The Basic Difference

Medicare is a federal health insurance program for people age 65 and older, regardless of income. You become covered automatically when you turn 65 if you have worked and paid Medicare taxes for at least 10 years. Medicaid is a joint federal and state program that pays for health care for people with low income, at any age. The key difference: Medicare is based on age and work history; Medicaid is based on income.

Because they are run by different agencies and have different rules, you may may have access to for one, both, or neither. A person can be on Medicare and Medicaid at the same time — this is called being "dual may be able to access." Understanding which program covers what will help you know what to expect when you get a medical bill or need to choose a plan.

Key Takeaways

  • Medicare covers people 65 and older who have paid Medicare taxes for at least 10 years, while Medicaid covers people of any age with low income.
  • Medicare is run by the federal government; Medicaid is run by each state with federal funding, so benefits and rules vary by state.
  • Some seniors may have access to for both programs and are called "dual may be able to access," which can lower their out-of-pocket costs.
  • Medicare has four parts (A, B, C, and D) that cover different services; Medicaid coverage varies widely depending on your state.
  • You must sign up for Medicare during specific enrollment periods, but Medicaid can be applied for at any time.

Who Medicare Covers

You are covered by Medicare automatically at age 65 if you have worked and paid Medicare taxes for at least 10 years (40 quarters). You do not have to be retired — you can still be working. If you are under 65, you may still may have access to if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS (Lou Gehrig's disease).

Medicare does not check your income or assets. A wealthy person and a person living in poverty can both have Medicare if they meet the age or disability requirement. This is why it is called a "universal" program for seniors — nearly everyone 65 and older in the United States is covered.

Who Medicaid Covers

Medicaid covers people with low income and limited assets. The income and asset limits vary by state, and they change each year. In most states, a single person with income below roughly $1,500 per month may may have access to, but this number is different in every state. Some states have expanded Medicaid to cover more people; others have not.

Medicaid covers people of any age — children, working-age adults, and seniors. A senior can have both Medicare and Medicaid if their income is low enough. Because each state runs its own Medicaid program, the services covered and the process for explore are different depending on where you live.

What Medicare 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, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurance companies — it bundles hospital and doctor coverage into one plan and usually includes drug coverage.

Medicare does not cover everything. It does not cover long-term care (nursing home care for non-medical reasons), dental care, vision care, or hearing aids. You may need to buy a supplemental insurance plan (called Medigap) to cover costs that Medicare does not pay, or you may choose a Medicare Advantage plan that includes some of these services.

What Medicaid Covers

Medicaid must cover certain services in every state: hospital care, doctor visits, lab work, X-rays, and nursing home care. Beyond that, each state decides what else to cover. Some states cover dental care, vision care, and hearing aids through Medicaid; others do not. Some states cover more mental health services or rehabilitation services than others.

Because Medicaid rules are set by each state, you need to know what your state's Medicaid program covers. You can find this information on your state's Medicaid website or by calling your state's Medicaid office. If you move to a different state, your Medicaid coverage may change.

Cost and How You Pay

Medicare Part A is free if you have paid Medicare taxes for 10 years. Part B costs a monthly premium (the standard amount is $164.90 in 2024, but it varies based on income). Part D (drug coverage) also has a monthly premium that varies by plan. You also pay a deductible and copayments when you use services.

Medicaid is free or very low cost. Some states charge a small copayment for certain services, but most Medicaid programs have no monthly premium. Because Medicaid is funded by taxes and is means-tested (based on income), it costs you nothing if you may have access to.

Enrollment and Timing

You must sign up for Medicare during specific windows. The main enrollment period is three months before, during, and three months after the month you turn 65. If you miss this window, you may pay a penalty for late enrollment. You can also sign up during the General Enrollment Period (January 1 to March 31 each year), but again, late sign-up penalties may explore.

Medicaid has no enrollment important date — you can explore at any time. However, coverage usually starts on the first day of the month in which you explore, or the first day of the following month. If you think you may may have access to, it is worth explore as soon as possible so your coverage can begin.

Frequently Asked Questions

Can I have both Medicare and Medicaid?

Yes. If you are 65 or older and your income is low enough to may have access to for Medicaid, you can be covered by both programs. This is called being "dual may be able to access." Medicare pays first, and Medicaid covers some of the costs Medicare does not pay, which can lower your out-of-pocket expenses.

What happens to my coverage if I move to another state?

Medicare coverage stays the same — it is federal and works the same way in every state. Medicaid coverage may change because each state runs its own program. When you move, contact your new state's Medicaid office to learn about you still may have access to and what services are covered.

Do I have to enroll in Medicare at 65 even if I am still working?

If you are still working and covered by your employer's health insurance, you may be able to delay Medicare Part B without penalty. However, you should still sign up for Part A (hospital insurance) at 65. Talk to your employer's benefits office and Medicare to understand your options before your 65th birthday.

How do I know if I may have access to for Medicaid?

Income and asset limits vary by state. The best way to find out is to contact your state's Medicaid office directly or visit your state's Medicaid website. You can also call 211 (a free helpline) and ask for a referral to your local Medicaid office.

What should I ask my doctor about Medicare and Medicaid coverage?

Ask whether your doctor accepts Medicare, Medicaid, or both. Ask which services require prior approval from your insurance plan. If you are on both programs, ask your doctor's office which one they will bill first. Understanding this before you receive care helps you know what you will owe.