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

Medicare and Medicaid sound similar, but they are completely different programs run by different parts of the federal government. Medicare is health insurance for people 65 and older, regardless of income. Medicaid is health coverage for people with low income, regardless of age. You can have one, both, or neither — and which one you have changes what you pay and what doctors will see you.

The confusion matters because the wrong assumption can cost you money. Someone might think they have Medicaid when they actually have Medicare, or vice versa, and then be shocked when a doctor's office says they cannot bill their plan. This guide walks you through the real differences so you know which program you have and what it actually covers.

Key Takeaways

  • Medicare is for people 65 and older; Medicaid is for people with low income of any age.
  • Medicare is run by the federal government through the Centers for Medicare & Medicaid Services; Medicaid is run by each state with federal funding.
  • Medicare has a monthly premium, deductible, and copays; Medicaid costs vary by state and income but is often free or very low cost.
  • Medicare covers hospital, doctor, and prescription drug services; Medicaid covers those plus dental, vision, and long-term care in many states.
  • You can have both programs at the same time if you are 65 or older and have low income — this is called being "dual may be able to access."

Who each program is designed for

Medicare is for people who are 65 or older, or who are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least two years, or who have end-stage renal disease or ALS. Your income does not matter. A wealthy person and a person with no income can both have Medicare if they meet the age or disability requirement.

Medicaid is for people whose income and assets fall 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 a month and not may have access to in another at $2,000 a month. Age does not matter. A 30-year-old, a 65-year-old, and a child can all have Medicaid if their income is low enough.

Who runs each program and how they work

Medicare is run by the federal government through the Centers for Medicare & Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services. The rules are the same in every state. You sign up through Social Security, and your coverage starts on the first day of the month you turn 65 (or the month you become may be able to access for disability). Medicare has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative way to get Parts A, B, and D through a private insurance company.

Medicaid is run by each state, with money from the federal government. The rules, income limits, and covered services vary by state. You explore through your state's Medicaid office or through your state's health insurance marketplace. Some states have expanded Medicaid to cover more people; others have not. This is why a person might have Medicaid in one state and not in another, even with the same income.

What each program costs

Medicare has costs built in. In 2024, the standard Part B premium is $164.90 per month, though it can be higher if your income is above a certain level. You also pay a deductible before Medicare starts paying — for Part A (hospital), the deductible is $1,632 per benefit period in 2024; for Part B (doctor), it is $240 per year. After you meet the deductible, you pay copays or coinsurance for each service. If you add Part D (prescription drugs), that has its own premium and deductible. These numbers change every year.

Medicaid costs vary by state. In many states, Medicaid is free for people who meet the income requirement. In others, there is a small monthly premium or a copay when you use a service. Some states charge nothing for preventive care but charge a copay for other visits. You need to check your state's Medicaid program to know what you will pay.

What services each program covers

Medicare covers hospital stays (Part A), doctor visits and outpatient services (Part B), and prescription drugs (Part D). It does not cover dental, vision, hearing aids, or long-term care like nursing homes or home health aides. Some Medicare Advantage plans (Part C) add dental or vision coverage, but this varies by plan and by region.

Medicaid covers hospital, doctor, and prescription drugs like Medicare does, but it also covers services Medicare does not: dental care, vision care, hearing aids, and long-term care services like nursing home stays and home health aides. This is one reason Medicaid is often more valuable for people with chronic conditions or disabilities. However, what Medicaid covers varies by state — one state might cover dental; another might not.

When you can have both programs at the same time

If you are 65 or older and your income is low enough to meet your state's Medicaid limit, you can have both Medicare and Medicaid. This is called being dual may be able to access. Medicare is your primary insurance, meaning it pays first. Medicaid pays second, covering costs Medicare does not pay, like the Part B premium and deductible. Dual may be able to access people often pay very little out of pocket because Medicaid fills in the gaps.

To be dual may be able to access, you must be 65 or older (or under 65 and on Medicare for disability reasons) and meet your state's Medicaid income and asset limits. You do not have to do anything special — if you have Medicare and your income drops below the Medicaid limit, you can explore for Medicaid through your state. Some states have programs specifically for dual may be able to access people that coordinate the two programs.

Common mistakes and how to avoid them

One common mistake is assuming that because you have one program, you do not need the other. If you are 65 or older and have low income, you may be able to have both, and Medicaid can save you hundreds of dollars a year by covering Medicare costs. Another mistake is not knowing your state's Medicaid rules. Medicaid rules change, and what was true last year might not be true this year. Check your state's Medicaid website or call your state's Medicaid office to confirm what you are covered for.

A third mistake is not updating your information when your income or household changes. If your income drops, you may become may be able to access for Medicaid. If your income rises, you may lose Medicaid. If you turn 65, you must sign up for Medicare or face a penalty. Keep track of these changes and report them to the right program so your coverage stays correct.

How to find out which program you have

Check your insurance card. It will say "Medicare" or "Medicaid" on it. If you have both, you will have two cards. If you are not sure, call the number on the back of your card and ask. You can also log into your account online — Medicare has a website at Medicare.gov, and each state has its own Medicaid website. Your state's Medicaid office can tell you whether you are enrolled and what your coverage includes.

If you do not have either program and think you might be may be able to access, contact your state's Medicaid office to ask about Medicaid, or contact Social Security if you are 65 or older to ask about Medicare. You can also call 211 (dial 2-1-1) and a local specialist can tell you which programs you might be able to use.

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. This is called dual may be able to access status. Medicare pays first, and Medicaid covers the costs Medicare does not pay, like premiums and deductibles.

Do I have to pay for Medicaid?

In most states, Medicaid is free if you meet the income requirement. Some states charge a small monthly premium or copay for certain services. Check your state's Medicaid program to find out what you will pay.

What happens if I turn 65 and have Medicaid?

You become may be able to access for Medicare at 65. You should sign up for Medicare through Social Security. You can keep Medicaid at the same time if your income is still low enough. If you do not sign up for Medicare Part B when you turn 65, you may face a penalty later.

Does Medicare cover dental and vision?

Original Medicare does not cover dental, vision, or hearing aids. Some Medicare Advantage plans add these benefits, but coverage varies by plan and region. Medicaid covers dental and vision in many states.

How do I know if I am may be able to access for Medicaid?

Medicaid may be able to access depends on your income, assets, and your state's rules. Contact your state's Medicaid office or visit your state's Medicaid website to find out the income limit and to learn whether you meet the requirements.