Medicare Savings Program vs. Medicaid: What's the Difference

Medicare Savings Program and Medicaid are separate programs that work differently

Medicare Savings Program (MSP) and Medicaid are not the same thing, though both are government health insurance programs and both can help with costs. The key difference: Medicare Savings Program helps people who already have Medicare pay their Medicare premiums and cost-sharing. Medicaid is a separate program that provides health coverage to people who meet income and other requirements — it is not tied to Medicare at all.

Many people are confused because both programs can help with medical bills and both have income limits. But they cover different groups of people, they pay different bills, and you apply to different agencies. Understanding which one you might be may be able to access for depends on your age, income, and whether you already have Medicare.

Key Takeaways

Medicare Savings Program is only for people already enrolled in Medicare; Medicaid is a separate program for people who meet income and other requirements regardless of age.
MSP pays your Medicare premiums, deductibles, and copayments; Medicaid covers medical services directly and may cover things Medicare does not.
You apply for MSP through your state Medicaid office, but being approved for MSP does not automatically make you may be able to access for Medicaid.
If you are under 65 and have low income, you may be may be able to access for Medicaid but not MSP, since MSP requires you to already have Medicare.
Some people may have access to for both programs at the same time, which is called "dual may be able to access" status.

Who each program covers

Medicare Savings Program is only for people who are already enrolled in Medicare. That means you must be 65 or older, or you must be under 65 and already approved for Medicare because of disability or end-stage renal disease. If you meet that requirement and your income is low enough, MSP helps you pay the costs that come with your Medicare coverage.

Medicaid covers people of any age who meet their state's income and other requirements. You do not need to have Medicare to be may be able to access for Medicaid. Many Medicaid recipients are working-age adults, children, pregnant people, and parents. Some are elderly or disabled, but age alone does not determine Medicaid may be able to access the way it does for Medicare.

The income limits are different for each program and vary by state. MSP has higher income limits than many Medicaid programs, which means some people can may have access to for MSP but not Medicaid. Others may have access to for both at the same time.

What each program pays for

Medicare Savings Program pays specific bills related to your Medicare coverage. It covers your Medicare Part B premium (the monthly fee for doctor visits and outpatient care), your Part A deductible (the amount you pay before Medicare starts covering hospital stays), and your copayments and coinsurance for Medicare-covered services. MSP does not pay for services that Medicare does not cover.

Medicaid is a broader program that covers medical services directly. It pays for doctor visits, hospital stays, prescription drugs, mental health care, and many other services. What Medicaid covers varies by state, but it often includes things Medicare does not, such as long-term care, dental care, and vision care. Medicaid also covers services for people who are not yet may be able to access for Medicare.

If you have both MSP and Medicaid, MSP pays your Medicare costs first, and Medicaid may cover additional services or costs that Medicare does not cover.

How to apply for each program

You apply for Medicare Savings Program through your state Medicaid office, even though MSP is technically a Medicare program. Contact your state Medicaid agency directly or call 1-800-MEDICARE to find your state office. You will need to provide proof of income, citizenship, and your Medicare enrollment. The application process is usually faster than Medicaid and can take a few weeks.

You apply for Medicaid through your state Medicaid office or through your state's health insurance marketplace. The application asks about your income, household size, citizenship, and other factors. Processing times vary by state but often take longer than MSP applications. Some states have continuous enrollment, while others have specific enrollment periods.

Being approved for one program does not automatically approve you for the other. You may need to apply separately, though some states allow you to apply for both at the same time.

Income limits and how they differ

Medicare Savings Program has income limits that are set by federal law but applied by each state. Generally, MSP covers people with income up to 135% to 200% of the federal poverty level, depending on which MSP category you fall into. For 2024, this means a single person could have income up to roughly $1,500 to $2,400 per month, though this varies by state and changes yearly.

Medicaid income limits are set by each state and vary widely. Some states cover people with income up to 138% of the federal poverty level; others have lower limits. Some states have expanded Medicaid to cover more working-age adults, while others have not. You need to check your specific state's limits.

Because MSP income limits are often higher than Medicaid limits in many states, you can may have access to for MSP without may have access to for Medicaid. The reverse is also possible in some cases, though less common.

What "dual may be able to access" means

If you may have access to for both Medicare and Medicaid at the same time, you are called "dual may be able to access." This usually happens when you are 65 or older with low income, or when you are under 65 and approved for Medicare due to disability. Dual may be able to access people have both programs working together to pay their medical bills.

When you are dual may be able to access, Medicare is your primary insurance and Medicaid is secondary. This means Medicare pays first for covered services, and Medicaid covers costs that Medicare does not pay, such as copayments, deductibles, or services Medicare does not cover. If you are dual may be able to access, you may also be enrolled in Medicare Savings Program, which helps with your Medicare costs.

Being dual may be able to access can significantly reduce your out-of-pocket costs, but it requires coordination between two separate programs. Your doctors and hospitals need to bill both programs correctly.

When you might may have access to for one but not the other

If you are under 65 and do not have Medicare, you cannot may have access to for Medicare Savings Program no matter how low your income is. You can only apply for Medicaid. This applies to working-age adults, children, and parents in most states.

If you are 65 or older and your income is above your state's Medicaid limit but below the MSP limit, you may may have access to for MSP but not Medicaid. This is common because MSP income limits are often higher. In this situation, MSP helps you afford your Medicare costs, but you do not have Medicaid coverage for additional services.

If you are 65 or older with very low income, you may may have access to for both programs. Your state will determine which program is primary based on your specific situation.

Frequently Asked Questions

Can I have Medicare Savings Program without having Medicaid?

Yes. MSP and Medicaid are separate programs with different income limits. You can be approved for MSP and not may have access to for Medicaid, especially if your income is above your state's Medicaid limit but below the MSP limit. MSP will help you pay your Medicare costs even if you do not have Medicaid coverage.

If I am approved for Medicaid, am I automatically approved for Medicare Savings Program?

No. Being approved for Medicaid does not automatically approve you for MSP. You must meet MSP's specific requirements, which include already having Medicare. If you are under 65 and approved for Medicaid but do not have Medicare, you cannot get MSP. You would need to apply for MSP separately if you later become may be able to access for Medicare.

What if my income changes after I am approved?

Both programs require you to report income changes. If your income increases above the limit for either program, you may lose coverage. If your income decreases, you may become may be able to access for a program you were not may be able to access for before. Contact your state Medicaid office to report changes and ask whether you should apply for other programs.

Does Medicare Savings Program cover prescription drugs?

No. MSP only covers your Medicare premiums, deductibles, and copayments for Medicare-covered services. It does not cover prescription drugs. However, if you also have Medicaid, your state's Medicaid program may cover prescription drugs that Medicare does not. You should also look into Medicare Part D (prescription drug coverage) to see if you may have access to for extra help paying premiums and copayments.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.