Medicare and Medicaid are two separate programs that serve different groups of people

Medicare is a federal health insurance program for people age 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it becomes your insurance when you turn 65.

Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state runs its own Medicaid program within federal guidelines, so what Medicaid covers and who qualifies varies significantly by state. Medicaid is not based on age — it is based on income and other factors.

Neither program is "better" than the other because they are designed for different people. The question is whether you fit into one category or the other, or possibly both.

Key Takeaways

  • Medicare is for people 65 and older; Medicaid is for low-income people of any age, and may be able to access rules differ by state.
  • Medicare requires you to have paid into the system through work history; Medicaid does not require work history and is based on current income.
  • Some people may have access to for both programs at the same time, a situation called "dual may be able to access."
  • Medicare covers hospital care, doctor visits, and prescription drugs through different parts you choose; Medicaid coverage varies by state but typically includes doctor visits, hospital care, and emergency services.
  • Your out-of-pocket costs, deductibles, and copays differ significantly between the two programs and depend on which Medicare parts you choose or which state's Medicaid you receive.

Who qualifies for each program

You may have access to for Medicare at age 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working. You do not have to be retired, and your income does not matter. If you are under 65, you may still may have access to if you have received Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS (amyotrophic lateral sclerosis).

Medicaid may be able to access is based on income, household size, and other factors that vary by state. In states that expanded Medicaid under the Affordable Care Act, most adults earning up to 138% of the federal poverty level can may have access to. In states that did not expand Medicaid, the income limits are much lower and often explore only to parents, children, pregnant women, elderly people, or people with disabilities. You can have Medicaid at any age.

Some people are "dual may be able to access" — they may have access to for both Medicare and Medicaid at the same time. This usually happens when someone is 65 or older and has low enough income to also may have access to for Medicaid in their state. Dual may be able to access people often have lower out-of-pocket costs because Medicaid can help pay Medicare premiums and cost-sharing.

What each program covers

Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient services, and some preventive care. 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 drug coverage and may include dental or vision benefits.

You must enroll in Part A and Part B when you turn 65, or pay a penalty for late enrollment. Part D and Part C are optional, but if you do not enroll in Part D when you first become may be able to access, you pay a penalty if you join later. Most people pay a monthly premium for Part B and Part D, and you pay deductibles and copays when you use services.

Medicaid coverage varies by state. All state Medicaid programs must cover emergency services, hospital care, doctor visits, and family planning. Many states also cover dental care, vision care, hearing aids, and other services that Medicare does not. Some states cover more mental health services or long-term care than others. You do not pay premiums for Medicaid in most states, though some states charge small copays for certain services.

Out-of-pocket costs and how they differ

Medicare has specific deductibles and copays set by federal law. For 2024, Part A has a deductible of $1,632 per hospital stay. Part B has a $240 annual deductible and then you pay 20% of the cost of covered services. Part D deductibles and copays vary by plan. These costs are the same no matter which state you live in.

Medicaid copays and deductibles are set by each state and are often lower than Medicare's. Some states charge no copay for preventive services or for people with low incomes. Long-term care (nursing home or assisted living) is covered by Medicaid in all states if you meet income and asset limits, but Medicare covers only limited skilled nursing care after a hospital stay.

If you are dual may be able to access, Medicaid typically pays your Medicare premiums and helps with deductibles and copays, which can significantly reduce your costs. Some dual may be able to access people pay almost nothing out of pocket.

How to find out which program you may have access to for

If you are 65 or older and worked in the United States for at least 10 years, you may have access to for Medicare. You should enroll three months before your 65th birthday, during your birthday month, or three months after. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

To learn about you may have access to for Medicaid, contact your state Medicaid office or use the Medicaid website for your state. You can also call 211 (a free referral line) and ask for Medicaid information in your area. The income limits and rules are different in every state, so you must check with your specific state program.

If you think you might may have access to for both, explore for Medicaid first. The Medicaid office can tell you whether you are dual may be able to access and help you understand how both programs work together.

When to choose Medicare Advantage versus Original Medicare

Original Medicare (Part A and Part B) is offered by the federal government. You can see any doctor or hospital that accepts Medicare, which is most providers. You pay the deductibles and copays set by federal law. You must separately choose and pay for Part D (prescription drug coverage) from a private insurance company.

Medicare Advantage (Part C) is offered by private insurance companies. It combines Part A, Part B, and usually Part D into one plan. Many Medicare Advantage plans include dental, vision, or hearing coverage that Original Medicare does not. However, you must use doctors and hospitals in the plan's network, except in emergencies. Copays and deductibles may be lower than Original Medicare, but they vary by plan.

Neither is objectively better — it depends on your doctors, your prescriptions, and how much health care you use. If you have a doctor you want to keep, check whether they accept your plan before you enroll. If you take many prescription drugs, compare the cost of Part D plans or Medicare Advantage plans that cover those drugs.

What happens if you have both Medicare and Medicaid

If you are dual may be able to access, Medicare is your primary insurance and Medicaid is secondary. This means Medicare pays first, and then Medicaid helps pay what Medicare does not cover. Medicaid also pays your Medicare premiums (Part B and Part D) and helps with deductibles and copays.

Some dual may be able to access people are automatically enrolled in a special type of Medicare Advantage plan called a D-SNP (Dual may be able to access Special Needs Plan) by their state. These plans are designed specifically for people with both Medicare and Medicaid. You can choose to stay in the D-SNP or switch to Original Medicare, but you should understand the differences before you decide.

If you are dual may be able to access, you should have a Medicaid case manager or social worker who can help you understand your coverage. Ask your state Medicaid office for a case manager if you do not have one.

Frequently Asked Questions

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

Yes. If you are 65 or older and have low enough income to may have access to for Medicaid in your state, you can have both. Medicaid will help pay your Medicare premiums and out-of-pocket costs. Contact your state Medicaid office to learn about you may have access to.

Do I have to choose between Medicare and Medicaid?

No. If you may have access to for both, you have both automatically or can enroll in both. They work together, with Medicare paying first and Medicaid helping with costs Medicare does not cover. You do not choose one or the other.

What if I am under 65 and have low income?

You would may have access to for Medicaid, not Medicare, unless you have a disability, end-stage renal disease, or ALS. Medicaid may be able to access and coverage vary by state. Call 211 or your state Medicaid office to find out what is available in your area.

Does Medicare cover long-term nursing home care?

Medicare covers only up to 100 days of skilled nursing care after a hospital stay, and only if you meet specific conditions. Medicaid covers long-term nursing home care if you meet your state's income and asset limits. This is one major difference between the two programs.

What should I ask my doctor about Medicare versus Medicaid?

Ask whether your doctor accepts Medicare, Medicaid, or both. Ask which prescription drug plans or Medicare Advantage plans your doctor recommends if you have choices. If you are dual may be able to access, ask your doctor's office which plan works best for your care.