Medicare and Medicaid Are Different Programs — Here's What Sets Them Apart

Medicare and Medicaid are separate government health insurance programs with different rules, costs, and who they cover

Medicare and Medicaid sound similar, but they are two completely different programs. Medicare is a federal health insurance program for people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low incomes of any age. The confusion is common — even some healthcare workers mix them up — but the differences matter for what you pay, what doctors you can see, and what services are covered.

If you are turning 65 or already on Medicare, understanding how it differs from Medicaid will help you know what coverage you actually have and what to expect when you go to the doctor or pharmacy.

Key Takeaways

Medicare is based on age (65 and older) or disability; Medicaid is based on income and is run by each state with different rules in each state.
Medicare has the same basic structure nationwide; Medicaid coverage, costs, and which doctors participate vary significantly by state.
You pay premiums, deductibles, and copays for Medicare; Medicaid typically has lower or no out-of-pocket costs, 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," and should understand how each one pays.

Who Each Program Covers

Medicare covers people who are 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease (ESRD) or ALS. You do not have to be poor to get Medicare — it is based on age and medical condition, not income. If you worked and paid Medicare taxes for at least 10 years, you are may have access to to it.

Medicaid covers people with low incomes. The income limit varies by state — some states are more generous than others. Medicaid also covers pregnant women, children, parents, seniors, and people with disabilities, but only if their income falls below their state's threshold. A 70-year-old with a very low income might have Medicaid. A 40-year-old with a moderate income might have Medicaid in one state but not in another.

Who Runs and Pays for Each Program

Medicare is run by the federal government through the Centers for Medicare & Medicaid Services (CMS). The same rules explore in every state. The program is funded through payroll taxes (the Medicare tax you see on your paychecks), premiums you pay, and general federal revenue.

Medicaid is run by each state, with federal funding and oversight. This means the rules, covered services, and provider networks are different in each state. What Medicaid covers in California may not be what it covers in Texas. Some states have expanded Medicaid to cover more people; others have not. If you move to a different state, your Medicaid coverage may change.

What You Pay Out of Pocket

Medicare requires you to pay a monthly premium for Part B (doctor visits and outpatient care) and Part D (prescription drugs). You also pay a deductible each year before Medicare starts paying, and you pay copays or coinsurance when you use services. In 2024, the Part B premium is $164.90 per month for most people, but this amount changes yearly. If you have higher income, you pay more.

Medicaid typically has much lower out-of-pocket costs. Many states charge little or nothing for Medicaid premiums, and copays are often $0, $1, or $3 per visit or prescription. Some states do charge premiums or copays, but they are usually much smaller than Medicare costs. The exact amount depends on your state and your income level within Medicaid.

Coverage and Services

Medicare covers hospital care (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D). It also covers some preventive services with no copay. However, Medicare does not cover dental, vision, or hearing aids — you have to buy separate coverage or pay out of pocket for these. Long-term care in a nursing home is covered only for a limited time under specific conditions.

Medicaid coverage varies by state but often includes more services than Medicare. Many state Medicaid programs cover dental, vision, and hearing aids. Medicaid also covers long-term care in nursing homes and assisted living facilities, which is a major difference from Medicare. However, Medicaid will only pay for nursing home care if you have spent down your assets to a very low level — this is called a "spend-down" requirement.

Doctor and Hospital Networks

Medicare is accepted by most doctors and hospitals nationwide. You can usually see any doctor who accepts Medicare, and you are not locked into a network the way you might be with a private insurance plan. If you choose Original Medicare (not a Medicare Advantage plan), you have broad freedom to choose providers.

Medicaid networks vary by state and sometimes by county. Some doctors do not accept Medicaid because the reimbursement rates are lower than Medicare or private insurance. In some areas, finding a Medicaid doctor can be harder than finding a Medicare doctor. If you move to a different state, you may have to find new doctors because your Medicaid coverage changes.

When Someone Has Both Medicare and Medicaid

Some people may have access to for both programs at the same time. This usually happens when someone is 65 or older with a low income, or when someone under 65 is disabled and has low income. People with both are called "dual may be able to access" or "Medicare-Medicaid enrollees."

If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid pays second and often covers the costs Medicare does not — like the Part B premium, deductibles, and copays. This can mean you pay very little out of pocket. However, you have to be enrolled in both programs correctly, and the rules for how they work together are complex. If you think you might be dual may be able to access, ask your state Medicaid office or call 1-800-MEDICARE to confirm your coverage.

Frequently Asked Questions

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

Yes. If you are 65 or older with low income, or disabled with low income, you may be dual may be able to access. Medicare pays first, and Medicaid covers some of the costs Medicare does not. Contact your state Medicaid office or 1-800-MEDICARE to learn about you may have access to for both.

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

No. You have to sign up for Medicare when you turn 65, even if you are on Medicaid. You will not be automatically enrolled. Contact Social Security or 1-800-MEDICARE at least three months before your 65th birthday to sign up.

Does Medicaid cover things Medicare does not?

Yes, in many states. Medicaid often covers dental, vision, hearing aids, and long-term nursing home care — services Medicare does not cover. However, coverage varies by state, so check with your state Medicaid program to see what is covered where you live.

What happens to my Medicaid if I move to another state?

Your Medicaid coverage ends when you move. You must explore for Medicaid in your new state, and the rules and covered services may be different. Contact your new state's Medicaid office as soon as you move to understand your coverage options.

Why do some doctors not accept Medicaid?

Medicaid pays doctors less than Medicare or private insurance. Some doctors choose not to accept Medicaid patients because the payment is lower or because the paperwork is more complex. This can make it harder to find a doctor in some areas, especially in rural regions.

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.