The Basic Difference Between Medicaid and Medicare

Medicare is a federal health insurance program for people age 65 and older, regardless of income. Some younger people with disabilities or end-stage renal disease also may have access to. Medicaid is a joint federal and state program that covers low-income individuals and families of any age. The key difference: Medicare is based on age or disability status; Medicaid is based on income.

Both programs help pay for medical care, but they work differently, cover different services, and have different rules depending on where you live. Many people assume they are the same program or that one leads to the other. They do not. You may have one, the other, both, or neither — and which one you have changes what you pay and where you can receive care.

Key Takeaways

  • Medicare covers people 65 and older or those with certain disabilities, while Medicaid covers low-income individuals and families of any age, with income limits that vary by state.
  • Medicare has four parts (A, B, C, D) with different coverage areas; Medicaid coverage varies significantly by state and may include services Medicare does not.
  • You can have both Medicare and Medicaid at the same time — people in this situation are called "dual may be able to access" and may pay lower out-of-pocket costs.
  • Medicare enrollment happens automatically at 65 or requires you to sign up during specific windows; Medicaid enrollment rules and important date vary by state.
  • Your state of residence determines what Medicaid covers and whether you can receive it, so the same income level may may have access to you in one state but not another.

Who Qualifies for Medicare

You are may be able to access for Medicare if you are age 65 or older and a U.S. citizen or permanent resident who has lived in the United States for at least five years. You do not have to be retired or have a low income. If you are under 65, you may may have access to if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, have end-stage renal disease, or have amyotrophic lateral sclerosis (ALS).

Medicare enrollment is automatic for most people. If you are already receiving Social Security benefits when you turn 65, Medicare Part A and Part B are enrolled for you. If you are not yet receiving Social Security, you must sign up for Medicare during your Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after. Missing this window can result in permanent late-enrollment penalties on your premiums.

Who Qualifies for Medicaid

Medicaid is for people with low income and limited resources. The income and resource limits vary significantly by state — what qualifies you in one state may not in another. Some states have expanded Medicaid to cover more working-age adults; others have not. Your state of residence determines whether you can receive Medicaid and what it covers.

You do not have to be retired, disabled, or a senior to receive Medicaid. Children, pregnant people, parents, and working adults may all may have access to depending on your state's rules and your household income. Each state sets its own income thresholds, so you will need to check your specific state's Medicaid program to learn whether you meet the income requirement. Your state's Medicaid office or a local community health center can tell you the current limits.

What Medicare Covers

Medicare has four parts, each covering different services. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies; it usually includes Part D and may cover additional services like dental or vision.

Original Medicare (Parts A and B) has deductibles, copayments, and coinsurance that you pay out of pocket. Part B has a monthly premium. Part D has a monthly premium and cost-sharing for medications. Medicare does not cover dental care, vision exams, hearing aids, or long-term custodial care in a nursing home — these gaps are why many people buy supplemental insurance or choose Medicare Advantage plans.

What Medicaid Covers

Medicaid must cover certain core services in every state: inpatient hospital care, outpatient hospital services, emergency services, physician services, laboratory and X-ray services, and nursing facility care. However, each state can add optional services and set its own coverage rules. Some states cover dental care, vision care, hearing aids, and transportation to medical appointments; others do not. Some states cover more mental health and substance use treatment than others.

Because Medicaid rules vary by state, the same person with the same income and health needs may have very different coverage depending on where they live. If you move to a different state, your Medicaid coverage may change. You will need to check your new state's Medicaid program to learn what is covered and whether you still meet the income requirements.

Having Both Medicare and Medicaid at the Same Time

You can have both Medicare and Medicaid simultaneously. People in this situation are called dual may be able to access. This often happens when someone turns 65 and qualifies for Medicare but also has low enough income to may have access to for Medicaid in their state. Dual may be able to access individuals typically pay lower out-of-pocket costs because Medicaid can help pay Medicare premiums, deductibles, and copayments.

If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid pays second and covers some costs Medicare does not, such as long-term nursing home care and dental services (in states that cover them). You will receive a Medicare card and a Medicaid card. When you see a doctor or receive care, you may present both cards so the billing is handled correctly.

How to Find Out Which Program You Have or Need

To learn whether you currently have Medicare, check your mail for a Medicare card or log into your Social Security account at ssa.gov. Your Social Security statement will show your Medicare status. If you are approaching 65 and do not have Medicare, contact Social Security at 1-800-772-1213 to enroll.

To learn whether you may may have access to for Medicaid, contact your state's Medicaid office directly. You can find your state Medicaid program by visiting medicaid.gov and selecting your state, or by calling 211 (a free referral service) and asking for your state's Medicaid office. Have your income information and household size ready. Some states allow you to check your potential may be able to access online before you formally explore.

Frequently Asked Questions

Do I automatically get Medicaid when I turn 65?

No. Medicare is automatic at 65 if you are already receiving Social Security, but Medicaid is not. You must meet your state's income and resource limits to receive Medicaid. Many people age 65 and older do not may have access to because their income is too high. Contact your state Medicaid office to learn the current income limit.

Can I have Medicare Advantage and Medicaid at the same time?

Yes. If you are dual may be able to access, you can enroll in a Medicare Advantage plan (Part C) instead of Original Medicare. Some Medicare Advantage plans are designed specifically for dual may be able to access individuals and may offer additional benefits like dental or vision coverage. Check with your state Medicaid program and your plan to confirm how coverage works together.

What happens to my Medicaid if I move to a different state?

Your Medicaid coverage ends when you move. You must explore for Medicaid in your new state, which has its own income limits and covered services. Contact your new state's Medicaid office as soon as you move. Some states have faster processing than others, so do not wait to explore.

If I am on Medicaid, do I need to sign up for Medicare at 65?

Yes. Even if you have Medicaid, you must enroll in Medicare when you turn 65 (or during your Initial Enrollment Period if you are under 65 with a disability). Medicare becomes your primary insurance. Medicaid will then help pay some of your Medicare costs. Missing the enrollment window can result in permanent penalties.

How do I know if my doctor accepts both Medicare and Medicaid?

Ask your doctor's office directly. Some doctors accept Medicare only, Medicaid only, or both. If you are dual may be able to access, confirm that your doctor accepts both programs before scheduling an appointment. You can also call your state Medicaid office or your Medicare plan to ask for a list of doctors in your area who accept both.