Medicare and Medicaid are separate programs that serve different groups of people

Medicare is a federal health insurance program for people age 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 care, doctor visits, and prescription drugs.

Medicaid is a joint federal and state program for people with low income. Income limits and covered services vary by state. Medicaid often covers more services than Medicare — including long-term care and dental — but you must meet your state's income and asset rules to be covered.

The programs overlap in some ways. Some people age 65 and older are enrolled in both Medicare and Medicaid (called "dual may be able to access"). But they are not the same program, they do not cover the same things, and which one is "better" depends entirely on your age, income, and health needs.

Key Takeaways

  • Medicare is for people 65 and older or with certain disabilities; Medicaid is for people with low income, and rules vary by state.
  • Medicare requires you to pay premiums and cost-sharing; Medicaid often has no premium but may have small copays depending on your state.
  • Medicaid covers services Medicare does not, such as long-term nursing home care and dental care, but not all states cover the same services.
  • Some people may have access to for both programs and use them together to cover more of their health costs.
  • Your state of residence affects what Medicaid covers and whether you can even be covered, so the answer to "which is better" depends on where you live.

Who each program covers

Medicare covers people age 65 and older who have worked and paid Medicare taxes, or whose spouse did. It also covers some people under 65 with disabilities, people with end-stage renal disease, and people with ALS (amyotrophic lateral sclerosis). You do not have to be poor to get Medicare — it is based on age or disability status, not income.

Medicaid covers people with low income. The income limit depends on your state, your family size, and whether you are pregnant, disabled, or caring for children. Some states have expanded Medicaid to cover more people; others have not. A person earning $20,000 a year might may have access to in one state and not in another.

Because the rules are so different, a person can be too young for Medicare but still covered by Medicaid, or too wealthy for Medicaid but covered by Medicare. A person can also be covered by both at the same time.

What Medicare covers versus what Medicaid covers

Medicare has four parts. Part A covers hospital stays, skilled nursing facility care (up to 100 days per benefit period), hospice, and some home health care. Part B covers doctor visits, outpatient care, and some 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 care, vision care, hearing aids, or long-term custodial nursing home care. These gaps are why many people buy supplemental insurance or enroll in Medicare Advantage plans that add some coverage.

Medicaid covers more types of services, but the list varies by state. All states must cover hospital care, doctor visits, and some preventive care. Most states also cover dental care, vision care, and long-term nursing home care — services Medicare does not pay for. Some states cover hearing aids; others do not. Some cover physical therapy without a doctor's referral; others require one.

Because Medicaid is state-run, what you get depends on where you live. A service covered in New York may not be covered in Texas. You can call your state Medicaid office or visit your state's Medicaid website to see what your state covers.

How much you pay out of pocket

Medicare requires you to pay a monthly premium for Part B (currently $164.90 per month for most people in 2024, though this changes yearly). You also pay a deductible before Medicare starts paying — $1,632 for Part A hospital care and $240 for Part B doctor visits in 2024. After you meet the deductible, you pay copays or coinsurance for each service. For prescription drugs under Part D, you pay a monthly premium and cost-sharing that varies by plan.

Medicaid usually has no monthly premium, though some states charge small premiums for certain groups. You may pay a small copay — often $1 to $5 — when you see a doctor or fill a prescription, but many states waive copays for people with very low income. Some states charge nothing at all.

If you are dual may be able to access (covered by both Medicare and Medicaid), Medicaid typically pays your Medicare premiums and cost-sharing, which can save you hundreds of dollars per year.

When you might have both Medicare and Medicaid

You can be covered by both programs at the same time if you meet the age or disability rules for Medicare and the income rules for Medicaid. This happens most often with people age 65 and older who have low income.

If you are dual may be able to access, Medicare is your primary insurance — it pays first. Medicaid pays second and typically covers your Medicare premiums, deductibles, and copays. This means your out-of-pocket costs are much lower than if you had Medicare alone.

To learn about you may have access to for both, contact your state Medicaid office. You can also call 1-800-MEDICARE to ask about your Medicare coverage and whether you might may have access to for Medicaid in your state.

How to find out which program covers you

If you are 65 or older, you are likely covered by Medicare. You can check your coverage by logging into your Medicare account at Medicare.gov or calling 1-800-MEDICARE. You can also visit your local Social Security office.

If you think you might may have access to for Medicaid, contact your state Medicaid office. You can find your state office by visiting Medicaid.gov and selecting your state, or by calling 211 (a free helpline that connects you to local health and human services). Your state will tell you the income limit, what documents you need, and what services are covered in your state.

If you are under 65 and not yet on Medicare, you may still have other coverage options. Your state may offer a marketplace plan through the Affordable Care Act, or you may be covered through an employer. A 211 call can help you sort out what is available to you.

Questions to ask your doctor or social worker

If you are trying to decide between programs or figure out if you may have access to for both, bring these questions to your next appointment:

  • Based on my age and income, which program should I be covered by?
  • If I have both Medicare and Medicaid, which one pays first for my prescriptions and doctor visits?
  • Are there services I need (like dental care or long-term nursing home care) that my current coverage does not pay for?
  • Should I look into a Medicare Advantage plan or a Medicaid managed care plan to get more coverage?
  • Can you help me contact my state Medicaid office to see if I may have access to?

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older and have low income, you may may have access to for both. Medicare pays first, and Medicaid pays your Medicare premiums and cost-sharing. Contact your state Medicaid office to learn about you may have access to based on your income and assets.

Does Medicaid cover long-term nursing home care?

Most states' Medicaid programs cover long-term nursing home care, but Medicare does not (except for the first 100 days after a hospital stay). Check your state's Medicaid website or call your state Medicaid office to confirm what your state covers and what the income and asset limits are.

Which program is cheaper?

Medicaid usually has lower out-of-pocket costs because there is no monthly premium and copays are small or zero. Medicare requires premiums and cost-sharing. However, if you have both programs, Medicaid covers your Medicare costs, making your total out-of-pocket expense very low.

What if I do not may have access to for either program?

If you are under 65 and do not may have access to for Medicaid, you may be able to buy a plan through your state's health insurance marketplace or through an employer. Call 211 or visit Healthcare.gov to see what options are available in your state.

How do I know what my state's Medicaid covers?

Visit your state's Medicaid website (search "[your state] Medicaid") or call your state Medicaid office. You can also call 211 and ask for a local health navigator who can explain what your state covers and help you understand the income limits.