Medicare and Medicaid are separate federal programs with different purposes, rules, and who runs them
Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). You become covered when you turn 65, regardless of income — or earlier if you have end-stage renal disease, ALS, or have received Social Security Disability Insurance (SSDI) for 24 months. You pay premiums, deductibles, and copayments.
Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state sets its own income limits and decides what services it covers, so the program you get in one state may not exist in another. There is no age requirement.
The confusion is understandable — both are government health programs, both have "care" in the name, and both are run by CMS. But they are fundamentally different in who pays for them, who can join, and what they cover. Understanding which one applies to you matters because the forms you fill out, the doctors you can see, and what you pay are all different.
Key Takeaways
- Medicare is based on age or disability and is the same nationwide; Medicaid is based on income and varies by state.
- You pay Medicare premiums and cost-sharing; Medicaid is free or very low-cost for those who meet income limits.
- Medicare covers hospital care, doctor visits, and prescription drugs; Medicaid covers those plus long-term care and dental in some states.
- You can have both Medicare and Medicaid at the same time — this is called being "dual may be able to access" and is common among older adults with low income.
How Medicare Works and Who It Covers
Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, and hospice. 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 Parts A, B, and D offered by private insurance companies — it bundles coverage and often includes dental or vision, but usually requires you to use doctors in a specific network.
You pay for Medicare through payroll taxes while you work (this is called FICA tax), and then through monthly premiums once you are covered. In 2024, the standard Part B premium is $164.90 per month, though it is higher if your income is above a certain threshold. Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years. Part D premiums vary by plan and range from roughly $7 to $100 per month. You also pay a deductible before coverage kicks in and copayments when you use services.
Medicare is the same in every state. A Medicare card from Florida works the same way in California. You do not have to prove low income to join — only that you are 65 or older, or that you meet the disability or disease criteria.
How Medicaid Works and Who It Covers
Medicaid is jointly funded by federal and state governments, and each state runs its own program. This means income limits, covered services, and how you explore are different depending on where you live. In some states, a single adult with $1,500 per month in income may may have access to; in others, the limit is $900. Some states cover dental care; others do not. Some cover vision; others do not.
Medicaid is free or nearly free. You may have a small copayment for certain services (usually $1 to $5 per visit), but there are no premiums or deductibles. If your income is below your state's limit, you can join regardless of age, employment status, or health history.
To join Medicaid, you explore through your state's Medicaid office or through your state's health insurance marketplace. The process and timeline vary by state. Some states process applications in days; others take weeks. You will need proof of income, citizenship or immigration status, and residency.
What Each Program Covers
The biggest practical difference between the two programs is what happens when you need long-term care. Medicare covers short-term skilled nursing care after a hospital stay — typically up to 100 days — but does not cover long-term nursing home care or assisted living. Medicaid covers both, which is why many people on Medicare eventually need Medicaid to pay for extended care in a nursing home or assisted living facility.
Medicare also does not cover dental or vision care, while some states include these services in Medicaid. Both programs cover hospital stays, doctor visits, home health care, and prescription drugs, though the details of what is covered and what you pay vary between the two.
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Yes (Part A) | Yes |
| Doctor visits | Yes (Part B) | Yes |
| Prescription drugs | Yes (Part D) | Yes (varies by state) |
| Nursing home care | Limited (up to 100 days after hospital stay) | Yes (long-term) |
| Home health care | Yes (Part A) | Yes |
| Dental | No | Yes (in some states) |
| Vision | No | Yes (in some states) |
| Long-term care (nursing home, assisted living) | No | Yes |
Being Dual may be able to access: Having Both Medicare and Medicaid
You can have both programs at the same time. This is called being dual may be able to access or a "dual." It happens when you are 65 or older (or disabled and on Medicare) and your income is low enough to also meet your state's Medicaid limit.
If you are dual may be able to access, Medicare is your primary insurance — it pays first — and Medicaid fills in gaps. Medicaid pays your Medicare premiums, deductibles, and copayments, and covers services Medicare does not, like long-term nursing home care and dental. This is why dual coverage is valuable: it reduces your out-of-pocket costs to nearly zero and covers services Medicare alone does not. You do not have to choose between them. If you are may be able to access for both, you should join both. You join Medicare when you turn 65 (or become disabled), and you join Medicaid by explore to your state's Medicaid office.
Income and Asset Limits
Medicare has no income or asset limits. You can be a millionaire and still join at 65.
Medicaid has income limits that vary by state and family size. A single adult might have a limit of $1,000 to $1,500 per month; a couple might have a limit of $1,500 to $2,200. Some states use the federal poverty level; others set their own. Your state's Medicaid office or your state health insurance marketplace can tell you the exact limit for your situation.
Medicaid also has asset limits in most states, though the rules are complex. Generally, you can own a home and a car without it counting against you. Savings, investments, and other property do count. The limit is often $2,000 for a single person and $3,000 for a couple, but this varies by state and by program (long-term care Medicaid has different rules than regular Medicaid).
How to Find Out Which Program You Need
If you are 65 or older, you are may be able to access for Medicare. You should join during your initial enrollment period, which starts three months before the month you turn 65 and ends three months after. If you miss this window, you may pay a penalty for the rest of your life.
If your income is low, you may also be may be able to access for Medicaid. Contact your state's Medicaid office or visit your state health insurance marketplace to learn your state's income limit and how the process works. You can explore for both at the same time. If you are under 65 and not disabled, you are not may be able to access for Medicare. You may be may be able to access for Medicaid if your income is low enough. You can also look into coverage through your state's health insurance marketplace or through an employer plan.
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, you can have both. Medicaid will pay your Medicare premiums and cost-sharing, and cover services Medicare does not, like long-term nursing home care. You should join both if you are may be able to access.
Which program pays first if I have both?
Medicare pays first. Medicaid is the secondary payer and covers what Medicare does not. This is why dual coverage is valuable — your out-of-pocket costs are much lower.
What if I turn 65 but do not want Medicare?
You can delay joining, but you will likely pay a penalty. If you are still working and covered by your employer's health plan, you may be able to delay without penalty — ask your employer's benefits office. Otherwise, join during your initial enrollment period to avoid the penalty.
Does Medicaid cover the same doctors as Medicare?
Not always. Each program has its own network of doctors and hospitals. A doctor who accepts Medicare may not accept Medicaid, and vice versa. When you join either program, you can check which doctors are in the network before you sign up.
What happens to my Medicaid if my income goes up?
You may lose Medicaid coverage if your income exceeds your state's limit. You should report income changes to your state's Medicaid office. If you lose Medicaid, you may be able to join a plan through your state's health insurance marketplace.