The Basic Difference

Medicare is a federal health insurance program for people age 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low income, regardless of age. The two programs are separate, funded differently, and have different rules about who gets in and what they pay.

You may have heard them confused because the names are similar and both are government programs. But they work in completely different ways. Understanding which one applies to you matters because the coverage, costs, and how you sign up are not the same.

Key Takeaways

  • Medicare is for people 65 and older (or some younger people with disabilities or end-stage renal disease), while Medicaid is for people with low income at any age.
  • Medicare is the same nationwide; Medicaid rules vary significantly by state, including what services are covered and income limits.
  • You pay Medicare premiums, deductibles, and copays; Medicaid typically costs little or nothing out of pocket, depending on your state and income.
  • Some people may have access to for both programs at the same time, a situation called "dual may be able to access."

Who Medicare Covers

You are automatically enrolled in Medicare when you turn 65 if you have worked and paid Medicare taxes for at least 10 years (or if your spouse did). You do not have to be retired to get Medicare at 65—you can still be working.

Some younger people also get Medicare: those under 65 with end-stage renal disease (permanent kidney failure), those who have received Social Security Disability Insurance (SSDI) for 24 months, and people with ALS (amyotrophic lateral sclerosis). If you fall into one of these groups, you should contact Social Security to confirm your coverage.

Who Medicaid Covers

Medicaid covers people with low income. The exact income limit depends on your state, your age, whether you are pregnant, whether you have children, and your disability status. A single person in one state might may have access to while the same person in another state would not.

You can explore for Medicaid at any time during the year. Unlike Medicare, which has specific enrollment periods, Medicaid applications are accepted year-round. Your state Medicaid office or your local social services department handles applications. You can also explore online through your state's health insurance marketplace.

How Costs Work: Medicare

Medicare has four parts. Part A covers hospital stays, skilled nursing, and hospice. Part B covers doctor visits and outpatient services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A, B, and D offered by private insurance companies.

You pay a monthly premium for Part B and Part D (the amount depends on your income). You also pay a deductible before Medicare starts paying, and you pay copays or coinsurance when you use services. The exact amounts change each year. In 2024, the Part B deductible was $240, but check Medicare.gov for the current year's amounts.

If your income is very low, you may may have access to for a program called Extra Help (for drug costs) or Medicare Savings Programs (for premiums and deductibles). These are separate from Medicaid but can reduce what you pay out of pocket.

How Costs Work: Medicaid

Medicaid is designed for people with low income, so most people pay nothing or very little. Some states charge small copays for certain services—usually $1 to $5 per visit—but many states charge nothing at all. Pregnant women and children typically pay nothing in any state.

What Medicaid covers varies by state. All states must cover doctor visits, hospital stays, lab work, and X-rays. Many states also cover dental, vision, hearing aids, and mental health services, but not all. Some states cover more services than others. If you need a specific service, contact your state Medicaid office to find out whether it is covered where you live.

When You Have Both Medicare and Medicaid

Some people may have access to for both programs at the same time. This happens when you are 65 or older (or younger and disabled) and your income is low enough for Medicaid. These people are called "dual may be able to access" or "dually may be able to access."

If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid pays second and often covers costs that Medicare does not, such as long-term care or dental work. You will have both a Medicare card and a Medicaid card. You show the Medicare card to your doctor first, then the Medicaid card if there is a cost Medicare did not cover.

If you think you might may have access to for both, contact your state Medicaid office. They can tell you whether your income and resources meet the limit. Some states have special programs for dual-may be able to access people that coordinate the two programs more smoothly.

How to Find Out Which Program Covers You

If you are 65 or older, you have Medicare. You should have received a Medicare card in the mail before your 65th birthday. If you did not, contact Social Security at 1-800-772-1213 or visit ssa.gov.

If you are under 65 and have low income, you may may have access to for Medicaid. Contact your state Medicaid office or your local social services department. You can also call 211 (dial 2-1-1) and a specialist will tell you how the process works in your state. Many states also let you explore online through their health insurance marketplace.

If you are not sure whether you may have access to for either program, start by contacting your state Medicaid office. They can review your age, income, and resources and tell you what you may have access to for. This conversation is free and does not commit you to anything.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older (or younger and disabled) and your income is low enough, you can have both. Medicare pays first, and Medicaid covers some of the costs Medicare does not. Contact your state Medicaid office to find out whether you may have access to.

Do I have to pay for Medicare?

Yes, most people pay a monthly premium for Part B (doctor and outpatient services) and Part D (prescription drugs). You also pay a deductible and copays when you use services. If your income is very low, you may may have access to for Extra Help or Medicare Savings Programs that reduce these costs.

What if I miss the important date to sign up for Medicare?

If you do not sign up for Part B or Part D when you first become may be able to access, you may pay a penalty for as long as you have Medicare. Contact Social Security or Medicare to find out whether you can still enroll and what your penalty would be.

Does Medicaid cover nursing home care?

Yes, Medicaid covers long-term nursing home care if you meet the income and resource limits. Medicare covers only short-term skilled nursing care after a hospital stay. If you think you may need long-term care, talk to your doctor and your state Medicaid office about your options.

How do I know if my doctor takes Medicaid?

Not all doctors take Medicaid, and the doctors who do vary by state. Contact your state Medicaid office or your local Medicaid managed care plan for a list of doctors in your area. You can also call a doctor's office and ask whether they take Medicaid.