The cost difference depends on which program you're in, not which one is "more expensive"
Medicare and Medicaid are separate programs with different costs because they serve different groups of people and work in different ways. If you're on Medicare, you pay premiums, deductibles, and copays based on your income and the coverage you choose. If you're on Medicaid, your costs depend entirely on your state — some states charge nothing, others charge small copays, and a few charge premiums. You cannot be on both programs at the same time, so the real question is: what will you actually pay under the program you may have access to for?
The answer matters because your out-of-pocket costs can range from nearly nothing to several thousand dollars a year, depending on which program covers you and what medical care you need.
Key Takeaways
- Medicare costs you a monthly premium (usually $164 to $560 in 2024), a yearly deductible ($1,632 for hospital care), and copays for each service, regardless of your income.
- Medicaid costs vary by state — some charge nothing, others charge small copays or premiums, and your income determines whether you may have access to at all.
- Medicare is for people 65 and older or with certain disabilities; Medicaid is for people with low income, and income limits differ by state.
- Your total yearly costs under Medicare can exceed $5,000 to $7,000 if you use significant medical services and do not have supplemental coverage.
- Medicaid typically costs less out-of-pocket, but availability and coverage rules depend on where you live.
What you pay under Medicare
Medicare has four parts, and each one costs money. Part A (hospital insurance) is free for most people 65 and older, but you pay a deductible of $1,632 per hospital stay in 2024. Part B (doctor visits and outpatient care) costs a monthly premium — $164.90 for most people in 2024, though it can be higher if your income is above $97,000 (or $194,000 for couples). You also pay a yearly deductible of $240 and then 20% of the cost of most services after that.
Part D (prescription drugs) requires a separate monthly premium that varies by plan, usually $5 to $100 per month. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers; it combines hospital and doctor coverage in one plan and often includes Part D, but costs and coverage rules vary widely by plan and location.
Many people also buy Medigap (supplemental insurance) to cover the deductibles and copays Medicare does not pay. Medigap premiums typically run $100 to $300 per month, depending on your age and the plan you choose. If you add Medigap to original Medicare, your total monthly cost can reach $400 to $500 or more.
What you pay under Medicaid
Medicaid is run by each state, so costs vary dramatically. Some states charge nothing — no premiums, no copays, no deductibles. Other states charge small copays ($1 to $5 per doctor visit or prescription) or monthly premiums of $10 to $50. A few states charge both. Your income determines whether you may have access to, and income limits differ by state; in some states, you can earn up to $1,500 per month and still may have access to, while in others the limit is much lower.
If you may have access to for Medicaid in your state, your out-of-pocket costs are usually much lower than Medicare. However, not all doctors accept Medicaid, and coverage rules can be stricter — for example, some states require prior approval before you see a specialist or have certain procedures.
When you might have both programs (dual may be able to access)
If you are 65 or older and have very low income and few assets, you may may have access to for both Medicare and Medicaid at the same time. This is called being dual may be able to access. When this happens, Medicare is your primary insurance and Medicaid is secondary — Medicaid covers some of the costs Medicare does not pay, like deductibles and copays. Dual may be able to access people typically have the lowest out-of-pocket costs of any group.
To learn about you may have access to for both programs, contact your state Medicaid office or call 1-800-MEDICARE. They can tell you whether your income and assets fall within your state's limits.
Comparing total yearly costs
Here is how costs might add up for someone using moderate medical services:
| Program | Monthly Premiums | Yearly Deductibles | Copays (estimated) | Yearly Total |
|---|---|---|---|---|
| Original Medicare + Part D | $165–$300 | $240–$1,632 | $500–$2,000 | $3,500–$6,000 |
| Medicare Advantage | $0–$200 | $0–$500 | $300–$1,500 | $1,500–$4,000 |
| Medicaid (varies by state) | $0–$50 | $0 | $0–$100 | $0–$700 |
| Dual may be able to access | $165 | $0–$240 | $0–$200 | $200–$2,000 |
These numbers assume you see a doctor several times a year, fill some prescriptions, and do not have a hospital stay. If you are hospitalized, your costs under original Medicare jump significantly because of the Part A deductible. If you have serious chronic illness requiring many specialist visits and medications, costs can exceed these ranges.
How to find out what you will actually pay
The only way to know your real costs is to look at the specific plan you are considering. For Medicare, use the Medicare Plan Finder at Medicare.gov — enter your zip code, the drugs you take, and the doctors you see, and it will show you the exact premium, deductible, and copay for each plan available to you. For Medicaid, contact your state Medicaid office directly; they can tell you the income limit, what services are covered, and what you will pay out-of-pocket.
If you are turning 65 soon, you can also call 1-800-MEDICARE to speak with someone who can walk you through your options. If you think you might may have access to for Medicaid, call your state Medicaid office or visit your state health department website to find the phone number.
When to ask your doctor or social worker for help
If you are confused about which program will cost you less, or if you are struggling to pay your premiums and copays, ask your doctor's office if they have a social worker on staff. Many hospitals and clinics have social workers who know the local programs and can help you figure out what you may have access to for. You can also contact your local Area Agency on Aging — they have counselors who specialize in Medicare and Medicaid questions and can review your situation for free.
If you are already on Medicare and your costs are too high, ask whether you may have access to for Extra Help (for Part D drug costs) or Medicare Savings Programs (which help pay your premiums and deductibles). These are separate programs with their own income limits, and many people who may have access to do not know about them.
Frequently Asked Questions
Can I switch from Medicare to Medicaid to save money?
No. Once you turn 65 and enroll in Medicare, you stay on Medicare. You cannot drop it to switch to Medicaid unless you move to a state with very different Medicaid rules and your income drops significantly. If you are struggling with Medicare costs, talk to your doctor or call 1-800-MEDICARE about programs that help pay your premiums and copays.
Does Medicare or Medicaid cover more services?
Medicare covers hospital stays, doctor visits, some preventive care, and prescription drugs (with Part D). Medicaid covers those things too, but coverage rules vary by state — some states cover dental and vision care, others do not. Ask your state Medicaid office or your Medicare plan what is covered before you need it.
What happens if I cannot afford my Medicare premiums?
You may may have access to for Medicare Savings Programs, which help pay your Part B and Part D premiums. Income limits vary by state, but many people earning $1,500 to $2,000 per month may have access to. Contact your state Medicaid office to learn about you are may be able to access.
Is Medicaid the same in every state?
No. Each state sets its own income limits, decides what services to cover, and chooses what copays to charge. A program that covers dental work in one state might not in another. Always check with your state Medicaid office about what is available where you live.
What if I am 65 but do not have enough work history for Medicare?
You can still enroll in Medicare Part B and Part D by paying the full premium. You may also may have access to for Medicaid if your income is low enough. Contact your state Medicaid office to find out the income limit in your state.