Medicare vs Medicaid

Key Differences Between Medicare and Medicaid

Medicare and Medicaid are both government health programs, but they work in very different ways. The names sound alike, which causes a lot of confusion. Here is a clear breakdown of how each program works.

Medicare is a federal program run by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance to people 65 and older, and to some younger people with disabilities. Your income does not affect whether you qualify for Medicare. Most people earn Medicare eligibility by working and paying Medicare taxes for at least 10 years (40 quarters). About 67 million Americans are enrolled in Medicare as of 2026.

Medicaid is a joint program between the federal government and each state. It provides health coverage to people with low income, regardless of age. Each state runs its own Medicaid program with its own rules, though all states must follow federal guidelines. About 79 million people are enrolled in Medicaid across the country. You can learn more about Medicaid eligibility in your state.

The biggest coverage difference is long-term care. Medicare only covers up to 100 days of skilled nursing care after a hospital stay. It does not cover ongoing nursing home care or help with daily activities at home. Medicaid, on the other hand, is the largest payer of long-term care in the United States. It covers nursing home stays, home health aides, and personal care services in most states. About 62% of all nursing home residents in the U.S. have their care paid for by Medicaid.

Cost is another major difference. Medicare charges a monthly premium of $202.90 for Part B (medical insurance) in 2026, plus deductibles and copays for most services. The Part A deductible for a hospital stay is $1,676 in 2026. Part D prescription drug coverage requires a separate premium. Medicaid is free or very low cost for people who qualify. Most Medicaid enrollees pay no premiums and only small copays, often $1 to $4 per visit. For full details on Medicare costs, visit Medicare.gov.

Medicare has four parts. Part A covers hospital stays. Part B covers doctor visits and outpatient care. Part C (Medicare Advantage) is an alternative way to get Part A and Part B through private insurers. Part D covers prescription drugs. You can read our full Medicare guide for a complete breakdown of each part.

Can You Get Both Medicare and Medicaid?

Yes. About 12.8 million Americans have both Medicare and Medicaid at the same time. These people are called "dual eligible" or "dually eligible." If you are 65 or older and have low income, you may qualify for both programs.

When you have both, Medicaid can help pay costs that Medicare does not cover. Medicaid can pay your Medicare Part B premium ($202.90/month), Part A premium (if you have one), deductibles, and copays. This saves dual-eligible people thousands of dollars each year. Medicaid also covers services Medicare does not, like long-term nursing home care, dental care, vision, and hearing aids in many states.

Medicare Savings Programs are a specific type of Medicaid help for Medicare beneficiaries. These programs pay some or all of your Medicare premiums and cost-sharing. There are four levels based on income, and you can apply through your state Medicaid office.

If you qualify for both programs, you may also be eligible for Extra Help (Low-Income Subsidy) with Medicare Part D prescription drug costs. This program can lower your drug copays to $0 to $11.20 per prescription.

Many states also offer Dual Special Needs Plans (D-SNPs), which are Medicare Advantage plans designed for people who have both Medicare and Medicaid. These plans coordinate your benefits from both programs into a single plan, making it simpler to get care. Ask your state Medicaid office about D-SNP options in your area.

Being dual eligible does not mean you need to pick one program over the other. Both programs work together to give you more coverage at lower cost than either program alone. If you think you might qualify, check your eligibility here.

Which Should You Apply For?

The right program depends on your age, income, and situation. Here are the most common scenarios:

If you are 65 or older with low income: Apply for both. You are likely eligible for Medicare based on age and Medicaid based on income. Start by checking your eligibility for both programs. In most states, a single person with income under $1,715/month may qualify for Medicaid alongside Medicare.

If you are under 65 with a disability: Start with Medicaid, which you can get right away based on income. If you receive Social Security Disability Insurance (SSDI), you will automatically get Medicare after 24 months of SSDI payments. You may also qualify for SSI, which provides monthly cash payments and automatic Medicaid in most states.

If you are under 65 with low income but no disability: Medicaid is your primary option. In the 40 states that expanded Medicaid, adults under 65 with income up to 138% of the federal poverty level ($21,597/year for a single person in 2026) qualify for coverage. If your income is above Medicaid limits, check if you qualify for ACA marketplace plans with premium tax credits.

If you are 65 or older with higher income: Medicare is your main coverage. Most people get Part A (hospital insurance) premium-free if they or a spouse paid Medicare taxes for 10+ years. You will need Part B for doctor visits and Part D for prescriptions. Consider a Medicare Supplement (Medigap) plan to cover gaps. Use our free screener to check if you qualify for any cost-saving programs.

Frequently Asked Questions

What happens if I have both Medicare and Medicaid?

Medicare becomes your primary insurance and pays first for covered services. Medicaid then pays for remaining costs like copays and deductibles. Medicaid also covers services Medicare does not, including long-term care, dental, and vision in many states. You do not need to choose between them. Having both gives you the broadest coverage available.

Is Medicare free?

Part A (hospital insurance) is premium-free for most people who worked and paid Medicare taxes for at least 10 years. Part B (doctor visits, outpatient care) costs $202.90/month in 2026 for most people. Part D (prescriptions) premiums vary by plan. You also pay deductibles and copays. If you have low income, Medicare Savings Programs can pay your premiums for you.

Does Medicaid cover things Medicare doesn't?

Yes. Medicaid covers several services that Medicare does not, or covers only in limited ways. These include long-term nursing home care, personal care at home, dental care for adults, vision exams and glasses, hearing aids, and transportation to medical appointments. The exact services vary by state. Check your state's Medicaid program for details.

Can I switch from Medicaid to Medicare?

You do not "switch" from one to the other. They are separate programs with different eligibility rules. When you turn 65, you become eligible for Medicare based on age. If your income is still low enough, you can keep Medicaid too. If your income is above Medicaid limits, you will transition to Medicare as your primary coverage. Contact your local Social Security office or call 1-800-772-1213 to sign up for Medicare.

What are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are state Medicaid programs that help pay Medicare costs. There are four levels: Qualified Medicare Beneficiary (QMB) pays your Part A and Part B premiums plus deductibles and copays. Specified Low-Income Medicare Beneficiary (SLMB) pays your Part B premium. Qualifying Individual (QI) also pays Part B premiums for people with slightly higher income. Qualified Disabled and Working Individuals (QDWI) pays Part A premiums. Learn more on our Medicare Savings Programs page.

Do I automatically get Medicaid when I turn 65?

No. Turning 65 makes you eligible for Medicare, not Medicaid. Medicaid eligibility is based on income, not age. If you had Medicaid before turning 65, you may keep it if your income stays below your state's limit. You will need to apply for Medicare separately. In most states, your Medicaid office will help coordinate the transition. Check your eligibility for both programs to see what you qualify for.

What is the income limit for Medicaid if I have Medicare?

Income limits for dual eligibility vary by state. In most states, a single person with income up to about $1,715/month (100% of the federal poverty level) can get full Medicaid benefits alongside Medicare. Medicare Savings Programs have higher limits: up to about $1,882/month for QMB and $2,123/month for SLMB in 2026. Some states set even higher limits. Use our free screener to check based on your state and income.

How do I apply for both Medicare and Medicaid?

Apply for Medicare through the Social Security Administration at ssa.gov or by calling 1-800-772-1213. Apply for Medicaid through your state's Medicaid agency. You can find your state's application at Medicaid.gov. Many states let you apply online. You can also check your eligibility for both programs in about 5 minutes using our free screener, which will tell you where to apply.