No, Medicare and Medicaid are not the same, even though their names sound alike

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 into Medicare through payroll taxes during your working years, and it becomes your insurance when you turn 65.

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 within federal guidelines, so what Medicaid covers and who it covers varies significantly by state. You do not pay into Medicaid through taxes; instead, it is funded by general tax revenue.

The two programs have different rules, different costs, different coverage, and different ways to sign up. Understanding which one you may use—or whether you may have access to for both—matters because it changes what you pay and what doctors and hospitals you can see.

Key Takeaways

  • Medicare is for people 65 and older (or some younger people with disabilities), while Medicaid is for low-income people of any age.
  • Medicare is run by the federal government; Medicaid is run by each state, so coverage and income limits differ by where you live.
  • You pay Medicare premiums, deductibles, and copays; Medicaid typically costs little or nothing out of pocket, depending on your state and income.
  • Some people may have access to for both Medicare and Medicaid at the same time, a situation called "dual may be able to access."
  • You sign up for Medicare through Social Security; you sign up for Medicaid through your state's health department or social services office.

Who Each Program Covers

Medicare covers nearly all Americans age 65 and older. You become may be able to access automatically when you turn 65 if you have worked at least 10 years in jobs where you paid Medicare taxes. If you have not worked that long, you can still buy Medicare coverage, though it costs more.

Medicare also covers some people under 65: those who have received Social Security Disability Insurance (SSDI) for at least two years, those with end-stage renal disease, and those with amyotrophic lateral sclerosis (ALS). Age is not a barrier for these groups.

Medicaid covers low-income individuals and families. The income limit varies by state and by family size. In some states, a single person earning $1,500 per month might may have access to; in others, the limit is higher. Your state's Medicaid office publishes its current income limits, and they change yearly. Medicaid also covers people who are blind, disabled, or pregnant, sometimes at higher income levels than the general population.

How Much You Pay Out of Pocket

Medicare requires you to pay a monthly premium for Part B (medical insurance) and Part D (prescription drug coverage). In 2024, the standard Part B premium is $164.90 per month, though it varies based on your income. You also pay a yearly deductible before Medicare starts to pay, and you pay copays or coinsurance when you use services. These costs add up, which is why many Medicare beneficiaries buy supplemental insurance (called Medigap) to cover what Medicare does not.

Medicaid typically costs little or nothing. Most states charge no premium, and many charge no copay or deductible. Some states charge a small copay—usually $1 to $5—when you see a doctor or fill a prescription. A few states charge a small monthly premium for people above a certain income threshold, but it is rare. Because Medicaid is designed for low-income people, out-of-pocket costs are kept minimal.

What Services Each Program Covers

Medicare covers hospital stays (Part A), doctor visits and outpatient care (Part B), prescription drugs (Part D), and some preventive services like screenings and vaccines. It does not cover dental, vision, or hearing aids unless you buy a supplemental plan. Long-term care in a nursing home is covered only for a limited time after a hospital stay, and only if you meet strict conditions.

Medicaid covers doctor visits, hospital stays, prescription drugs, and preventive care. It also covers services Medicare does not: dental care, vision care, hearing aids, and long-term care in nursing homes. Because Medicaid is state-run, coverage varies. One state's Medicaid may cover acupuncture or mental health services more generously than another's. Your state Medicaid office publishes a list of covered services.

How to Sign Up for Each Program

You sign up for Medicare through Social Security. You can explore online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You should sign up three months before you turn 65—the month you turn 65, and three months after. If you miss this window, you may pay a penalty for the rest of your life, so timing matters.

You sign up for Medicaid through your state. Most states have an online portal where you can explore; some allow phone or in-person applications. You can find your state's Medicaid office by searching "[your state] Medicaid" or by calling 211, which is a free helpline that connects you to local health and human services. You can explore for Medicaid any time of year; there is no enrollment important date like there is for Medicare.

When You Might may have access to for Both Programs

Some people may have access to for both Medicare and Medicaid at the same time. This is called being dual may be able to access. It happens when you are 65 or older (or may have access to for Medicare through disability) and your income is low enough for Medicaid. For example, a 68-year-old with Medicare whose monthly income is $1,000 might may have access to for Medicaid in a state with a higher income limit.

If you are dual may be able to access, Medicaid fills in gaps that Medicare leaves. Medicaid pays your Medicare premiums and deductibles, covers services Medicare does not (like dental and long-term care), and keeps your out-of-pocket costs very low. Being dual may be able to access is often the best financial position you can be in for health coverage, because you get the breadth of Medicare plus the low costs of Medicaid.

State Differences in Medicaid

Because Medicaid is run by each state, the program you have access to depends on where you live. Some states have expanded Medicaid to cover more low-income adults; others have not. Some states cover more dental or mental health services than others. Income limits, copay amounts, and the list of covered providers all vary.

If you move to a different state, your Medicaid coverage may change. You may lose coverage, gain coverage, or find that your copays or covered services are different. When you move, contact your new state's Medicaid office to understand what coverage is available to you. The same applies if you are considering moving in retirement—check what Medicaid looks like in the state you are thinking of, because it can affect your healthcare costs significantly.

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, you can have both. Medicaid then pays your Medicare premiums and covers services Medicare does not, like dental and long-term care. Contact your state Medicaid office to see if you may have access to.

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

You can still buy Medicare coverage when you turn 65, though the premium is higher than the standard rate. You can also may have access to through a spouse's work history if you have been married at least 10 years. Contact Social Security to discuss your options.

Does Medicaid cover nursing home care?

Yes, Medicaid covers long-term nursing home care if you meet income and asset limits. Medicare covers only a limited stay after a hospital admission. If you think you may need long-term care, understanding your state's Medicaid rules is important, because they vary.

Can I switch from Medicaid to Medicare when I turn 65?

You become may be able to access for Medicare at 65 regardless of Medicaid status. You should sign up for Medicare even if you have Medicaid, because Medicare becomes your primary insurance. You can keep Medicaid if you still may have access to by income, and it will cover what Medicare does not.

What if I cannot afford Medicare premiums?

If your income is low, you may may have access to for Medicaid, which will pay your Medicare premiums. You may also may have access to for a Medicare Savings Program, which is a state program that helps pay premiums and out-of-pocket costs. Contact your state Medicaid office or call 211 to learn what programs are available where you live.