Medicare is for people 65 and older; Medicaid is for people with low income at any age

The two programs serve different groups and work in different ways. Medicare is a federal insurance program you become part of when you turn 65, regardless of income. You pay into it through payroll taxes during your working years. Medicaid is a joint federal and state program that covers people with low income — including children, working-age adults, pregnant people, and older adults. Many people over 65 are on both programs at the same time.

If you are over 65, you will be offered Medicare automatically. If you have low income, you may also be on Medicaid. The two programs cover different things and work together when you have both.

Key Takeaways

  • Medicare starts at age 65 and is based on age and work history, not income.
  • Medicaid is based on income and is available to people of any age, including older adults with low income.
  • Many people over 65 have both Medicare and Medicaid at the same time.
  • Medicare covers hospital care, doctor visits, and prescription drugs; Medicaid covers services Medicare does not, like long-term care and dental.
  • Each state runs Medicaid differently, so what is covered depends on where you live.

How Medicare works for people 65 and older

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

You pay premiums for Parts B and D, and you pay deductibles and copays when you use services. If you worked for at least 10 years and paid Medicare taxes, Part A is free. If you did not work that long, you can still get Medicare at 65, but you pay a premium for Part A.

You sign up for Medicare when you turn 65. If you do not sign up on time, you may pay a penalty for the rest of your life. You can sign up during your birthday month and the three months before and after it, or during the general enrollment period from January 1 to March 31 each year.

How Medicaid works for older adults with low income

Medicaid covers people whose income and assets fall below a limit set by their state. The income limit varies widely — some states set it at 100 percent of the federal poverty line, others at 200 percent or higher. Your state also decides what services Medicaid covers, so two people with the same income in different states may have different coverage.

To be on Medicaid as an older adult, you usually must have income below your state's limit and assets below a certain amount (often around $2,000 for a single person, though this varies). You apply through your state's Medicaid office or online portal. Processing can take 30 to 45 days.

If you are over 65 and have low income, you may be on both Medicare and Medicaid. When you have both, Medicare is your primary insurance and Medicaid fills in gaps — it pays some of the costs Medicare does not cover, like copays and deductibles.

What Medicare covers that Medicaid usually does not

Medicare covers doctor visits, hospital stays, and prescription drugs for people 65 and older. It also covers some preventive care like cancer screenings and vaccinations at no cost to you. Medicare covers these services whether your income is high or low.

Medicaid does not cover these services for older adults in the same way. If you are on Medicaid but not Medicare, you would need to rely on Medicaid for doctor visits and hospital care — but Medicaid rules and coverage differ by state.

What Medicaid covers that Medicare usually does not

Medicaid covers long-term care in a nursing home or assisted living facility, which Medicare does not. Medicare only covers skilled nursing care for a limited time after a hospital stay. If you need ongoing help with daily activities like bathing or dressing, Medicaid may cover that cost, but Medicare will not.

Medicaid also covers dental care, vision care, and hearing aids in most states, though the scope varies. Medicare does not cover routine dental, vision, or hearing services. If you are on both programs, Medicaid can cover these gaps.

Medicaid also covers personal care services — help with bathing, dressing, and toileting in your home — which Medicare does not. This is a major difference for older adults who want to stay at home as they age.

How to know which program you are on

If you are 65 or older, you are on Medicare unless you actively declined it. You will receive a Medicare card in the mail before your 65th birthday. Your card shows your Medicare number and which parts you are enrolled in.

To know if you are on Medicaid, contact your state's Medicaid office or check your state's Medicaid website. You can also call 211 and ask for your state's Medicaid office number. If you applied for Medicaid and were approved, you will have received a Medicaid card or letter confirming your coverage.

If you are unsure whether you are on both programs, call the number on your Medicare card and ask. Medicare customer service can tell you if Medicaid is linked to your account.

What happens to your coverage if your income or circumstances change

If you are on Medicare, your coverage does not change if your income goes up or down. Medicare is based on age, not income. Your premiums and out-of-pocket costs may change, but your coverage stays the same.

If you are on Medicaid, your coverage can end if your income goes above your state's limit. You must report changes in income to your state's Medicaid office. If your income increases, you may lose Medicaid coverage. If your income decreases, you may become newly on Medicaid or have your coverage reinstated.

If you lose Medicaid coverage, you still have Medicare at 65 and older. But you will be responsible for Medicare premiums, deductibles, and copays without Medicaid to help pay them.

Frequently Asked Questions

Can I be on both Medicare and Medicaid at the same time?

Yes. Many people over 65 with low income are on both programs. Medicare is your primary insurance, and Medicaid helps pay for costs Medicare does not cover, like copays, deductibles, and long-term care. This combination is sometimes called "dual coverage."

Do I have to pay for Medicare if I am 65 or older?

Part A is free if you or your spouse worked for at least 10 years and paid Medicare taxes. You pay a monthly premium for Part B (usually around $165 per month in 2024, though this changes yearly) and for Part D if you want prescription drug coverage. If you did not work long enough, you pay a premium for Part A as well.

What is the income limit for Medicaid for older adults?

The income limit varies by state. Some states cover people up to 100 percent of the federal poverty line (about $1,600 per month for a single person in 2024), while others cover up to 200 percent or more. Contact your state's Medicaid office to learn your state's specific limit.

If I turn 65, do I automatically lose Medicaid?

No. If you are on Medicaid and turn 65, you become on Medicare automatically, but you can stay on Medicaid if your income is still low enough. You will be on both programs. Your state will coordinate the two programs so Medicaid helps pay Medicare costs.

What should I do if I am 65 and think I might be on Medicaid?

Contact your state's Medicaid office or visit your state's Medicaid website. You can also call 211 to find your state's Medicaid office. Have your Social Security number and income information ready. If you are not on Medicaid but think you should be, you can apply through your state's office or online portal.