No — Medicaid and Medicare are separate federal programs with different rules, different funding, and different people they cover

The names sound alike, but they work in opposite directions. Medicare is a federal insurance program for people 65 and older, regardless of income. Medicaid is a joint federal-state program for people with low income, regardless of age. You can be on both at the same time — in fact, millions of people are — but they pay different bills, have different may be able to access rules, and are run by different agencies.

The confusion matters because it affects which program pays for your care, what you pay out of pocket, and where you go to get help. Knowing which one covers you (or whether you have both) changes what you actually owe when you see a doctor.

Key Takeaways

  • Medicare covers people 65 and older and some younger people with disabilities, while Medicaid covers people with low income of any age.
  • Medicare is run by the federal government; Medicaid is run by individual states with federal funding, so benefits and rules vary by state.
  • Medicare is funded by payroll taxes; Medicaid is funded by federal and state taxes, and may be able to access depends on your income and assets.
  • You can have both programs at the same time, and when you do, Medicare pays first and Medicaid covers what Medicare does not.
  • Enrollment in Medicare is automatic at 65 if you have worked and paid taxes; Medicaid enrollment requires you to contact your state program.

Who each program covers

Medicare covers people who are 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease or ALS. You do not have to be poor to get Medicare — income does not matter. If you worked and paid Medicare taxes for at least 10 years, you are covered.

Medicaid covers people with low income and limited assets. The income and asset limits vary by state, and so does the list of who counts as low-income. Some states cover parents, some cover childless adults, some cover people with disabilities, and the rules change based on your state's decisions and federal law. Your state Medicaid program decides who is in and who is out.

How they are funded and run

Medicare is a federal program funded by payroll taxes (the Medicare tax you see on your paystub). It is run by the Centers for Medicare & Medicaid Services, a federal agency. The same rules apply everywhere in the country.

Medicaid is jointly funded by federal and state taxes. Each state runs its own Medicaid program within federal guidelines, which means the program you get in one state may look completely different from the program in another state. Your state decides income limits, which services are covered, how much doctors are paid, and how long you can stay enrolled.

What each program pays for

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 way to get Parts A, B, and D through a private insurance company. Medicare does not cover long-term care, dental, vision, or hearing aids in most cases.

Medicaid covers a broader range of services because it is designed for people with low income who may need more help. Every state 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 details vary. Some states cover more mental health services, more prescription drugs, or more therapy than others.

What you pay out of pocket

Medicare has deductibles, copays, and coinsurance. For 2024, the Part A hospital deductible is $1,632 per stay (this amount changes yearly). Part B has a deductible and a 20% coinsurance for most services. Part D has a deductible and copays for drugs. If you have a Medigap or Medicare Advantage plan, those costs change.

Medicaid has lower out-of-pocket costs than Medicare because it is designed for people with low income. Many states charge no copay or a small copay (often $1 to $5). Some states charge nothing at all. Medicaid cannot charge you a deductible in most cases. The exact copays and what services require them depend on your state.

How to enroll

You do not have to do anything to enroll in Medicare if you are receiving Social Security. Medicare enrollment happens automatically three months before you turn 65. If you are not yet receiving Social Security, you need to contact Social Security to enroll. You can enroll online at ssa.gov, by phone at 1-800-772-1213, or in person at a Social Security office.

Medicaid enrollment is different in every state. You contact your state Medicaid office or your state's health insurance marketplace. Some states let you apply online, some by mail, some by phone. You will need to provide proof of income, citizenship, and residency. Your state will tell you if you are approved and what your benefits are.

When you have both programs

If you are 65 or older and have low income, you may be on both Medicare and Medicaid. When you have both, Medicare pays first for services it covers, and Medicaid covers what Medicare does not pay. This is called "coordination of benefits." Medicaid also pays your Medicare premiums and cost-sharing in many cases, which is why people on both programs often pay very little out of pocket.

People on both programs are sometimes called "dual may be able to access." Your state Medicaid program can tell you whether you may have access to for both and what your benefits are under each program. Being on both programs is common for older adults with limited income, and it significantly reduces what you pay for health care.

Why the names are confusing

Both programs were created in 1965 as part of the same law, which is why they have similar names. Medicare was designed as an insurance program for older people (like an extension of Social Security). Medicaid was designed as a welfare program for people with low income. The names reflect their original purpose, but they have evolved over 60 years and now serve overlapping but different populations.

The similarity in names has led to decades of confusion, even among people who use both programs. Understanding the difference matters because it determines which program handles your claims, what you pay, and what services you can use.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older (or disabled and on Medicare) and have low income, you may be on both. When you have both, Medicare pays first and Medicaid covers what Medicare does not. Contact your state Medicaid office to see if you may have access to.

Do I have to pay for Medicare?

Most people do not pay a premium for Part A if they worked and paid Medicare taxes for 10 years. Part B has a monthly premium (around $175 in 2024, but it varies). Part D has a premium that depends on the plan. If you have low income, Medicaid may pay your premiums.

What if I do not have Medicare or Medicaid?

If you are under 65 and do not have low income, you can buy health insurance through your employer, the health insurance marketplace, or a private insurer. If you are 65 or older, you must enroll in Medicare or pay a penalty when you do enroll later.

Does Medicaid cover nursing homes?

Most states cover long-term nursing home care through Medicaid, but not all. Coverage rules vary by state. Contact your state Medicaid office to find out what is covered where you live. Medicare covers skilled nursing for a limited time after a hospital stay, but not long-term custodial care.

How do I know which program I am on?

If you are 65 or older, you are on Medicare automatically. Your Medicare card will arrive in the mail before your 65th birthday. If you think you may also be on Medicaid, contact your state Medicaid office. They can tell you your enrollment status and what your benefits are.