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-state program that covers people with low income, regardless of age. The two programs operate separately, use different rules, and cover different groups — though some people may have access to for both.
The confusion is understandable because both are government health programs and both help pay medical bills. But they answer different questions. Medicare asks: "Did you work and pay taxes?" Medicaid asks: "Do you have low income right now?" A 72-year-old with a high pension gets Medicare but not Medicaid. A 35-year-old with no income gets Medicaid but not Medicare. A 68-year-old with low income may get both.
Key Takeaways
- Medicare is based on age (65+) or disability, funded by payroll taxes, and available to almost all seniors regardless of income.
- Medicaid is based on low income and is run by each state, so rules and coverage vary by where you live.
- Medicare has four parts (A, B, D, and supplemental coverage), each covering different services and requiring different payments.
- Medicaid covers more services than Medicare in many states, including long-term care and dental, but has strict income and asset limits.
- Some people may have access to for both programs — called "dual may be able to access" — and should understand how each one pays to avoid gaps.
Who Qualifies: Age, Work History, and Income
You may have access to for Medicare Part A (hospital insurance) at 65 if you or your spouse paid Medicare taxes for at least 10 years. You do not need to be retired. Income does not matter. If you are under 65, you can get Medicare if you have received Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS.
You may have access to for Medicaid based on income limits set by your state. Most states cover adults earning up to 138% of the federal poverty line (about $1,900 per month for a single person in 2024, though this varies). Some states have not expanded Medicaid and use lower limits. Medicaid also has asset limits — in most states, you cannot own more than $2,000 in countable assets (though a home and car usually do not count). Your state's Medicaid office can tell you the exact limits where you live.
If you are 65 or older and have low income, you may may have access to for both. Being on Medicare does not disqualify you from Medicaid, and Medicaid can help pay your Medicare premiums and cost-sharing.
What Each Program Covers
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Part A covers, with deductible | Covers, varies by state |
| Doctor visits | Part B covers, with copay | Covers, varies by state |
| Prescription drugs | Part D covers, with gaps and copays | Covers, varies by state |
| Nursing home care | Up to 100 days after hospital stay | Covers long-term care, no time limit |
| Dental | Not covered | Covered in most states |
| Vision | Limited (eye exams only) | Covered in most states |
| Hearing aids | Not covered | Covered in some states |
| Home health care | Covered after hospital or skilled nursing stay | Covers, varies by state |
Medicare covers hospital care, doctor visits, and prescription drugs, but has gaps. It does not cover dental, vision, or hearing aids unless you buy a supplemental plan. It covers nursing home care only for the first 100 days after a hospital stay of at least three days, and only at a skilled nursing facility — not custodial care.
Medicaid covers more services in most states, including long-term nursing home care with no time limit, dental, vision, and hearing aids. However, coverage details vary by state. Some states cover more services than others, and some states pay providers less, which can affect where you can receive care.
How Much You Pay: Premiums, Deductibles, and Copays
Medicare Part A has no monthly premium if you paid taxes for 10 years, but it has a deductible ($1,632 in 2024 for each hospital stay). Part B (doctor visits) costs a monthly premium (around $175 in 2024, higher if your income is above $97,000). Part D (prescription drugs) has a monthly premium that varies by plan. You also pay copays and coinsurance for services.
Medicaid has no premium in most states. You may pay small copays for some services (usually $1 to $5), but many states waive copays for low-income people. Medicaid does not have deductibles the way Medicare does. However, Medicaid has strict income and asset limits, so if your income rises above the limit, you lose coverage.
If you have both Medicare and Medicaid, Medicaid usually pays your Medicare premiums and helps with cost-sharing. This is called Medicare Savings Programs or Medicaid Buy-In, depending on your state.
How Each Program Is Administered
Medicare is run by the federal government through the Centers for Medicare and Medicaid Services (CMS). The rules are the same in every state. You enroll through Social Security or Medicare.gov. Once you are enrolled, your coverage is the same whether you live in Maine or California.
Medicaid is run by each state with federal funding and federal guidelines. This means the income limits, covered services, and payment rates differ by state. A service covered in New York may not be covered in Texas. You enroll through your state's Medicaid office or health department, not through a federal office. If you move to a different state, you must reapply for Medicaid in your new state.
This also means that if you are on Medicaid and your income changes, you should report it to your state office right away. Medicaid coverage can end quickly if your income rises above the limit, whereas Medicare coverage continues as long as you pay the premiums.
When You Might Have Both: Dual may be able to access
If you are 65 or older, have low income, and have limited assets, you may may have access to for both Medicare and Medicaid. This is called being dual may be able to access. Medicaid fills in gaps that Medicare leaves — it pays your Medicare premiums, covers services Medicare does not (like dental and long-term care), and helps with copays and deductibles.
If you are dual may be able to access, you need to understand which program pays first. Generally, Medicare pays first for services it covers, and Medicaid pays second. For services only Medicaid covers (like long-term nursing home care), Medicaid pays. You should not have to pay out of pocket for most services if you are dual may be able to access, but you need to use providers who accept both programs.
Some states run special programs for dual may be able to access people, such as managed long-term care plans that combine Medicare and Medicaid benefits into one plan. Ask your state Medicaid office whether you may have access to and what options are available.
Common Mistakes and How to Avoid Them
One common mistake is assuming Medicare covers everything at 65. It does not. Many people turn 65, enroll in Medicare, and are shocked to find that dental, vision, and hearing aids are not covered. If you want coverage for these services, you need to buy a supplemental plan (Medigap) or a Medicare Advantage plan that includes them.
Another mistake is not reporting income changes to Medicaid. If you are on Medicaid and your income rises, you must report it. If you do not and you are later found to be over the income limit, you may have to repay benefits. Conversely, if your income drops, report it right away so you can stay on Medicaid.
A third mistake is not understanding the difference between Medicare Advantage and Original Medicare. Medicare Advantage is a private insurance option that includes prescription drug coverage and often dental and vision. Original Medicare is the federal program. They have different rules, different out-of-pocket costs, and different provider networks. Choose based on your health needs and budget, not just because a plan is advertised.
Frequently Asked Questions
Can I be on Medicare and Medicaid at the same time?
Yes. If you are 65 or older and have low income and limited assets, you may may have access to for both. Medicaid will help pay your Medicare premiums and cover services Medicare does not, like dental and long-term care. Contact your state Medicaid office to see if you may have access to.
What happens to my Medicaid if I turn 65?
You automatically become may be able to access for Medicare at 65 if you paid taxes for 10 years. Your Medicaid does not end — you can keep both if your income is still low enough. However, you must enroll in Medicare Part B during your enrollment window, or you may face penalties later.
Does Medicare cover nursing home care?
Medicare covers up to 100 days in a skilled nursing facility, but only if you were hospitalized for at least three days first. After 100 days, you pay out of pocket. Medicaid covers long-term nursing home care with no time limit if you meet income and asset limits, making it the main payer for most people in nursing homes.
Why do Medicaid rules differ by state?
Medicaid is a partnership between the federal government and each state. The federal government sets minimum standards, but each state decides its own income limits, which services to cover, and how much to pay providers. This is why coverage and may be able to access vary by state.
What should I do if I think I may have access to for Medicaid?
Contact your state Medicaid office or health department. You can also call 211 (a free referral service) and ask for Medicaid information in your area. Have your income, asset, and household information ready. Many states now let you explore online or by phone.