No, Medicare and Medicaid are two separate government programs with different rules, funding, and who they cover

Medicare and Medicaid sound similar, but they are completely different programs run by different parts of the government. Medicare is federal health insurance for people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low income at any age. You can have one, both, or neither — it depends on your age and income. Understanding which one you have (or might have) matters because the coverage, costs, and rules are not the same.

Key Takeaways

  • Medicare is a federal program for people 65 and older; Medicaid is for people with low income of any age.
  • Medicare is funded by payroll taxes; Medicaid is funded by federal and state taxes, and rules vary by state.
  • Some people may have access to for both programs at the same time — this is called "dual may be able to access" status.
  • Your out-of-pocket costs, covered services, and how you sign up are different for each program.
  • You can have Medicare without Medicaid, or Medicaid without Medicare, depending on your age and income.

Who Medicare covers and how it works

Medicare covers almost everyone 65 and older, no matter how much money they have. You do not have to be retired, and you do not have to be poor. If you worked and paid Medicare taxes for at least 10 years, you get Part A (hospital insurance) and Part B (doctor and outpatient care) automatically when you turn 65. If you did not work long enough, you can still buy in by paying a monthly premium.

Medicare has four parts: Part A covers hospital stays, skilled nursing, hospice, and some home health care. Part B covers doctor visits, lab tests, imaging, and outpatient procedures. 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. Most people pay a monthly premium for Part B and Part D, and there are deductibles and copays when you use care.

Who Medicaid covers and how it works

Medicaid covers people with low income. The income limit depends on your state — some states are more generous than others. You can be any age: a child, a working adult, a parent, or a senior. Medicaid is run jointly by the federal government and each state, so the rules, covered services, and income limits are different in every state. What Medicaid covers in one state may not be covered the same way in another.

Medicaid typically covers doctor visits, hospital care, prescription drugs, mental health services, and long-term care (nursing home or home care). Many Medicaid programs have little or no monthly premium, and copays are usually lower than Medicare. However, not all doctors accept Medicaid, and wait times for appointments can be longer. If your income goes up, you may lose Medicaid coverage.

When someone has both Medicare and Medicaid

Some people are "dual may be able to access" — they have both Medicare and Medicaid at the same time. This usually happens when someone is 65 or older and has low income. Medicare is the primary payer, meaning it pays first. Medicaid then covers some of the costs that Medicare does not pay, like deductibles and copays. This can significantly lower out-of-pocket costs.

To have both, you must meet the age and income requirements for Medicare (65 or older) and the income requirements for Medicaid in your state. You do not have to do anything special to coordinate them — once you are enrolled in both, they work together automatically. However, if your income changes, you may lose Medicaid while keeping Medicare.

How funding and may be able to access differ

Medicare is funded by payroll taxes that workers and employers pay during their working years. It is a federal program with the same rules nationwide. You earn Medicare coverage by working and paying taxes; income does not matter for may be able to access once you turn 65.

Medicaid is funded by federal and state taxes. Each state designs its own program within federal guidelines, so may be able to access rules, income limits, and covered services vary widely. Some states expanded Medicaid to cover more people; others did not. Your Medicaid coverage depends on where you live and your current income.

Costs and out-of-pocket expenses

Medicare has standard costs nationwide. Part B has a monthly premium (the amount changes each year), an annual deductible, and copays or coinsurance when you use services. Part D (prescription drugs) has a monthly premium, an annual deductible, and copays. If you choose Part C (Medicare Advantage), costs vary by plan but are often lower than Original Medicare.

Medicaid costs vary by state. Many people pay no monthly premium, but some states charge small premiums based on income. Copays are usually very low or zero. If you have both Medicare and Medicaid, Medicaid typically covers the costs Medicare does not, which can mean almost no out-of-pocket expense.

What to ask your doctor or insurance company

If you are turning 65 or recently turned 65, ask your doctor's office which insurance they accept — Medicare, Medicaid, or both. Ask whether your current medications are covered under the plan you are considering. If you think you might have low income and may have access to for Medicaid, ask your local Medicaid office or your state health department what the income limit is and what documents you need.

If you have both Medicare and Medicaid, ask which one pays first for a specific service, and what your out-of-pocket cost will be. If you are moving to a different state, ask how your Medicaid coverage will change, because rules are different in every state.

When to contact your state health department or Social Security

Contact your state Medicaid office if you think you might may have access to for Medicaid based on low income. They can tell you the exact income limit in your state and what to do next. Contact Social Security if you are turning 65 and need to sign up for Medicare, or if you already have Medicare and your circumstances have changed.

If you are already on Medicare and your income drops, contact your state Medicaid office to see if you now may have access to for Medicaid. If you are on Medicaid and your income goes up, report it to your Medicaid office, because your coverage may change. Do not wait until you lose coverage to report a change — tell them as soon as you know.

Frequently Asked Questions

Can I have Medicare without Medicaid?

Yes. Most people 65 and older have Medicare only. You have Medicare without Medicaid if your income is above your state's Medicaid limit. You will pay the standard Medicare premiums, deductibles, and copays, but you do not may have access to for Medicaid's help with those costs.

Can I have Medicaid without Medicare?

Yes. If you are under 65 and have low income, you can have Medicaid without Medicare. You will have Medicaid coverage for doctor visits, hospital care, and other services. When you turn 65, you will become may be able to access for Medicare, and you may have both at that point.

What happens to my Medicaid if I turn 65?

When you turn 65, you become may be able to access for Medicare. Your Medicaid does not automatically end, but the rules change. Medicare becomes your primary insurance. If your income is still low enough, you can keep Medicaid to help pay Medicare costs. Contact your state Medicaid office before you turn 65 to understand how your coverage will change.

Do I have to choose between Medicare and Medicaid?

No. If you may have access to for both, you can and should have both. They work together, with Medicare paying first and Medicaid helping with the remaining costs. You do not have to pick one or the other — having both usually saves you money.

How do I know which program I have?

Check your insurance card. Medicare cards say "MEDICARE" at the top and have a red, white, and blue design. Medicaid cards vary by state but usually say "Medicaid" or your state's name. If you are unsure, call the number on your card or contact your state health department.