none of the three pays for a funeral or burial.
The core difference is who each program is for and who pays. Medicare is based on age or disability and funded mainly through payroll taxes and premiums. Medicaid is based on financial need and funded jointly by the federal government and each state. Private insurance is based on employment or individual purchase and funded by premiums, with insurers taking on the risk.
| Feature | Medicare | Medicaid | Private insurance |
| Who it’s for | 65 and older; people under 65 on SSDI for 24 months; people with ESRD or ALS | Low-income adults, children, pregnant women, seniors, and people with disabilities | Workers and families through employers; individuals through the ACA Marketplace |
| Funded by | Federal payroll taxes, premiums, general revenue | Federal and state governments | Employer and employee premiums; individual premiums, sometimes with ACA tax credits |
| Run by | CMS (federal); private insurers for Medicare Advantage and Part D | Each state, often through managed care plans, under CMS rules | Private insurance companies |
| Income test | None | Yes; 138% FPL in expansion states, stricter limits elsewhere | None (subsidies depend on income) |
| Monthly premium (2026) | $0 Part A for most; $202.90 standard Part B | Usually $0 | Varies by employer or plan |
| Out-of-pocket costs | Deductibles and 20% Part B coinsurance; no cap in Original Medicare | Minimal or none | Deductibles, copays, coinsurance up to an annual out-of-pocket maximum |
| Doctor network | Original Medicare: any doctor that takes Medicare nationwide | Narrower; fewer doctors accept it | Plan network (HMO, PPO, EPO) |
| Long-term custodial care | Not covered | Covered (nursing homes; home and community-based services) | Generally not covered |
| Dental, vision, hearing | Not in Original Medicare; often in Medicare Advantage | Children yes; adult benefits vary by state | Often separate dental and vision plans |
| Funeral and burial | Not covered | Not covered (some states or counties offer limited burial aid) | Not covered |
Note: You can have more than one. About one in five Medicare beneficiaries also has Medicaid (“dual eligible”), and many working people over 65 keep employer coverage alongside Medicare.
Get Free Quotes
Customized Options Await
Medicare is split into parts: A for hospitals, B for doctors, C for private all-in-one plans, and D for drugs. Medicaid is run by each state, mostly through managed care plans, and it’s the main payer for long-term care. Private insurance comes as employer group plans or individual ACA plans, and is organized by network type.
| Part | What it covers | Key 2026 costs |
| Part A (hospital) | Inpatient hospital, skilled nursing facility (up to 100 days), hospice, some home health | 0premiumwith40workquarters(311 or $565/month otherwise); $1,736 deductible per benefit period; $434/day for days 61–90; $217/day for SNF days 21–100 |
| Part B (medical) | Doctor visits, outpatient care, preventive services, durable medical equipment | $202.90/month standard premium (more at higher incomes); $283 deductible; then generally 20% coinsurance |
| Part C (Medicare Advantage) | Private plans that replace A and B, usually with D and extras like dental and vision | Average premium about $14/month; in-network out-of-pocket maximum up to $9,250 |
| Part D (drugs) | Prescription drug coverage | Deductible up to $615; out-of-pocket drug costs capped at $2,100 a year |
| Medigap | Private supplement that pays Original Medicare’s deductibles and coinsurance | Premium varies by plan, age, and state |
Original Medicare has no annual out-of-pocket limit, which is why most people add a Medigap plan, choose Medicare Advantage (which has a limit), or have retiree or Medicaid coverage alongside it. Higher earners pay more for Part B: in 2026, individuals with income above $109,000 pay $284.10 to $689.90 a month.
Each state runs its own Medicaid program within federal rules, so benefits and names differ (Medi-Cal in California, for example). Most enrollees get care through managed care organizations (MCOs), private health plans paid a fixed monthly amount per member by the state. Medicaid covers doctor and hospital care, prescriptions, and, unlike Medicare or private insurance, long-term care:
Cost-sharing is minimal or nothing for most enrollees.
All ACA-compliant plans cap annual in-network out-of-pocket costs and cannot deny coverage for pre-existing conditions. Learn more about term life insurance and other coverage that protects families beyond health insurance.
Private insurers pay doctors about 143% of Medicare rates on average, Medicare sets the benchmark, and Medicaid pays about 75% of Medicare for all services and about 66% for primary care. Those payment gaps help explain why almost every doctor takes private insurance and Medicare, while fewer accept new Medicaid patients.
| Factor | Private insurance | Medicare | Medicaid |
| Physician payment vs. Medicare | About 143% (range 118–179%) | 100% (benchmark) | About 75% overall; 66% primary care |
| Hospital payment vs. Medicare | About 199% | 100% | Varies; often at or below Medicare |
| Doctors accepting new patients | About 91% (2019) | About 89% (2019) | Lower than Medicare or private; varies by state and specialty |
| Network flexibility | Depends on plan type | Original Medicare: any participating provider nationwide | Usually restricted to the managed care plan’s network |
| Referrals needed | HMOs yes; PPOs no | No (Original Medicare) | Often yes |
A practice that receives 66 cents from Medicaid for every Medicare dollar, and $1.43 from private plans, can lose money on Medicaid visits once overhead is covered. Some specialists limit how many new Medicaid patients they accept, which can mean longer waits. Medicaid managed care plans try to close this gap with contracted networks, and some states pay higher rates for primary care or high-demand specialties.
Note: Payment rates don’t measure quality of care. Medicaid enrollees can get excellent care. The practical issue is finding an in-network doctor with openings, so check the plan’s directory and call to confirm before you choose.
Medicare has no income test: you qualify at 65, or earlier with a qualifying disability. Medicaid is income-based: in the 41 expansion states (including DC), adults qualify with income up to 138% of the federal poverty level, about $22,025 a year for one person in 2026. Seniors and people with disabilities face separate, often stricter, income and asset tests.
Your Initial Enrollment Period runs for seven months around your 65th birthday. Missing it without other qualifying coverage can mean a lifelong Part B late penalty.
| Group | 2026 benchmark | Notes |
| Adults 19–64, expansion states | 138% FPL: about $22,025 (single), $45,540 (family of 4) | 2026 FPL is $15,960 for one person; no asset test |
| Adults, non-expansion states (10 states) | Often very low limits for parents; most adults without children ineligible | AL, FL, GA, KS, MS, SC, TN, TX, WI, WY |
| Aged, blind, or disabled (ABD) | Often tied to SSI: $994/month (individual) | Typical asset limit $2,000; some states higher |
| Nursing home Medicaid | Many states: up to 300% of SSI, about $2,982/month | Most income goes to care costs; 60-month look-back on asset transfers |
The 2025 reconciliation law adds Medicaid work requirements for expansion adults starting January 1, 2027, so check your state’s rules if you’re 19–64 and enrolled through expansion.
Note: Medicaid estate recovery. States must try to recover long-term care costs from the estates of Medicaid enrollees aged 55 and older after death. This can affect the home and assets families expect to inherit, which is one more reason to plan for final expenses separately.
People who qualify for both programs are called dual eligibles. Medicare pays first, and Medicaid fills in:
| Benefit | What it does |
| Medicare Savings Programs (QMB, SLMB, QI) | Pay the Part B premium ($202.90) and, for QMB, Medicare deductibles and coinsurance |
| Extra Help (Part D Low-Income Subsidy) | Lowers drug premiums and copays; automatic for full duals |
| Dual-Eligible Special Needs Plans (D-SNPs) | Medicare Advantage plans built for duals, coordinating both programs, often with $0 cost-sharing and extra benefits like dental, vision, and transportation |
| Medicaid long-term care | Nursing home or home care that Medicare doesn’t cover |
To plan for funeral costs that neither program pays, see our guides to pre-need life insurance and senior burial insurance.
Medicare, Medicaid, and private health insurance all stop paying at death. None of them covers a funeral, cremation, casket, burial plot, or headstone. Original Medicare also leaves out long-term custodial care, routine dental, eyeglasses, and hearing aids, so even well-insured seniors carry real out-of-pocket risk.
| Expense | Original Medicare | Medicare Advantage | Medicaid | Private insurance |
| Long-term custodial care | No | No | Yes (if eligible) | No |
| Routine dental | No | Often, with limits | Varies by state for adults | Separate dental plan |
| Eyeglasses and routine eye exams | No | Often | Varies | Separate vision plan |
| Hearing aids | No | Often, with limits | Varies | Rarely |
| Funeral, burial, cremation | No | No | No (limited state or county aid in some areas) | No |
The National Funeral Directors Association’s latest study puts the median funeral with viewing and burial at $8,300 and with cremation at $6,280. Neither figure includes a cemetery plot, opening and closing the grave, or a headstone, which can push a traditional burial past $10,000. Social Security pays only a one-time $255 death benefit to an eligible spouse or child. Final medical bills, deductibles, and Medicaid estate recovery can shrink what’s left in the estate.
Final expense insurance, also called burial insurance, is a small whole life policy, typically 5,000–25,000, that pays cash to your beneficiary within days or weeks. Premiums are fixed for life, there’s usually no medical exam, and many seniors qualify for full coverage from day one. For example, a healthy 70-year-old non-smoker pays about $53 a month (women) or $70 (men) for $10,000 of level coverage, based on 2026 sample rates.
For Medicaid applicants, how this coverage is set up matters. Small life insurance policies, a burial fund of up to $1,500, and irrevocable funeral contracts or burial trusts can be excluded from Medicaid asset limits under SSI-based rules, which vary by state. Some families assign a burial policy to a funeral home or irrevocable trust; see transferring a life insurance policy to a funeral home and final expense insurance.
Medicare, Medicaid, and private insurance each solve a different problem: Medicare for age and disability, Medicaid for financial need and long-term care, and private insurance for working-age families. The right choice depends on your age, income, and health, and many people combine two. But all three end at the same place: none pays for a funeral.
| Your situation | Best-fit coverage | Gap to plan for |
| Turning 65, retiring | Medicare A + B, plus Medigap and Part D, or Medicare Advantage | Dental, vision, hearing; funeral costs |
| Working past 65 with large-employer coverage | Employer plan plus Part A; delay Part B without penalty | Funeral costs |
| Low income, under 65, expansion state | Medicaid (income up to about $22,025 single) | Work requirements from 2027; funeral costs |
| Low income, 65+ | Medicare plus Medicaid (dual eligible), often a D-SNP | Estate recovery; funeral costs |
| Self-employed or no job coverage | ACA Marketplace plan | Subsidy cliff above 400% FPL; funeral costs |
| Needs nursing home care | Medicaid after spend-down | Asset rules, estate recovery; funeral costs |
Your health plan protects you while you’re living. Final expense insurance protects your family afterward. Burial Senior Insurance is an independent agency that compares final expense whole life policies from more than 15 top-rated carriers for seniors aged 50 to 85 in all 50 states, including options with no waiting period for those who qualify and guaranteed acceptance for those who don’t.
Explore senior burial coverage on Burial Senior Insurance, get a free quote, or call (800) 718-4568 to speak with a Burial Senior Insurance final expense specialist.
Part A is premium-free for most people who worked about 10 years (40 quarters). Part B isn't free: the standard premium is $202.90 a month in 2026, plus a $283 deductible and 20% coinsurance. People with limited income may get help through a Medicare Savings Program or Medicaid.
Private insurance isn't better for everyone. It usually offers wider doctor networks, because it pays doctors about 143% of Medicare rates versus Medicaid's roughly 75%, so appointments can be easier to get. But Medicaid usually costs little or nothing and covers long-term care, which private insurance doesn't. For people with low income, Medicaid is often the better financial deal.
Funeral Mass often about an hour, and a graveside service 15 to 30 minutes. Baptist homegoing services and celebrations of life can run longer when there are many tributes or musical selections.
In the 41 expansion states (including DC), adults 19–64 qualify with income up to 138% of the federal poverty level: about $22,025 for one person and $45,540 for a family of four in 2026. Limits for children and pregnant women are often higher. Seniors and people with disabilities usually face lower income limits, often about $994 a month, plus asset tests. Nursing home Medicaid in many states allows income up to about $2,982 a month.
Original Medicare generally doesn't cover long-term custodial care, routine dental care, routine eye exams and eyeglasses, or hearing aids. It also doesn't cover funeral or burial costs. Medicare Advantage plans often add dental, vision, and hearing benefits with annual limits.
Yes. Many people over 65 keep employer or retiree coverage alongside Medicare, and Medigap and Medicare Advantage plans are sold by private insurers. Which plan pays first depends on employer size and whether you're still working.
No. Neither program pays funeral or burial costs. Some states and counties offer limited burial assistance for people with very low income, and Social Security pays a one-time $255 death benefit to an eligible spouse or child.
Note: Medicaid rules, income limits, and asset tests vary by state; check with your state Medicaid office. Insurance rates shown are samples.
Senior Writer & Licensed Life Insurance Agent
Jazmine Cooke is a dynamic and insightful senior writer with a passion for life insurance and financial planning. With over 8 years of hands-on experience in the insurance industry, Jazmine Cooke has earned a reputation for delivering clear, actionable advice that empowers individuals to make informed decisions about their financial future. At Burial Senior Insurance, she not only excels as a licensed insurance agent but also as a trusted guide who has successfully advised over +1500 clients, helping them navigate the often complex world of life insurance and annuities. Her articles have been featured in top-tier financial publications, making her a respected voice in the industry.
Have Any Questions? Ask us anything — we’d love to answer!
Burial Senior Insurance provides information and services related to burial insurance for senior citizens, including policy options and end-of-life support services.
Copyright © Burial Senior Insurance 2026. All Right Reserved.
