Medicare and Medicaid are separate government programs with different rules, funding sources, and who they cover
Medicare is a federal health insurance program for people 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it becomes your insurance when you turn 65.
Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state runs its own Medicaid program within federal guidelines, so may be able to access and what is covered varies significantly by state. Medicaid is funded through general tax revenue, not payroll deductions.
The two programs overlap in some ways — some people may have access to for both, and both cover hospital stays, doctor visits, and prescription drugs — but they are entirely separate systems with different enrollment processes, different costs to you, and different coverage rules.
Key Takeaways
- Medicare is for people 65 and older (or younger people with certain disabilities), while Medicaid is for low-income individuals and families of any age.
- Medicare is the same nationwide and funded through payroll taxes; Medicaid varies by state and is funded through general tax revenue.
- You enroll in Medicare through Social Security; you enroll in Medicaid through your state's Medicaid office or health department.
- Some people may have access to for both programs at the same time, which is called "dual may be able to access" status.
- Medicare has monthly premiums and deductibles; Medicaid typically has no or very low premiums and varies by state on out-of-pocket costs.
How Medicare Works and Who It Covers
Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS). You become may be able to access the month you turn 65, and you must enroll during your Initial Enrollment Period — a seven-month window that starts three months before your 65th birthday month and ends three months after. If you miss this window, you may pay a permanent penalty on your premiums.
Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Part B covers doctor visits, outpatient care, and medical equipment. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies — it bundles hospital and doctor coverage and usually includes prescription drug coverage and extra benefits like dental or vision.
Most people do not pay a premium for Part A because they or their spouse paid Medicare taxes while working. Part B has a monthly premium (the standard amount in 2024 is $164.90, but it varies based on your income). Part D premiums vary by plan. If you choose Original Medicare, you also pay deductibles and copayments when you use services.
How Medicaid Works and Who It Covers
Medicaid is jointly funded and administered by the federal government and individual states. Because each state designs its own program, income limits, covered services, and enrollment processes differ. For example, one state may cover dental care while another does not; one state may have an income limit of $1,500 per month while another has $2,000.
Generally, Medicaid covers low-income children, pregnant people, parents, seniors, and people with disabilities. Some states have expanded Medicaid to cover more working-age adults with low incomes; others have not. You must check your specific state's rules to know whether you might be covered.
Medicaid typically has no monthly premium or a very low one. Out-of-pocket costs (copayments and deductibles) are usually minimal or zero, especially for low-income enrollees. Medicaid covers a broad range of services, including hospital care, doctor visits, prescription drugs, mental health services, and long-term care — coverage that is often more comprehensive than Medicare alone.
When Someone Qualifies for Both Medicare and Medicaid
People who may have access to for both programs are called "dual may be able to access" or "dually may be able to access." This typically happens when someone is 65 or older (or younger with a may have access to disability) and also has income and resources low enough to meet Medicaid limits in their state.
If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid then covers some or all of what Medicare does not pay, including deductibles, copayments, and premiums. This can significantly reduce your out-of-pocket costs. You enroll in Medicare through Social Security and in Medicaid through your state's Medicaid office — they do not automatically coordinate, so you must explore to both.
Some states offer special programs for dual-may be able to access people, such as integrated care plans that coordinate services between the two programs. Ask your state Medicaid office whether such a program exists where you live.
How to Enroll in Medicare
You enroll in Medicare through Social Security. You can explore online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You must enroll during your Initial Enrollment Period — the seven-month window centered on your 65th birthday month.
If you are already receiving Social Security benefits when you turn 65, you are enrolled in Medicare Part A and Part B automatically. If you are not yet receiving benefits, you must explore. You will receive your Medicare card in the mail about two weeks after you enroll.
If you miss your Initial Enrollment Period and do not have may have access to coverage (such as employer health insurance), you will pay a permanent late-enrollment penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full 12-month period you were late, and 1 percent of the Part D premium for each month you were late.
How to Enroll in Medicaid
You explore for Medicaid through your state's Medicaid office or health department. The process process and required documents vary by state. Most states now allow you to explore online through their Medicaid website, by mail, by phone, or in person.
To find your state's Medicaid office, search "[your state name] Medicaid" or visit medicaid.gov, which has links to every state program. You will need to provide proof of income, citizenship or immigration status, and residency. Processing times vary but typically take 30 to 45 days.
Some states have continuous enrollment, meaning once you are approved, you stay enrolled until you report a change in income or circumstances. Other states require you to renew your coverage periodically. Your state Medicaid office will tell you the renewal schedule when you enroll.
Key Differences in Coverage and Costs
| Feature | Medicare | Medicaid |
|---|---|---|
| Who it covers | Age 65+, some younger people with disabilities | Low-income individuals and families, any age |
| Funding | Federal (payroll taxes) | Federal and state (general tax revenue) |
| Monthly premium | Part A: usually $0; Part B: $164.90 (2024); Part D: varies | $0 or very low |
| Deductibles and copayments | Yes, varies by part and plan | Usually $0 or minimal |
| Prescription drug coverage | Part D (separate enrollment) | Included |
| Long-term care coverage | Limited (skilled nursing only, up to 100 days) | Covers nursing home and home care for may be able to access people |
| Dental, vision, hearing | Not covered in Original Medicare; may be in Medicare Advantage | Varies by state |
| How to enroll | Social Security (ssa.gov or 1-800-772-1213) | Your state's Medicaid office |
Frequently Asked Questions
Do I have to choose between Medicare and Medicaid?
No. If you may have access to for both, you can and should enroll in both. Medicare will be your primary insurance, and Medicaid will help cover costs Medicare does not pay. You enroll in each program separately through different agencies.
What happens to my Medicaid if I turn 65 and get Medicare?
You do not automatically lose Medicaid when you turn 65. If your income and resources still meet your state's Medicaid limits, you remain enrolled in Medicaid. Your state Medicaid office may contact you to update your information, but you should not assume you are dropped. Contact your state Medicaid office to confirm your status.
Can I switch from Original Medicare to Medicaid or vice versa?
No. Medicare and Medicaid are separate programs with different may be able to access rules. You cannot switch from one to the other. However, if your circumstances change — for example, your income drops — you may become newly may be able to access for Medicaid while still on Medicare, and you can enroll in both.
Which program covers nursing home care?
Medicare covers up to 100 days in a skilled nursing facility after a hospital stay, but only if you meet strict conditions. Medicaid covers long-term nursing home care for people who meet income and asset limits, and it covers many more days. If you need long-term care, Medicaid is usually the program that will pay for it.
What if I cannot afford Medicare premiums?
If your income is low, you may be may be able to access for programs that help pay Medicare premiums and out-of-pocket costs. These include the may have access to Medicare Beneficiary (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB) program, and may have access to Individual (QI) program. You explore through your state Medicaid office. You may also be may be able to access for Medicaid itself, which would cover these costs.