No, Medicaid and Medicare are separate federal programs with different rules, funding sources, and who they cover
Medicare is a federal health insurance program for people age 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and it functions like an earned benefit.
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 rules and income limits vary by state. Medicaid is means-tested, meaning your income and assets determine whether you may have access to.
The two programs are often confused because they sound similar and both help pay medical bills. But they operate under different laws, have different income thresholds, cover different services, and are administered by different agencies. Some people are covered by both programs at the same time — this is called "dual may be able to access" — but that does not make them the same program.
Key Takeaways
- Medicare is federal, age-based (65+), and funded by payroll taxes you paid during work; Medicaid is state-run, income-based, and funded by federal and state tax dollars.
- Medicare covers hospital care, doctor visits, and prescription drugs through Parts A, B, and D; Medicaid covers those services plus dental, vision, and long-term care depending on your state.
- Medicare income limits do not exist — anyone 65 or older can enroll; Medicaid has strict income and asset limits that vary by state and family size.
- You enroll in Medicare through Social Security; you enroll in Medicaid through your state's Medicaid office or health insurance marketplace.
- Some people over 65 with low income may have access to for both programs and receive coverage from each for different services.
How Medicare and Medicaid funding works differently
Medicare is funded by payroll taxes. When you work, you and your employer each pay 1.45% of your wages into the Medicare trust fund. This money sits in the system until you turn 65 and become may be able to access. The federal government administers Medicare directly through the Centers for Medicare & Medicaid Services (CMS).
Medicaid is funded by both federal and state tax dollars. The federal government sets minimum standards and pays a portion of the cost; each state pays the rest and decides how to run its program within those standards. This is why Medicaid rules, income limits, and covered services differ from state to state. A person who qualifies for Medicaid in one state may not may have access to in another.
Because of this difference, you cannot "run out" of Medicare may be able to access based on income — once you turn 65, you are in. Medicaid, by contrast, can end if your income rises above your state's limit, even temporarily.
Who each program covers
Medicare covers people age 65 and older, people under 65 with certain disabilities (after 24 months on Social Security Disability Insurance), and people of any age with end-stage renal disease or ALS. You do not have to be a U.S. citizen, but you must have worked and paid Medicare taxes for at least 10 years (40 quarters).
Medicaid covers low-income individuals and families. The income limit depends on your state and family size. Most states cover children, pregnant people, parents, and people with disabilities. Some states have expanded Medicaid to cover all adults under a certain income threshold; others have not. Your state's rules determine who qualifies.
A person can be on both programs. This typically happens when someone is 65 or older with low income, or when someone under 65 has both a disability (may have access to them for Medicare) and low income (may have access to them for Medicaid).
What services each program pays for
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Yes (Part A) | Yes |
| Doctor visits | Yes (Part B) | Yes |
| Prescription drugs | Yes (Part D) | Yes |
| Dental care | Limited | Varies by state |
| Vision care | Limited | Varies by state |
| Nursing home care | Up to 100 days | Yes, long-term |
| Home health care | Yes, if homebound | Yes |
| Mental health services | Yes | Yes |
Medicare covers hospital care (Part A), doctor visits and outpatient services (Part B), and prescription drugs (Part D). It does not cover dental, vision, or hearing aids unless they are part of a covered procedure. Medicare covers up to 100 days in a nursing home after a hospital stay, but not long-term custodial care.
Medicaid covers the same basic services — hospital, doctor, drugs — but also covers dental, vision, and long-term nursing home care in most states. Medicaid also covers services Medicare does not, such as personal care assistance and transportation to medical appointments. The exact services vary by state.
Income and asset limits
Medicare has no income limit. You can earn any amount and still be may be able to access at 65. There is no asset test either — your savings, home, or investments do not affect your Medicare may be able to access.
Medicaid has strict income limits that vary by state and family size. As of 2024, most states cover individuals with income below 138% of the federal poverty line, though some states have lower limits. Medicaid also has asset limits in most states — you may own a home and one vehicle, but savings above a certain amount (typically $2,000 for individuals) can disqualify you.
If your income or assets change, you must report the change to your Medicaid office. Medicaid can end mid-year if you exceed the income limit. Medicare continues regardless of income changes.
How to enroll in each program
You enroll in Medicare through Social Security. You can sign up starting three months before you turn 65. Most people enroll automatically if they are already receiving Social Security benefits. If you are not receiving benefits, you must contact Social Security directly or go to Medicare.gov to enroll. Enrollment happens once a year during the general enrollment period (January 1 to March 31), though you can enroll anytime after you turn 65 with potential late penalties.
You enroll in Medicaid through your state's Medicaid office or through the health insurance marketplace (Healthcare.gov). Each state has its own application process and timeline. Some states process applications within days; others take weeks. You can apply year-round, and coverage can start as early as the first day of the month you apply.
If you think you may may have access to for both programs, apply to Medicaid first through your state office. If you are approved, your Medicaid office can tell you whether you also may have access to for Medicare and help you enroll.
What happens if you are covered by both programs
If you are "dual may be able to access" — covered by both Medicare and Medicaid — Medicare is your primary insurance and pays first. Medicaid pays second and covers costs Medicare does not, such as copayments, coinsurance, and services like dental or long-term care. This can significantly reduce your out-of-pocket costs.
Some states offer special programs for dual-may be able to access people, such as integrated care plans that coordinate services between the two programs. Ask your Medicaid office whether your state has a dual-may be able to access program and whether you can enroll.
Frequently Asked Questions
Can I have Medicare and Medicaid at the same time?
Yes. If you are 65 or older with low income, or under 65 with a disability and low income, you may may have access to for both. Medicare covers hospital and doctor services; Medicaid covers copayments, coinsurance, and services Medicare does not cover, like dental or long-term care.
Do I have to pay for Medicare?
Most people do not pay a premium for Medicare Part A (hospital insurance) because they paid payroll taxes during their working years. Part B (doctor visits) and Part D (prescription drugs) have monthly premiums that vary based on income. Medicaid is free or low-cost depending on your state and income.
What if I did not work long enough to may have access to for Medicare?
You need 40 quarters (10 years) of work history to may have access to for Medicare at 65. If you do not have that, you may still may have access to for Medicaid based on age and income. Contact your state Medicaid office to learn your options.
Can I lose Medicaid if my income goes up?
Yes. Medicaid ends if your income exceeds your state's limit. You must report income changes to your Medicaid office. If you lose Medicaid, you may be able to enroll in a marketplace plan instead. Medicare, by contrast, does not end based on income.
How do I know which program to contact with a question?
Contact Medicare (1-800-MEDICARE or Medicare.gov) for questions about hospital, doctor, or drug coverage. Contact your state Medicaid office for questions about income limits, dental, vision, or long-term care. If you are dual may be able to access, ask your Medicaid office which program covers the service you need.