Medicare and Medicaid are separate federal programs with different purposes, funding sources, and rules

Medicare is a federal health insurance program for people 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. Each state runs its own Medicaid program within federal guidelines, which means may be able to access rules, covered services, and income limits vary significantly by state. Medicaid is means-tested — your income and assets determine whether you may have access to.

The programs overlap in one important way: some people may have access to for both. These individuals are called "dual may be able to access" and receive coverage from both programs. But the two programs are funded differently, administered differently, and cover different groups of people.

Key Takeaways

  • Medicare is for people 65 and older or those with certain disabilities; Medicaid is for low-income individuals and families, with rules that differ by state.
  • Medicare is funded through payroll taxes and is the same nationwide; Medicaid is funded jointly by federal and state governments and varies by location.
  • You do not choose between them — if you meet the requirements for both, you receive coverage from both programs.
  • Some services are covered by one program but not the other, so knowing which program covers what matters when you need care.

Who Medicare covers and how it works

Medicare automatically covers you when you turn 65, as long as you or your spouse paid Medicare taxes for at least 10 years. You do not need to be retired or have low income. The program has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative way to receive Parts A, B, and D through a private insurance company.

You pay premiums for Medicare Part B and Part D, and you may pay premiums for Part C depending on the plan. You also pay deductibles and copayments when you use services. Medicare is the same in every state — the coverage rules do not change based on where you live.

Who Medicaid covers and how it works

Medicaid covers low-income adults, children, pregnant people, seniors, and people with disabilities. The income limit to may have access to varies by state and by category. For example, a parent in one state might may have access to with a household income of $20,000 per year, while a parent in another state might may have access to only if their income is under $12,000. Some states have expanded Medicaid to cover more low-income adults; others have not.

Each state designs its own Medicaid program, so covered services differ. One state might cover dental care; another might not. One state might cover vision care; another might limit it. You apply for Medicaid through your state's Medicaid office or through the state health insurance marketplace. Processing times and approval decisions vary by state.

What happens if you may have access to for both programs

If you are 65 or older and have low income, you may may have access to for both Medicare and Medicaid. Medicaid then acts as a "wraparound" program, covering costs that Medicare does not pay — such as premiums, deductibles, and copayments. Medicaid may also cover services Medicare does not, such as long-term care or dental work, depending on your state.

If you are under 65 with a disability and may have access to for both, the same principle applies. Your Medicaid program covers gaps in Medicare coverage. The specific services Medicaid adds depend on your state's program rules.

Major differences in coverage and cost

Medicare covers hospital care, doctor visits, and some preventive services, but it does not cover long-term nursing home care, dental care, vision care, or hearing aids in most cases. You pay premiums, deductibles, and copayments. There is no annual limit on what you pay out of pocket for Part A and Part B services, though Part D has a coverage gap.

Medicaid covers a broader range of services in most states, including long-term care, dental, vision, and hearing aids. In many states, Medicaid has no copayments or very low ones. However, what Medicaid covers depends entirely on your state. A service covered in one state may not be covered in another.

How to find out which program covers your situation

If you are 65 or older, you are may be able to access for Medicare. You do not apply — you are enrolled automatically if you have a Social Security account. If you have not claimed Social Security yet, you can enroll in Medicare at 65 through Medicare.gov or by calling 1-800-MEDICARE.

If you think you have low income and may may have access to for Medicaid, contact your state Medicaid office directly. You can find your state office through Medicaid.gov. Each state has different income limits and application processes. Some states allow you to apply online; others require you to apply in person or by mail.

If you are unsure whether you may have access to for either program, 211 is a free referral service that can tell you what programs may be available in your area and how to contact them. Call 211 or visit 211.org.

Frequently Asked Questions

Can I have both 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. When you have both, Medicaid typically covers costs that Medicare does not pay, such as premiums and deductibles.

Do I have to pay for Medicare?

Most people pay a monthly premium for Medicare Part B (doctor visits) and Part D (prescription drugs). You also pay deductibles and copayments when you use services. Part A (hospital care) is free for most people who paid Medicare taxes for 10 years.

Do I have to pay for Medicaid?

In most states, Medicaid is free or has very low copayments. Some states charge small copayments for certain services. If you have Medicaid, you should not be charged a monthly premium, though your state's rules may vary.

What if I move to a different state?

Medicare coverage stays the same no matter where you live. If you have Medicaid and move to another state, your coverage ends in the old state. You must apply for Medicaid in your new state, which has different income limits and covered services.

How do I know if my doctor accepts Medicare or Medicaid?

Ask your doctor directly, or search Medicare.gov for doctors who accept Medicare. For Medicaid, contact your state Medicaid office or check your state's Medicaid provider directory online. Acceptance varies by program and by state.