Medicare and Medicaid are two separate programs that serve different groups of people

Medicare is a federal health insurance program for people age 65 and older, regardless of income. It also covers some younger people with disabilities and people with end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it becomes available to you at 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 coverage and income limits vary significantly by state. Medicaid is not based on age — it is based on income and household size.

The choice between them is not really a choice: your age, income, and health status determine which program you can use. Most people do not pick one or the other. Many people over 65 have both — this is called being "dual may be able to access."

Key Takeaways

  • Medicare is for people 65 and older; Medicaid is for low-income people of any age, with income limits that vary by state.
  • Medicare is funded by payroll taxes and is the same nationwide; Medicaid is jointly funded by federal and state money and differs by state.
  • Medicare has three main parts (A for hospital, B for doctor visits, D for prescriptions) that you must enroll in; Medicaid covers what your state decides to cover.
  • If you are over 65 and have low income, you may have both Medicare and Medicaid, and Medicaid can help pay Medicare premiums and out-of-pocket costs.
  • You cannot switch from one to the other based on preference — your circumstances determine which program covers you.

How Medicare and Medicaid differ in who they cover

Medicare is age-based. You become may be able to access at 65, and enrollment is automatic if you are already receiving Social Security. If you are not yet receiving Social Security at 65, you must enroll yourself during your initial enrollment period, which is the three months before the month you turn 65, the month you turn 65, and the three months after.

Medicaid is income-based. To be covered, your household income must fall below your state's limit. These limits change year to year and vary widely — a single person might may have access to in one state at $1,500 per month but not in another at $1,200 per month. Your state's Medicaid office or a local community action agency can tell you the current limit where you live.

Some people may have access to for both. If you are 65 or older and your income is low enough, you can have Medicare as your primary insurance and Medicaid as a secondary payer. Medicaid can then help cover Medicare premiums, deductibles, and copayments — this is a significant benefit if your income is very limited.

What each program pays for

Medicare has four parts, and you must enroll in the parts you want. Part A covers hospital stays, skilled nursing facility care, and some home health services. Part B covers doctor visits, outpatient care, and preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies.

Medicaid coverage varies by state, but all states must cover certain services: hospital care, doctor visits, emergency services, lab work, X-rays, and nursing home care for people who may have access to. Many states also cover dental, vision, hearing aids, and mental health services — check your state's Medicaid website to see what is included where you live.

Medicare does not cover dental, vision, or hearing aids unless you choose a Medicare Advantage plan that includes them. Medicaid may cover these services depending on your state. If you have both Medicare and Medicaid, Medicaid may cover services Medicare does not.

How costs work under each program

Medicare has premiums, deductibles, and copayments. Most people pay a monthly premium for Part B (the amount changes yearly based on income). Part A is usually free if you paid Medicare taxes for at least 10 years while working. You also pay a deductible when you use hospital or doctor services, and you pay copayments or coinsurance for many services.

Medicaid has no premiums in most states — you do not pay a monthly fee to have coverage. Some states charge small copayments for certain services, but many services are free. If you have both Medicare and Medicaid, Medicaid typically pays your Medicare premiums and helps with out-of-pocket costs, which can save you hundreds of dollars per month.

If you are on Medicare and your income is low, you may be able to get help paying premiums and out-of-pocket costs through programs like the Medicare Savings Program or Extra Help (for prescription drugs). These are separate from Medicaid but serve the same purpose — reducing what you pay out of pocket.

How to find out which program you can use

If you are 65 or older, you are may be able to access for Medicare. You do not need to do anything if you are already receiving Social Security — Medicare enrollment happens automatically. If you are not receiving Social Security, contact Social Security at 1-800-772-1213 or visit ssa.gov to enroll in Medicare during your initial enrollment period.

If you are under 65 and have low income, contact your state's Medicaid office to learn the income limits and what services are covered. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services website (cms.gov) or by calling 211, which connects you to local health and human services programs.

If you are 65 or older and think your income may be low enough for Medicaid, explore to your state Medicaid program even if you already have Medicare. Many people do not realize they may have access to, and Medicaid can significantly reduce what you pay for healthcare. Your state Medicaid office can tell you whether you may have access to and what to bring when you explore.

What happens if you have both Medicare and Medicaid

If you have both programs, Medicare is your primary insurance and pays first. Medicaid is secondary and pays what Medicare does not cover — including Medicare premiums, deductibles, and copayments. This arrangement is called "dual coverage" and is common for people over 65 with low income.

Dual coverage means you have access to a wider range of services. Medicare covers hospital and doctor care; Medicaid may add dental, vision, and hearing services depending on your state. You also have lower out-of-pocket costs because Medicaid helps pay what Medicare requires you to pay.

If you have dual coverage, you will receive a Medicare card and a Medicaid card. Always show both cards when you go to a doctor or hospital. Providers use both to make sure you get the full benefit of both programs.

Frequently Asked Questions

Can I choose Medicaid instead of Medicare when I turn 65?

No. Medicare is automatic at 65 if you are receiving Social Security, and you must enroll if you are not. Medicaid is a separate program based on income, not age. You can have both if your income qualifies, but you cannot choose one over the other.

Does Medicaid cover everything Medicare does not?

Not necessarily. Medicaid coverage depends on your state. Some states cover dental and vision; others do not. Check your state's Medicaid website or call your state Medicaid office to see what services are covered where you live. If you have both programs, Medicaid will help pay your Medicare costs first, then cover additional services your state offers.

What if my income goes up — will I lose Medicaid?

If your income rises above your state's Medicaid limit, you will lose Medicaid coverage. However, you will still have Medicare at 65. Some states have programs that let you keep Medicaid for a few months after your income rises, so contact your state Medicaid office if your situation changes.

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

You automatically may have access to for Medicare at 65. To learn about you also may have access to for Medicaid, contact your state Medicaid office with your income and household size information. You can find your state office through cms.gov or by calling 211.

Is there a program to help me pay Medicare costs if I do not may have access to for Medicaid?

Yes. The Medicare Savings Program helps pay Medicare premiums and out-of-pocket costs for people with income slightly above the Medicaid limit. Income limits vary by state. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.