No — Medicare and Medicaid are separate federal programs with different rules, different funding, and different people they serve

The names sound alike, but Medicare and Medicaid work in opposite directions. Medicare is a federal insurance program you pay into through payroll taxes during your working years — it covers people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low incomes, regardless of age. You can have both at the same time, but they are run by different agencies, funded differently, and cover different services.

The confusion is understandable. Both are government health programs. Both use the word "medical". But thinking of them as the same thing will cost you money and coverage. Understanding which one you have — or whether you have both — determines what you pay, what doctors you can see, and what services are covered.

Key Takeaways

  • Medicare is for people 65 and older (or some younger people with disabilities), while Medicaid is for people with low incomes of any age.
  • You pay Medicare payroll taxes while working and then pay premiums and deductibles when you turn 65; Medicaid is free or very low-cost for those who meet income limits.
  • Medicare is run by the federal government; Medicaid is run by each state, so coverage and rules vary by where you live.
  • Some people may have access to for both programs at the same time — these people are called "dual may be able to access" and may have lower out-of-pocket costs.

Who Each Program Covers

Medicare covers people who are 65 or older, people under 65 with certain disabilities (including 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. If you worked and paid Medicare taxes for at least 10 years, you are covered.

Medicaid covers people with low incomes. The income limit varies by state and by family size, but it is always based on how much money you make, not how old you are. A 30-year-old and an 80-year-old can both have Medicaid if their income is low enough. Some states also cover people who are disabled or blind, regardless of income.

You can have both programs at the same time. People who are 65 or older with low incomes, or people under 65 who are disabled and have low incomes, may be covered by Medicare for some services and Medicaid for others. These people are called dual may be able to access.

How Each Program Is Funded and Run

Medicare is funded by payroll taxes — you and your employer each paid 1.45% of your wages into the Medicare trust fund while you worked. The federal government runs Medicare the same way in every state. When you turn 65, you contact Medicare directly (or through Social Security), and the rules you follow are the same whether you live in California or Maine.

Medicaid is funded partly by the federal government and partly by each state. Because states run their own Medicaid programs, the income limits, covered services, and rules are different in every state. What Medicaid covers in New York may not be covered in Texas. This is why you must check your own state's Medicaid rules — there is no single national answer.

What Each Program Covers

Medicare has four parts. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and some preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies. Medicare does not cover long-term care, dental, vision, or hearing aids (though some Part C plans add these).

Medicaid covers a wider range of services, including doctor visits, hospital care, prescription drugs, and long-term care (nursing home or home care). However, what is covered depends on your state. Some states cover dental and vision; others do not. Some cover more mental health services than Medicare does. You must check what your state's Medicaid program covers.

What You Pay Under Each Program

Medicare requires you to pay premiums, deductibles, and copayments. Most people pay a monthly premium for Part B (the amount changes each year based on income). You pay a deductible before Medicare starts paying for hospital care or doctor visits. You also pay copayments or coinsurance for services. The exact amounts change each year.

Medicaid is free or very low-cost. Most people with Medicaid pay nothing or a small copayment (usually $1 to $5 per visit). Some states charge small premiums for Medicaid, but only for people above a certain income level. If you have both Medicare and Medicaid, Medicaid usually pays the Medicare premiums and deductibles you cannot afford.

How to Find Out Which Program You Have

If you are 65 or older, you have Medicare unless you turned it down. You should have received a Medicare card in the mail. If you did not, you can create an account at Medicare.gov or call 1-800-MEDICARE to check your status.

If you think you might have Medicaid, you must check with your state. Each state has a Medicaid office or a website where you can look up whether you are covered. You can also call 211 (a free referral line) and ask for your state's Medicaid office. Medicaid is not automatic — you must be found to meet your state's income and other rules, and coverage can end if your income goes up.

If you are not sure whether you have both, look at your insurance cards. A Medicare card says "MEDICARE" and has a claim number. A Medicaid card varies by state but usually says "Medicaid" or your state's name. If you have both cards, you are dual may be able to access.

What Happens If You Have Both Programs

If you are dual may be able to access, Medicare is your primary insurance and Medicaid is your secondary. This means Medicare pays first, and Medicaid pays some or all of what Medicare does not cover. In practice, this usually means you pay less out of pocket because Medicaid covers Medicare premiums, deductibles, and copayments you cannot afford.

Dual may be able to access people often have access to more services than people with only Medicare, because Medicaid covers long-term care and some other services Medicare does not. However, you must stay within both programs' rules. If you lose Medicaid coverage (for example, because your income goes up), you will owe the full Medicare costs again.

Common Mistakes People Make

The biggest mistake is assuming that because you have Medicare, you do not need to check whether you also have Medicaid. If your income is low, you may be able to get Medicaid to help pay your Medicare costs. Many people miss this because they do not realize the programs are separate and can work together.

Another mistake is thinking Medicaid rules are the same everywhere. If you move to a different state, your Medicaid coverage may change or end. You must reapply in your new state and learn the new rules. Do not assume coverage will transfer.

A third mistake is not understanding that Medicaid is income-based and can end. If you get a raise, inherit money, or have a change in circumstances, you may lose Medicaid. Keep track of your income and report changes to your state's Medicaid office.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older (or disabled) and have low income, you may have both. Medicare covers hospital and doctor care; Medicaid helps pay your Medicare costs and covers services Medicare does not, like long-term care. You are called dual may be able to access.

Do I have to pay for Medicaid?

No. Medicaid is free for people who meet the income limit. A few states charge small premiums for people above a certain income, but most people pay nothing. Copayments are usually $1 to $5 per visit.

What if I move to a different state?

Your Medicaid coverage does not move with you. You must reapply in your new state because each state runs its own Medicaid program with different income limits and rules. Medicare coverage stays the same everywhere.

How do I know if I make too much money for Medicaid?

Income limits vary by state and family size. Contact your state's Medicaid office or call 211 to find out the limit for your situation. You can also check your state's Medicaid website, which usually has an income calculator.

Does Medicare cover long-term care like nursing homes?

Medicare covers skilled nursing care for a limited time after a hospital stay, but not long-term care. Medicaid covers long-term care if you meet the income and asset limits. This is one reason dual may be able to access people often have better coverage for long-term care.