Medicare and Medicaid are separate federal programs with different purposes, funding, and who they cover

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 of any age. Each state runs its own Medicaid program within federal guidelines, so may be able to access and benefits vary by state. Medicaid is funded through general tax revenue, not payroll deductions.

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 each program for different services. But the programs operate independently, have different rules, and cover different groups of people.

Key Takeaways

  • Medicare is primarily for people 65 and older; Medicaid is for low-income people of any age.
  • Medicare is funded through payroll taxes you pay during your working years; Medicaid is funded through general tax revenue.
  • Medicare is the same nationwide; Medicaid rules and benefits change from state to state.
  • Some people may have access to for both programs at the same time, which is called being dual may be able to access.
  • You cannot have one program instead of the other based on preference — may be able to access is determined by age, income, and disability status.

Who Medicare covers

Medicare automatically covers most people when they turn 65, even if they are still working. You do not have to be retired or have a low income to receive it. If you worked and paid Medicare taxes for at least 10 years, you are covered.

Medicare also covers people under 65 who have been receiving Social Security disability benefits for 24 months, or who have end-stage renal disease or ALS (amyotrophic lateral sclerosis). These are the only exceptions to the age 65 rule.

Because Medicare is based on work history rather than income, a wealthy 67-year-old and a low-income 67-year-old both receive the same Medicare coverage. Your bank account does not affect whether you get Medicare.

Who Medicaid covers

Medicaid covers low-income individuals and families. The income limit varies by state and by family size. In some states, a single person earning $1,500 per month might may have access to; in others, the limit is higher. Each state also sets its own rules about which groups of people can receive Medicaid — for example, whether it covers childless adults, and at what income level.

Medicaid covers people of all ages: children, working-age adults, seniors, and people with disabilities. Unlike Medicare, there is no age requirement. A 30-year-old with a low income can receive Medicaid in their state if they meet the income and other may be able to access rules.

Because Medicaid is income-based, your financial situation directly affects whether you may have access to. If your income rises above your state's limit, you may lose Medicaid coverage. If it falls below the limit, you may become may be able to access.

How the programs pay for care

Medicare has four parts. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits and outpatient services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative way to receive Parts A, B, and D through a private insurance company.

Most people pay a monthly premium for Part B and Part D. You also pay deductibles and copayments when you use services. Medicare does not cover everything — dental, vision, and hearing care are typically not included unless you choose a Medicare Advantage plan that offers them.

Medicaid coverage varies by state. All states must cover certain services like doctor visits, hospital care, and emergency services. Many states also cover dental, vision, and hearing care through Medicaid, though this differs from state to state. Medicaid typically has lower copayments than Medicare, and some services may have no copayment at all.

What happens if you may have access to for both programs

If you are 65 or older and have a low income, you may may have access to for both Medicare and Medicaid. This is called being dual may be able to access. Medicaid then acts as a "wraparound" program, covering costs that Medicare does not pay, such as copayments, deductibles, and some services Medicare excludes.

Dual may be able to access individuals benefit because Medicaid fills gaps in Medicare coverage. For example, if Medicare requires a $200 deductible for a hospital stay, Medicaid may pay that deductible. If Medicare does not cover dental care but your state's Medicaid does, Medicaid covers it.

To be dual may be able to access, you must meet both programs' requirements: you must be 65 or older (or meet Medicare's disability exceptions) and have income low enough to may have access to for your state's Medicaid program. You do not choose to be dual may be able to access — if you meet the criteria, you are automatically enrolled in both.

State differences in Medicaid that do not apply to Medicare

Because Medicaid is run by states, the program you receive in one state may be very different from the program in another. One state might cover dental care for adults; another might not. One state might have a higher income limit; another might be stricter.

If you move from one state to another, your Medicaid coverage may change. You may lose coverage entirely if your income no longer qualifies in the new state, or you may gain new benefits that were not available before. Medicare, by contrast, is identical everywhere — a Medicare beneficiary in California receives the same coverage as one in Texas.

This is why it is important to check your specific state's Medicaid rules rather than assuming coverage will be the same as somewhere else. Your state's Medicaid website or your local health department can tell you what your state covers and what the current income limits are.

How to find out which program you might receive

If you are 65 or older, you are may be able to access for Medicare. You should enroll during your initial enrollment period, which begins three months before the month you turn 65. If you miss this window, you may face penalties when you do enroll.

To learn about you may have access to for Medicaid, contact your state's Medicaid office or visit your state's health department website. You will need to provide information about your income, family size, and household composition. Many states also allow you to check your potential may be able to access online before you formally submit information.

If you think you might may have access to for both programs, apply for Medicaid through your state. The Medicaid office will determine your may be able to access for both programs and enroll you in each one if you may have access to. You do not apply separately to Medicare if you are already receiving Social Security — Medicare enrollment happens automatically.

Frequently Asked Questions

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

No. If you are 65 or older and have worked long enough to may have access to for Medicare, you are enrolled in Medicare automatically. You cannot opt out or choose Medicaid instead. However, if you also may have access to for Medicaid based on income, you will receive both programs simultaneously.

Do I pay the same amount for Medicare in every state?

Yes. Medicare premiums, deductibles, and copayments are set by the federal government and are the same everywhere. However, if you also receive Medicaid, your state's Medicaid program may cover some or all of these costs, which means your out-of-pocket expenses could differ from another state.

What if I am under 65 and have no income?

You would likely may have access to for Medicaid if your state covers your situation. Medicaid is available to people of any age with low or no income. Contact your state's Medicaid office to find out the specific income limits and rules in your state.

If I move to a different state, do I keep my Medicare coverage?

Yes. Medicare follows you anywhere in the United States. Your coverage does not change when you move. However, your Medicaid coverage may change, so you should contact your new state's Medicaid office to learn about you still may have access to under that state's rules.

Can I use Medicare and Medicaid at the same doctor's office?

Yes. If you are dual may be able to access, you can use both programs at the same provider, as long as the provider accepts both Medicare and Medicaid. The provider will bill Medicare first, then bill Medicaid for any remaining costs. You should tell the provider's office that you have both programs so they can bill correctly.