Medicaid and Medicare are two separate government programs with different rules, costs, and who they serve

Medicare and Medicaid sound similar, but they are completely different programs. Medicare is federal health insurance for people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low income, regardless of age. You can have one, both, or neither — and which one you have changes what doctors you can see, what you pay, and what gets covered.

The confusion matters because it affects your choices. If you are turning 65, you need Medicare. If you have low income and are under 65, you may have Medicaid. Some people have both — they are called "dual may be able to access" — and they follow different rules than people with only one program.

Key Takeaways

  • Medicare is a federal program for people 65 and older; Medicaid is a state program for people with low income of any age.
  • Medicare has a monthly premium, deductibles, and copays; Medicaid costs vary by state and is usually free or very low cost for those who meet income limits.
  • Medicare covers hospital care, doctor visits, and prescription drugs through separate parts (A, B, D); Medicaid covers similar services but the exact coverage depends on your state.
  • If you are 65 or older, you must enroll in Medicare even if you have Medicaid, or you will face penalties when you finally do.
  • Some people may have access to for both programs at the same time, and when that happens, Medicare is the primary payer and Medicaid covers some of what Medicare does not.

How Medicare and Medicaid differ in who they serve

Medicare is based on age and work history. You are may be able to access at 65 if you or your spouse paid into Social Security for at least 10 years. You do not have to be poor. A millionaire who is 65 gets Medicare the same way a person with no savings does.

Medicaid is based on income and family size. Each state sets its own income limit, so a person who qualifies in one state may not may have access to in another. Some states cover people making up to 138% of the federal poverty line; others cover much less. Medicaid also covers children, pregnant people, and people with disabilities, not just older adults.

The two programs can overlap. A 68-year-old with low income can have both Medicare and Medicaid at the same time. In that case, Medicare pays first, and Medicaid may pay some of the costs Medicare does not cover.

What each program pays for

Medicare has four parts. Part A covers hospital stays, skilled nursing, and hospice. Part B covers doctor visits, outpatient care, and some preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to A and B offered by private insurers. Medicare does not cover long-term care, dental, vision, or hearing aids unless you choose a plan that does.

Medicaid must cover hospital care, doctor visits, emergency services, and some prescription drugs in every state. Beyond that, coverage varies. Some states cover dental, vision, and hearing; others do not. Some cover long-term care in nursing homes; others limit it. You need to check your state's Medicaid program to know what is covered where you live.

The key difference: Medicare is the same nationwide. Medicaid is a patchwork. Two people with identical health needs and income may have very different coverage depending on which state they live in.

How much each program costs

Medicare has a monthly premium for Part B (the amount changes each year and is higher if you have higher income). You also pay a deductible before coverage starts, and then copays or coinsurance for each service. If you choose Part D for drugs, that has its own premium. If you choose Part C (Medicare Advantage), the premium is often lower or free, but you may pay more per visit.

Medicaid is usually free or very low cost if you meet the income limit. Some states charge a small monthly premium or copay, but most do not. Once you are enrolled, you typically pay nothing or a few dollars per doctor visit or prescription.

If you have both Medicare and Medicaid, you pay Medicare's premiums and deductibles, but Medicaid may cover some of those costs for you.

What happens if you turn 65 and have Medicaid

When you turn 65, you become may be able to access for Medicare. You do not lose Medicaid automatically — you can have both. But you must enroll in Medicare Part A and Part B during your enrollment window, or you will face a permanent penalty on your Part B premium for every year you delay.

Your enrollment window is the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss it and do not have a may have access to reason, the penalty stays with you for life. This is one of the most common and costly mistakes people make.

If you cannot afford Medicare's premiums and deductibles, Medicaid may help pay them. Some states have programs specifically for people who are dual may be able to access. Ask your state Medicaid office what help is available to you.

What happens if you turn 65 and have Medicare but low income

If you are 65 or older and your income is low enough, you may be able to enroll in Medicaid even though you already have Medicare. This is called "dual may be able to access" status. Medicaid can help pay your Medicare premiums, deductibles, and copays, which can make a big difference in what you actually pay for care.

Each state runs its own Medicaid program, so the income limit and process are different depending on where you live. Contact your state Medicaid office or call 211 to learn about you may have access to and how to enroll.

Common mistakes to avoid

The biggest mistake is not enrolling in Medicare when you turn 65. Even if you are still working or have other coverage, you should enroll in Part A (hospital insurance) at 65 to avoid the lifetime penalty. Part A has no premium if you paid into Social Security, so there is no reason to skip it.

Another mistake is assuming Medicaid will cover you after 65. Medicaid does not automatically end when you turn 65, but Medicare becomes your primary insurance. If you want Medicaid to help pay your Medicare costs, you have to enroll in Medicaid separately — it does not happen automatically.

A third mistake is not knowing your state's Medicaid rules. Medicaid varies so much by state that a person with the same income and health needs can have very different coverage in different places. If you think you might may have access to, contact your state Medicaid office directly rather than assuming you do not.

How to find out which program you have or need

If you are 65 or older, you should have Medicare. You can check your coverage by logging into Medicare.gov or calling 1-800-MEDICARE. If you do not have it, you can enroll through Medicare.gov or by calling that same number.

If you think you have low enough income for Medicaid, contact your state Medicaid office. You can find the number on your state's health department website, or call 211 (a free referral line) and ask for Medicaid in your area. You will need to provide proof of income and citizenship.

If you are not sure whether you have Medicare, Medicaid, both, or neither, your insurance card will tell you. Medicare cards say "MEDICARE" at the top. Medicaid cards vary by state but usually say "Medicaid" or your state's name. If you cannot find your card, call the number on any recent medical bill, and the provider can tell you what insurance is on file.

Frequently Asked Questions

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

Yes. If you are 65 or older and have low income, you may be able to have both. When you do, Medicare pays first, and Medicaid may cover some of what Medicare does not. This is called dual may be able to access status, and it can significantly reduce your out-of-pocket costs.

Do I have to pay for Medicaid if I have low income?

In most states, Medicaid is free if you meet the income limit. Some states charge a small monthly premium or copay, but the cost is usually very low or nothing. Check your state's Medicaid program to find out what you would pay.

What if I am 65 but do not want Medicare?

You should enroll in Medicare Part A at 65 even if you do not think you need it, because there is no premium and it protects you from a lifetime penalty. If you have other coverage and do not want to use Medicare, you can enroll and straightforward not use it, but skipping enrollment entirely will cost you later.

Does Medicaid cover nursing home care?

Some states cover long-term nursing home care through Medicaid; others do not or limit it. This varies significantly by state. Contact your state Medicaid office to find out what long-term care coverage is available where you live.

What should I do if I think I may have access to for both programs?

Contact your state Medicaid office and tell them you are 65 or older and want to know if you may have access to for Medicaid. Bring proof of income (recent pay stubs, tax return, or bank statements) and proof of citizenship. If you may have access to, enrolling in Medicaid can help pay costs that Medicare does not cover.