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

Medicare is a federal health insurance program for people 65 and older, regardless of income. Some younger people with disabilities or end-stage renal disease also may have access to. You pay premiums, deductibles, and copays, and the program covers hospital stays, doctor visits, and prescription drugs.

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 with different income limits and covered services. Medicaid typically has little or no premium, but covers a broader range of services including long-term care and dental work that Medicare does not.

The confusion is understandable — both are government health programs with similar names. But they are funded differently, have different may be able to access rules, and cover different things. Some people may have access to for both programs at the same time, which is called being "dual may be able to access."

Key Takeaways

  • Medicare is for people 65 and older; Medicaid is for low-income people of any age.
  • Medicare is run by the federal government; Medicaid is run by each state with federal funding.
  • Medicare requires you to pay premiums and has deductibles; Medicaid usually has no or very low premiums.
  • Medicaid covers services Medicare does not, including long-term nursing home care and dental care.
  • You can be enrolled in both programs at the same time if you meet the income and age requirements for each.

Who each program covers

Medicare covers almost everyone at age 65, whether they are working or retired, rich or poor. You become may be able to access automatically if you or your spouse paid Medicare taxes for at least 10 years while working. If you did not pay those taxes, you can still buy Medicare at age 65, but the premiums are higher. Medicare also covers some people under 65 who have been on Social Security disability for 24 months, or who have end-stage renal disease or ALS.

Medicaid covers people whose income falls below a certain level set by their state. The income limit varies widely — a single person might may have access to in one state at $1,500 per month and in another at $900 per month. Medicaid also covers pregnant women, children, parents, and people over 65 with low income. Some states have expanded Medicaid to cover more working-age adults; others have not. Your state's Medicaid office can tell you the current income limit.

What you pay out of pocket

Medicare has a monthly premium for Part B (doctor visits) and Part D (prescription drugs). In 2024, the standard Part B premium is $164.90 per month, though it is higher if your income is above a certain level. You also pay a deductible before Medicare starts paying — for hospital care in 2024, that is $1,556 per stay. After you meet the deductible, you pay copays or coinsurance for each service.

Medicaid typically has no monthly premium or a very small one. You may pay a small copay when you see a doctor or fill a prescription, but many states charge nothing for preventive care. The exact copay amounts vary by state and by the type of service. Because Medicaid has lower out-of-pocket costs, it is often the better choice for people with very low income, even if they also have Medicare.

What services each program covers

Medicare covers hospital stays, doctor visits, lab tests, imaging, and some preventive care like cancer screenings and vaccines. Part D covers prescription drugs. Medicare does not cover dental care, vision care, hearing aids, or long-term nursing home care. It also does not cover custodial care — help with bathing, dressing, and meals — unless it is part of skilled nursing care after a hospital stay.

Medicaid covers all the services Medicare covers, plus dental care, vision care, and long-term nursing home care. This is a major difference: if you need to live in a nursing home for months or years, Medicare will not pay for it, but Medicaid will if your income and assets are low enough. Medicaid also covers some services Medicare does not, such as transportation to medical appointments and personal care information at home. However, what Medicaid covers varies by state — some states cover more services than others.

How each program is funded and run

Medicare is funded by payroll taxes that workers and employers pay while working. The federal government runs the program the same way in all 50 states. When you turn 65, you enroll in Medicare through Social Security, and the rules are identical whether you live in Maine or California.

Medicaid is funded by both federal and state taxes. Each state designs and runs its own Medicaid program within federal guidelines, which is why the income limits, covered services, and copay amounts differ from state to state. If you move to a different state, your Medicaid coverage may change. You enroll in Medicaid through your state's Medicaid office, not through Social Security.

When you might have both Medicare and Medicaid

If you are 65 or older and your income is low enough to meet your state's Medicaid limit, you can be enrolled in both programs. This is called being "dual may be able to access." Medicare is your primary insurance, meaning it pays first. Medicaid then pays some of the costs Medicare does not cover, such as the Part B premium and deductibles. Medicaid also covers services Medicare does not, like long-term nursing home care.

Being dual may be able to access is often the best situation financially if you may have access to, because you get the broad coverage of Medicare plus the additional services and lower out-of-pocket costs of Medicaid. If you think you might may have access to for both, contact your state's Medicaid office to ask about the income limit and how to enroll. Your state's office can also tell you whether you need to take any action or if you will be enrolled automatically.

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

If you are 65 or older, you may have access to for Medicare. You enroll through Social Security — you can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You should enroll in the three months before you turn 65, during your birthday month, or in the three months after. If you enroll late, you may pay a higher premium for the rest of your life.

To learn about you may have access to for Medicaid, contact your state's Medicaid office. You can find the phone number and website by searching "[your state] Medicaid" or by calling 211, which is a free helpline that connects you to local health and human services programs. When you call, have your income information ready — they will ask about your monthly income and sometimes about your assets. The process usually takes a few weeks.

Questions to ask your doctor or insurance counselor

If you are newly may be able to access for Medicare, ask your doctor which Medicare plan covers your current medications and doctors. If you have both Medicare and Medicaid, ask which program pays first for each service you use. If you are thinking about enrolling in Medicaid, ask your state's Medicaid office whether your income qualifies and what services are covered in your state.

You can also ask for a free insurance counselor through your State Health Insurance information Program (SHIP) — search "[your state] SHIP" online to find the phone number. SHIP counselors can answer questions about both Medicare and Medicaid and help you understand your coverage options at no cost.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older and your income is low enough to meet your state's Medicaid limit, you can be enrolled in both. Medicare pays first, and Medicaid helps cover costs Medicare does not pay. This is called being "dual may be able to access."

Do I have to pay for Medicare?

Yes. Most people pay a monthly premium for Part B (doctor visits) and Part D (prescription drugs). You also pay a deductible and copays for services. Medicaid, by contrast, usually has no or very low premiums.

Does Medicaid cover nursing home care?

Yes, Medicaid covers long-term nursing home care if your income and assets are low enough. Medicare does not cover this. This is one of the biggest differences between the two programs.

What if I do not have 10 years of work history for Medicare?

You can still buy Medicare at age 65, but your premiums will be higher than the standard amount. You can also check if you may have access to for Medicaid based on your current income, which does not require any work history.

How do I know which program to use when I see a doctor?

Tell your doctor's office that you have Medicare and/or Medicaid, and they will bill the correct program. If you have both, Medicare is the primary payer. Your insurance card will show which programs you are enrolled in.