The Core Difference: Who Pays and Who Gets Covered
Medicare is a federal insurance program you pay into through payroll taxes during your working years. You become covered at 65, regardless of income. Medicaid is a joint federal and state program that covers people with low income, at any age. The programs are separate, funded differently, and cover different groups of people.
Medicare is the same nationwide. Medicaid rules change by state — what you pay, what is covered, and who qualifies all vary where you live. Many people assume they are the same program with different names. They are not. Understanding which one you are in, or whether you are in both, changes what you actually pay for care.
Key Takeaways
- Medicare is for people 65 and older (or some younger people with disabilities), while Medicaid is for people with low income at any age.
- You pay Medicare premiums and deductibles based on your work history; Medicaid costs little or nothing if you meet income limits, but rules vary by state.
- Medicare covers hospital stays, doctor visits, and some prescription drugs; Medicaid covers those plus long-term care and dental in many states.
- Some people may have access to for both programs at the same time, which is called "dual may be able to access" status.
- Your state of residence determines Medicaid coverage, so moving or changing income can change what you are covered for.
Who Medicare Covers
You are covered by Medicare if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years. You do not have to be retired. You do not have to be poor. If you worked and paid Medicare taxes, you are in the system.
Some people under 65 also may have access to: those who have received Social Security Disability Insurance (SSDI) for 24 months, those with end-stage renal disease, and those with ALS (Lou Gehrig's disease). For everyone else under 65, Medicare is not an option — you would need Medicaid, employer coverage, or a plan from the marketplace.
Who Medicaid Covers
Medicaid covers people with low income. The exact income limit depends on your state and your household size. In some states, a single person earning $1,500 per month might may have access to; in others, the limit is higher. Some states expanded Medicaid in 2014 to cover more working-age adults; others did not. Your state decides.
Medicaid also covers children, pregnant people, parents of dependent children, and people over 65 with low income. You do not have to be disabled to may have access to. You do not have to be retired. You just have to meet your state's income and asset limits. Many people may have access to for Medicaid without knowing it because they have never checked.
What Medicare Covers vs. What Medicaid Covers
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Yes, with deductible | Yes, varies by state |
| Doctor visits | Yes, with copay | Yes, usually free or low cost |
| Prescription drugs | Yes, Part D (separate plan) | Yes, varies by state |
| Nursing home care | Limited (100 days max) | Yes, if you meet income limits |
| Home health care | Yes, if medically necessary | Yes, varies by state |
| Dental | No | Yes, in most states |
| Vision | Limited | Yes, in most states |
| Long-term care (assisted living, memory care) | No | Yes, in some states |
Medicare covers acute care — hospital stays, doctor visits, tests, and surgery. It does not cover dental, vision, or hearing aids. It covers only 100 days of nursing home care after a hospital stay. For long-term care, you pay out of pocket unless you also have Medicaid.
Medicaid covers more types of care but the specifics change by state. Most states cover dental and vision. Many cover long-term care in nursing homes and assisted living facilities. Some cover hearing aids. Medicaid is often the only way a person with low income can pay for a nursing home or memory care facility for more than a few months.
What You Pay: Premiums, Deductibles, and Copays
Medicare has a monthly premium (the amount you pay to be covered). In 2024, the standard Part B premium is $164.90 per month, though it is higher if your income is above a certain level. You also pay a yearly deductible before Medicare starts paying — $240 for Part B in 2024. Then you pay a percentage of the cost of each service (usually 20 percent). These amounts change every year.
Medicaid costs little or nothing if you meet income limits. Most states charge no monthly premium. Some charge small copays for doctor visits or prescriptions, but many states waive copays for people with very low income. If you may have access to for Medicaid, the cost barrier is much lower than Medicare, but you have to meet your state's income and asset rules.
If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid usually pays your Medicare premiums and deductibles. This is why some people with low income and Medicare actively look for Medicaid coverage — it makes Medicare affordable.
Being Covered by Both Programs at the Same Time
You can be on both Medicare and Medicaid. This happens when you are 65 or older (or disabled and on Medicare) and your income is low enough to also may have access to for Medicaid. Your state determines the income cutoff. In some states, you can earn more and still may have access to; in others, the limit is stricter.
If you are dual may be able to access, Medicare is your primary insurance — it pays first. Medicaid pays second, covering costs Medicare does not. Medicaid also usually pays your Medicare premiums and deductibles, which makes a huge difference in what you actually spend. If you are on Medicare and struggling to pay premiums, checking whether you also may have access to for Medicaid is worth doing.
How to Find Out Which Program Covers You
If you are 65 or older, you are almost certainly on Medicare. You should have received a Medicare card in the mail. If you did not, contact Social Security at 1-800-772-1213 to confirm your coverage.
To learn about you may have access to for Medicaid, contact your state Medicaid office. You can find the phone number by searching "[your state] Medicaid" online, or by calling 211 (a free helpline that connects you to local programs). Have your income and household size ready. Many states also let you check online or through a mobile app. If you think you might may have access to, it is worth checking — many people are covered without knowing it.
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, you can may have access to for both. Medicaid becomes your secondary insurance and often pays your Medicare premiums and deductibles. Contact your state Medicaid office to see if you may have access to based on your income.
Does Medicare cover long-term care in a nursing home?
Medicare covers up to 100 days of skilled nursing care after a hospital stay of at least three days. After that, you pay out of pocket. Medicaid covers nursing home care for longer periods if you meet income limits, which is why many people eventually rely on Medicaid to pay for long-term care.
What if I move to a different state — does my coverage change?
Medicare coverage stays the same nationwide. Medicaid changes by state, so if you move, your Medicaid coverage may change. You should contact your new state's Medicaid office within 30 days of moving to report the change and see if you still may have access to under the new state's rules.
Do I have to be retired to get Medicare?
No. You become covered at 65 whether you are working or retired. If you are under 65 and disabled, you can also may have access to if you have received SSDI for 24 months. Your work status does not matter — your age or disability status does.
Why does Medicaid coverage vary so much by state?
Medicaid is jointly funded and run by the federal government and individual states. Each state sets its own income limits, decides which services to cover, and determines how much to pay providers. This is why a person might may have access to in one state but not another, or have dental coverage in one state but not the next.