Medicare and Medicaid are separate government programs with different rules, who they serve, and how they work

Medicare and Medicaid sound similar, but they are two completely different programs. Medicare is a federal health insurance program for people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers low-income individuals and families of any age. The confusion is understandable — they share a name, they both involve the government, and they both help pay for medical care. But the may be able to access rules, what they cover, and how much you pay are different for each one.

Understanding which program you may be covered by — or whether you may have access to for both — matters because it affects which doctors you can see, what prescriptions are covered, and how much you pay out of pocket. Some people are covered by both programs at the same time, a situation called "dual may be able to access." Others may have access to for only one. Knowing the difference helps you understand your coverage and find the right resources when you need care.

Key Takeaways

  • Medicare is a federal program for people 65 and older; Medicaid is a state and federal program for low-income people of any age.
  • You pay Medicare premiums and deductibles; Medicaid typically has no premium or very low cost, depending on your state.
  • Medicare covers hospital care, doctor visits, and prescription drugs through different parts (A, B, D); Medicaid coverage varies by state.
  • Some people may have access to for both programs at the same time, which is called being "dual may be able to access."
  • Your state of residence affects Medicaid coverage and costs, but Medicare rules are the same everywhere in the United States.

Who Medicare covers versus who Medicaid covers

Medicare is primarily for people age 65 and older. You become automatically enrolled in Medicare when you turn 65 if you have worked and paid Medicare taxes for at least 10 years (or if your spouse has). Some younger people with disabilities or end-stage renal disease can also receive Medicare, but age 65 is the main entry point.

Medicaid is based on income and family size, not age. Each state sets its own income limits, so what qualifies you in one state may not in another. Medicaid also covers children, pregnant people, parents, seniors, and people with disabilities — but only if their income falls below their state's threshold. Some states have expanded Medicaid to cover more people; others have not. This is why your state matters for Medicaid but not for Medicare.

How you pay: premiums, deductibles, and out-of-pocket costs

Medicare requires you to pay a monthly premium for Part B (doctor and outpatient care) and Part D (prescription drugs). In 2024, the standard Part B premium is $164.90 per month, though this amount changes yearly. You also pay a deductible before Medicare starts covering costs, and you share costs with Medicare through copayments and coinsurance. If you have higher income, you may pay higher premiums.

Medicaid typically has no monthly premium or a very small one, depending on your state. Some states charge small copayments for doctor visits or prescriptions, but many do not. Because Medicaid is designed for low-income people, the out-of-pocket costs are generally much lower than Medicare. However, what Medicaid covers and what you pay varies significantly from state to state.

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 way to receive Parts A, B, and D through a private insurance company. Most people with Medicare have some combination of these parts.

Medicaid coverage varies by state, but it must cover certain services: hospital care, doctor visits, emergency services, and family planning. Beyond that, each state decides what else to cover — things like dental care, vision, hearing aids, or therapy services. This is a major difference: your Medicaid coverage depends on where you live, while Medicare coverage is the same across the country.

When you might have both Medicare and Medicaid

Some people may have access to for both programs at the same time. This usually happens when someone is 65 or older and has a low enough income to also may have access to for Medicaid. These people are called "dual may be able to access." Being dual may be able to access can be helpful because Medicaid may cover costs that Medicare does not, like long-term care or dental work.

If you think you might may have access to for both, contact your state Medicaid office or call 211 to speak with someone who can review your situation. They can tell you whether you meet the income and other requirements for Medicaid in your state. Some states have special programs designed specifically for people who are dual may be able to access, which can simplify your coverage.

How to find out which program covers you

If you are 65 or older and have worked in the United States, you are almost certainly covered by Medicare. You can check your Medicare status by creating an account on Medicare.gov or by calling 1-800-MEDICARE. They can tell you which parts of Medicare you have and what your premiums and deductibles are.

To find out about Medicaid, contact your state Medicaid office directly. You can find your state office through Medicaid.gov, or call 211 and ask for the Medicaid office in your area. They will ask about your income, family size, and other factors to determine whether you may have access to. If you do, they will explain what services are covered in your state and what your costs will be.

What happens if you have Medicare but need more coverage

If you have Medicare but find that your out-of-pocket costs are high, you have options. You can switch to a Medicare Advantage plan (Part C) if you want different coverage. You can also add a Medigap policy, which is private insurance that helps pay for costs Medicare does not cover. Some people add both a Medigap policy and Part D for prescription drugs.

If your income is low, you may also may have access to for a Medicare Savings Program, which is run by your state and helps pay your Medicare premiums and deductibles. These programs have income limits that vary by state, but they are designed for people with Medicare who cannot afford their costs. You can ask about this when you contact your state Medicaid office.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older and have a low income, you may may have access to for both. Medicaid can help pay for costs that Medicare does not cover. Contact your state Medicaid office to learn about you may have access to based on your income and other factors.

Do I have to pay for Medicare?

Yes. Most people pay a monthly premium for Part B and Part D. You also pay deductibles and share costs with Medicare through copayments. However, if your income is very low, you may may have access to for help paying these costs through a Medicare Savings Program.

Does Medicaid cover the same things in every state?

No. While all states must cover certain services like hospital care and doctor visits, each state decides what else to cover. Dental, vision, and hearing aid coverage vary by state. Check with your state Medicaid office to see what is covered where you live.

What is the income limit for Medicaid?

Income limits vary by state and by family size. Some states have expanded Medicaid to cover more people; others have not. Contact your state Medicaid office or call 211 to find out the income limit in your area and whether you may may have access to.

How do I sign up for Medicare?

Most people are automatically enrolled in Medicare when they turn 65 if they have worked and paid Medicare taxes. You can check your status on Medicare.gov or call 1-800-MEDICARE. If you are not automatically enrolled, you can sign up during the initial enrollment period around your 65th birthday.