No — Medicaid and Medicare are two separate programs with different rules, who pays, and who qualifies
Medicare is a federal health insurance program for people 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 the program is run by the Centers for Medicare & Medicaid Services (CMS).
Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state sets its own income limits and decides which services to cover, so the program looks different depending on where you live. Medicaid is funded by federal and state taxes, not by individual payroll contributions.
The confusion is understandable — both are government health programs, both names start with "Medi-", and both are run by CMS. But they operate on completely different may be able to access rules, funding sources, and benefit structures. A person can be on Medicare, Medicaid, both, or neither.
Key Takeaways
- Medicare is based on age (65+) or disability status; Medicaid is based on income and household size.
- Medicare is the same nationwide; Medicaid rules and covered services vary by state.
- You pay into Medicare during your working years; Medicaid is need-based and does not require prior contributions.
- Some people may have access to for both programs at the same time, a situation called "dual may be able to access".
- Each program has different deductibles, copays, and coverage limits that affect your out-of-pocket costs.
How Medicare and Medicaid Differ in Who Qualifies
Medicare may be able to access is straightforward: you must be 65 or older, or under 65 with a may have access to disability or end-stage renal disease. Your income does not matter. If you worked and paid Medicare taxes for at least 10 years (40 quarters), you may have access to for Part A (hospital insurance) at no monthly premium. If you did not work long enough, you can still buy in at a higher cost.
Medicaid may be able to access depends on your state and your household income. Most states cover adults earning up to 138% of the federal poverty level, though some states have lower limits. You must also be a U.S. citizen or may have access to immigrant, and rules about assets and resources vary by state. A single person in one state might may have access to while the same person in another state does not.
Because the rules are so different, a 62-year-old with a low income might be on Medicaid but not Medicare (too young). A 70-year-old with a high income is on Medicare but not Medicaid (too much money). A 68-year-old with low income could be on both.
What Each Program Covers
Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, and preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative way to get Parts A, B, and D through a private insurance company.
Medicare does not cover dental, vision, hearing aids, or long-term custodial care (help with daily living activities). It also does not cover most nursing home care unless it follows a hospital stay and meets specific conditions.
Medicaid covers more services than Medicare in many cases, including dental, vision, hearing aids, and long-term care in nursing homes or at home. However, what Medicaid covers depends on your state. One state might cover dental for adults; another does not. This variation is one of the biggest practical differences between the two programs.
How Costs Work: Premiums, Deductibles, and Copays
| Cost Type | Medicare | Medicaid |
|---|---|---|
| Monthly Premium | Part B and Part D have premiums (amount varies by income and coverage choice) | No monthly premium in most states |
| Deductible | Part A and Part B each have annual deductibles | Varies by state; many states have no deductible |
| Copay or Coinsurance | You pay a share of costs after deductible is met | Varies by state; often lower or zero for low-income people |
| Out-of-Pocket Maximum | Medicare has limits on what you pay for Part A and Part B combined | Varies by state |
Medicare costs are predictable because they are the same across the country. You know what your Part B premium will be, what your deductible is, and roughly what you will pay for a doctor visit. Medicaid costs vary wildly by state — some states charge no copay for any service; others charge small amounts; a few charge more.
If you are on both Medicare and Medicaid (dual may be able to access), Medicaid often pays your Medicare premiums and deductibles, which can save you hundreds of dollars per year. This is one reason some people actively look into whether they may have access to for Medicaid even after turning 65.
When You Might Be on Both Programs
You can be on Medicare and Medicaid at the same time. This happens when you meet the age or disability requirement for Medicare and also meet your state's income and asset limits for Medicaid. People in this situation are called "dual may be able to access" or "Medicare-Medicaid enrollees".
Dual may be able to access status is common among people 65 and older with low incomes. If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid pays second and often covers services Medicare does not, like dental and long-term care. Medicaid also typically covers your Medicare premiums and cost-sharing (deductibles and copays).
To learn about you may have access to for Medicaid while on Medicare, contact your state Medicaid office. Income limits and rules differ by state, and some states have special programs for people who are dual may be able to access.
How to Enroll in Each Program
You enroll in Medicare through Social Security. If you are 65 and receiving Social Security benefits, you are automatically enrolled in Parts A and B. If you are not yet receiving benefits, you must sign up during your initial enrollment period (the three months before the month you turn 65, the month you turn 65, and the three months after). Missing this window can result in late enrollment penalties that last for life.
You enroll in Medicaid through your state Medicaid office or through your state's health insurance marketplace. Each state has its own process and process. Some states use online portals; others require paper applications or phone calls. You can find your state Medicaid office through Medicaid.gov or by calling 1-800-MEDICARE.
If you think you might may have access to for both, start with Medicare (if you are 65 or older or have a may have access to disability). Then contact your state Medicaid office to ask about income limits and whether you may have access to. Do not assume you do not may have access to based on income alone — some states have special pathways for people on Medicare.
Common Mistakes and Misconceptions
One common mistake is waiting to enroll in Medicare because you have Medicaid. Medicaid does not replace Medicare, and missing your Medicare enrollment window can cost you thousands in penalties over time. If you are on Medicaid and turn 65, enroll in Medicare on schedule.
Another mistake is thinking Medicare covers long-term care. It does not, except for short-term skilled nursing care after a hospital stay. If you need help with daily living activities for an extended period, Medicare will not pay. Medicaid does cover this in most states, which is why some people on Medicare look into Medicaid may be able to access.
A third mistake is assuming Medicaid is the same everywhere. It is not. A service covered in one state may not be covered in another. If you move states, your Medicaid coverage may change. Always check with your new state's Medicaid office after moving.
Frequently Asked Questions
Can I have Medicare and Medicaid at the same time?
Yes. If you are 65 or older (or disabled and on Medicare) and your income is low enough to meet your state's Medicaid limits, you can be on both. Medicaid will typically pay your Medicare premiums and deductibles, reducing your out-of-pocket costs significantly.
Do I have to pay for Medicare?
Part A (hospital insurance) is free if you worked and paid Medicare taxes for at least 10 years. Part B (doctor visits) has a monthly premium that varies by income. Part D (prescription drugs) has a monthly premium that varies by plan. You can reduce these costs if you also may have access to for Medicaid.
What if I am under 65 and have a low income?
You would likely may have access to for Medicaid, not Medicare. Medicare is available to people under 65 only if they have a may have access to disability or end-stage renal disease. Contact your state Medicaid office to learn about income limits and what services are covered in your state.
Does Medicaid cover everything Medicare does not?
Medicaid covers some things Medicare does not, like dental and long-term care, but not everything. Medicaid coverage varies by state, and some services may have limits or require prior approval. Check your state's Medicaid handbook or call your state Medicaid office to see what is covered.
What happens to my coverage if I move to a different state?
Your Medicare coverage stays the same — it is federal and works the same way everywhere. Your Medicaid coverage ends when you move, and you must explore in your new state. Rules and covered services may be different, so contact your new state's Medicaid office as soon as you move.