Medicaid and Medicare Are Separate Programs — Here's What Each Covers

Medicaid and Medicare are two different government health insurance programs, not parts of each other

Medicaid and Medicare sound similar, but they are separate programs run by different parts of the government, with different rules about who can use them and what they cover. Medicare is a federal program for people 65 and older, regardless of income. Medicaid is a joint federal and state program for people with low income, at any age. You can have both at the same time — in fact, many older adults do — but being on one does not automatically put you on the other.

The confusion is understandable. Both are government health insurance, both use similar claim processes, and both cover hospital and doctor visits. But the may be able to access rules are completely different, the benefits are different, and the way you sign up is different. Understanding which program covers what can save you money and help you avoid coverage gaps.

Key Takeaways

Medicare is for people 65 and older (or some younger people with disabilities), while Medicaid is for people with low income at any age.
Medicare is run by the federal government; Medicaid is run by each state with federal funding, so benefits and income limits vary by state.
You can be on both programs at the same time — these people are sometimes called "dual may be able to access" — and many older adults are.
If you are 65 or older and have low income, you may be able to get help paying your Medicare premiums and costs through Medicaid or other programs.

How Medicare and Medicaid differ in who they serve

Medicare is primarily for people age 65 and older. You do not have to be retired, and your income does not matter — if you are 65, you can get Medicare. Some younger people with disabilities or end-stage renal disease can also get Medicare, but age 65 is the main gateway.

Medicaid is for people with low income. There is no age requirement. A child, a working-age adult, a parent, or an older person can all be on Medicaid if their income is low enough. Each state sets its own income limit, so what qualifies in one state may not in another. Some states have expanded Medicaid to cover more people; others have not.

Because of these different rules, an older adult might be on Medicare but not Medicaid (if their income is too high), or on both (if their income is low enough), or on Medicaid but not yet Medicare (if they are under 65 and have low income).

What each program covers

Medicare has four parts. Part A covers hospital stays, skilled nursing care, 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 way to get Parts A and B through a private insurance company, usually with prescription drug coverage included.

Medicaid covers many of the same things — hospital care, doctor visits, prescription drugs — but the exact benefits depend on your state. Medicaid also covers some services Medicare does not, including long-term care (nursing home and home care), dental, and vision, though again this varies by state. If you are on both programs, Medicare is usually your primary insurance, and Medicaid covers some of the costs Medicare does not pay.

One major difference: Medicare has out-of-pocket costs (premiums, deductibles, copays). Medicaid typically has much lower or no out-of-pocket costs for people with very low income, though some states charge small copays.

When you might be on both programs at the same time

If you are 65 or older and your income is low enough to meet your state's Medicaid limit, you can be on both Medicare and Medicaid. These people are called dual may be able to access. Medicaid in this situation often helps pay your Medicare premiums and covers some of the costs Medicare does not, like long-term care.

You do not automatically get Medicaid when you turn 65 and sign up for Medicare. You have to explore for Medicaid separately, usually through your state's Medicaid office or online portal. If you think your income might may have access to, it is worth checking — Medicaid can significantly reduce your out-of-pocket health costs.

How to learn about you might be on Medicaid while on Medicare

Start by finding your state's Medicaid office. You can search online for "[your state] Medicaid" or call 211, which is a free referral line that connects you to local health and human services programs. When you contact them, have your income information ready — they will ask about your household income and size to determine if you meet the limit.

If your income is close to the limit, ask about Medicaid savings programs even if you do not quite may have access to for full Medicaid. Programs like may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI) help pay Medicare premiums and costs for people with slightly higher income. These are run by Medicaid but have their own income limits, which are higher than full Medicaid.

You can also contact your State Health Insurance information Program (SHIP), which is free and can help you understand your Medicare and Medicaid options. Find your local SHIP by searching online for "[your state] SHIP" or calling 1-800-MEDICARE.

What happens to your coverage if your income changes

If you are on both Medicare and Medicaid and your income goes up, you might lose Medicaid coverage. If your income goes down, you might become newly may be able to access. Changes in income should be reported to your state Medicaid office, usually within 30 days, though the exact timeline varies by state.

If you lose Medicaid, you will still have Medicare, but you will be responsible for Medicare premiums and out-of-pocket costs again. If you become newly may be able to access for Medicaid, you may have a gap in coverage while your process is being processed — this is another reason to report changes promptly.

Programs that help pay Medicare costs if you do not may have access to for Medicaid

If your income is too high for Medicaid but still modest, you may be able to get help through other programs. The Medicare Savings Programs (QMB, SLMB, QI) mentioned above are one option. There is also the Low-Income Subsidy program, which helps pay prescription drug costs under Medicare Part D if your income and resources are low enough.

Your state's SHIP can help you figure out which programs you might be able to use. They can also help you understand your Medicare coverage and answer questions about how Medicare and Medicaid work together in your situation.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you are 65 or older and your income is low enough, you can have both at the same time. Medicare and Medicaid are designed to work together in this situation, with Medicaid helping to cover costs that Medicare does not pay.

If I am on Medicaid now, will I automatically get Medicare when I turn 65?

No. You have to sign up for Medicare separately when you turn 65. You can do this online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You can stay on Medicaid after you turn 65 if your income still qualifies.

What if I turn 65 but do not want Medicare?

You can delay signing up for Medicare, but there may be penalties if you wait too long. If you have health coverage through a current job, you may be able to delay without penalty. Talk to your employer's benefits office or call 1-800-MEDICARE to understand your specific situation before you decide.

Can Medicaid pay for things Medicare does not cover?

Yes. If you are on both programs, Medicaid can cover some services Medicare does not, such as long-term nursing home care, dental, and vision — though this depends on your state. Medicaid also typically covers more of your out-of-pocket costs under Medicare.

How do I know if my state's Medicaid covers something Medicare does not?

Contact your state Medicaid office or your SHIP. They can tell you what your state's Medicaid covers and whether it will pay for a specific service you need. Coverage varies significantly by state, so it is worth asking directly rather than assuming.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.