Medical and Medicare are two separate systems that often get confused because of their similar names

Medical (also called Medicaid) is a joint federal and state program that covers low-income people of any age. Medicare is a federal program that covers people age 65 and older, regardless of income, plus some younger people with disabilities or end-stage renal disease. The biggest difference: Medicaid is means-tested (your income and assets matter), while Medicare is age-based (turning 65 is what matters most).

The confusion happens because both programs pay medical bills, both use the word "care" in their names, and both are run by the Centers for Medicare & Medicaid Services (CMS). But they are funded differently, cover different groups, and work in different ways. Understanding which one you fall under — or whether you fall under both — changes what you pay and what doctors you can see.

Key Takeaways

  • Medicaid is for low-income people of any age and is run jointly by states and the federal government, so rules vary by state.
  • Medicare is for people 65 and older and is run entirely by the federal government, so the rules are the same everywhere.
  • You can have both Medicaid and Medicare at the same time — this is called being "dual may be able to access" — and it changes how your bills are paid.
  • Medicaid covers things Medicare does not, like long-term care and dental, but only if your state includes them in its plan.
  • Income limits for Medicaid vary by state and family size, while Medicare has no income limit.

Who each program covers

Medicare covers nearly everyone at age 65, with no income test. You do not have to be poor to get it. If you worked and paid Medicare taxes, or if your spouse did, you are covered. Some people under 65 also may have access to: those on Social Security Disability Insurance (SSDI) for 24 months, those with end-stage renal disease, and those with ALS (amyotrophic lateral sclerosis).

Medicaid covers people whose income and assets fall below a threshold set by their state. The threshold is different in every state and changes based on family size. A single person in one state might earn too much to may have access to, while the same person in another state would may have access to easily. Medicaid also covers children, pregnant people, parents, and people with disabilities — but only if their income is low enough.

Some people are covered by both. These "dual may be able to access" people are usually older adults or people with disabilities whose income is low enough for Medicaid but who also turned 65 or may have access to for Medicare through disability. About 12 million people in the United States are dual may be able to access.

How they are funded and run

Medicare is entirely federal. The federal government sets the rules, collects the payroll taxes that fund it, and pays the bills. When you turn 65, you deal with Medicare — the same program, the same rules — no matter which state you live in.

Medicaid is a partnership. The federal government sets broad rules and pays a share of the cost (usually between 50 and 75 percent, depending on the state's wealth). Each state designs its own program within those rules, sets its own income limits, decides which services to cover, and pays the rest of the cost. This is why Medicaid in New York is different from Medicaid in Texas. It is also why some states expanded Medicaid under the Affordable Care Act and others did not.

What each program covers

Medicare has four parts. Part A covers hospital stays, skilled nursing, hospice, and some home health care. Part B covers doctor visits, outpatient care, and some preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A, B, and D offered by private insurers. Medicare does not cover dental, vision, hearing aids, or long-term custodial care (help with bathing, dressing, meals).

Medicaid covers more ground but varies by state. All states must cover hospital care, doctor visits, emergency services, and some preventive care. Most states also cover dental, vision, hearing aids, and long-term care — but not all, and the scope differs. Some states cover more mental health services than others. Some cover more therapy. Medicaid also covers family planning and transportation to medical appointments in ways Medicare does not.

If you are dual may be able to access, Medicare pays first (it is called the "primary payer"), and Medicaid fills in gaps — copays, deductibles, and services Medicare does not cover. This is why dual may be able to access people often pay very little out of pocket.

Cost differences

Medicare has premiums, deductibles, and copays. Most people pay a monthly premium for Part B (the amount changes yearly). There is an annual deductible for Part A and Part B. You pay copays or coinsurance when you use services. The exact amounts depend on which parts you have and whether you chose Original Medicare or Medicare Advantage.

Medicaid has no premium for most people. Some states charge small copays for doctor visits or prescriptions, but many services are free. If you are dual may be able to access, Medicaid usually pays your Medicare premiums and cost-sharing, so your out-of-pocket cost can be very low or zero.

Both programs have limits on what they pay providers. Medicare sets a fixed payment for each service. Medicaid payments are set by each state and are often lower than Medicare pays. This is why some doctors accept Medicare but not Medicaid, or vice versa.

What happens if you turn 65 while on Medicaid

When you turn 65, you become may be able to access for Medicare. You do not lose Medicaid automatically — you can have both. However, you must sign up for Medicare Part A and Part B during your enrollment window (usually the three months before, the month of, and three months after your 65th birthday). If you miss this window and do not have other may have access to coverage, you pay a permanent penalty on your Part B premium.

Once you have both, Medicare becomes your primary insurance. Medicaid steps in to help pay Medicare costs and cover services Medicare does not. In some states, you may need to re-enroll in Medicaid or switch to a Medicaid plan designed for dual may be able to access people. Contact your state Medicaid office to confirm what you need to do.

How to find out which program covers you

If you are 65 or older, you are covered by Medicare. You may also be covered by Medicaid if your income is low enough. Contact your state Medicaid office to learn the income limit for your situation and whether you may have access to.

If you are under 65, you are not covered by Medicare unless you have a disability or end-stage renal disease. You may be covered by Medicaid if your income is low enough. Your state Medicaid office can tell you the threshold and help you understand whether you meet it. You can also call 211 (a free helpline) and ask for a referral to your state Medicaid program.

If you are not sure which program you are in, look at your insurance card. It will say "Medicare" or "Medicaid" (or both). If you do not have a card, call the number on any medical bill you have received — the provider can tell you which program is listed.

Frequently Asked Questions

Can I have both Medicaid and Medicare at the same time?

Yes. If you are 65 or older and your income is low enough, you can be covered by both. Medicare pays first, and Medicaid covers gaps. About 12 million people in the United States have both programs. Your state Medicaid office can tell you if you may have access to.

If I am on Medicaid now, do I automatically get Medicare when I turn 65?

No. You become may be able to access for Medicare at 65, but you must sign up during your enrollment window (three months before, the month of, and three months after your birthday). If you miss it, you pay a penalty. Contact Medicare or your state Medicaid office to enroll.

Why do some doctors not take Medicaid but do take Medicare?

Medicaid pays doctors less than Medicare does, and payment rules vary by state. Some doctors choose not to accept Medicaid because the reimbursement is too low or the paperwork is too complex. Ask your doctor's office which programs they accept before you schedule an appointment.

Does Medicaid cover things Medicare does not?

Yes. Medicaid often covers dental, vision, hearing aids, and long-term care — services Medicare does not. However, coverage varies by state. Contact your state Medicaid office to learn what is covered in your state.

What if I do not may have access to for Medicaid but cannot afford Medicare?

Medicare has no income limit, so you may have access to at 65 regardless of income. However, you may pay premiums and cost-sharing. Medicare offers programs like Extra Help (for prescriptions) and Savings Programs (for premiums and deductibles) based on income. Call 1-800-MEDICARE to learn if you may have access to for cost information.