The core difference: who pays and who is covered

Medicare is a federal insurance program you pay into through payroll taxes during your working years. You become covered at 65, regardless of income. Medicaid is a joint federal and state program that covers people with low income, regardless of age. The two programs operate separately, cover different groups of people, and work in completely different ways.

Think of Medicare as insurance you've already paid for. Think of Medicaid as a safety net based on what you earn right now. A person can be on both programs at the same time — this is called "dual coverage" — but the programs themselves are distinct.

Key Takeaways

  • Medicare covers people 65 and older, plus some younger people with disabilities or end-stage renal disease, and is funded through payroll taxes.
  • Medicaid covers people with low income and is jointly funded by federal and state governments, with may be able to access rules that vary by state.
  • Medicare has four parts (A, B, C, D) covering hospital, medical, private plan, and prescription drug costs; Medicaid coverage varies by state.
  • You pay premiums, deductibles, and copays for Medicare; Medicaid typically has no or very low cost-sharing, depending on your state.
  • A person can be enrolled in both programs simultaneously, which is common for low-income seniors.

Who Medicare covers

Medicare covers people 65 and older who have worked and paid Medicare taxes for at least 10 years (or whose spouse did). It also covers some people under 65: those who have received Social Security disability benefits for 24 months, those with end-stage renal disease, and those with amyotrophic lateral sclerosis (ALS).

You do not have to be poor to get Medicare. A millionaire at 65 is covered the same way as someone with no savings. Income does not matter for Medicare coverage — only age or disability status matters.

Who Medicaid covers

Medicaid covers people with low income. The exact income limit depends on your state, your household size, and your situation. In most states, a single adult earning under $1,500 per month might be covered; a family of four earning under $3,000 per month might be covered. These numbers change by state and are adjusted yearly.

Medicaid also covers pregnant people, children, parents or caretakers of children, people who are blind or disabled, and seniors with low income. Some states have expanded Medicaid to cover more working-age adults; others have not. Your state's rules determine whether you can get Medicaid.

What each program pays for

Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient care, and medical equipment. 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.

Medicaid must cover hospital care, doctor visits, emergency services, and lab work in every state. Beyond that, coverage varies. Some states cover dental, vision, hearing aids, and mental health services; others do not. Some states cover more prescription drugs than others. You need to check your state's Medicaid program to know what is covered where you live.

How much you pay out of pocket

Medicare requires you to pay premiums (monthly fees), deductibles (amounts you pay before coverage kicks in), and copays or coinsurance (your share of each service). In 2024, Part B has a monthly premium and an annual deductible; Part D has a monthly premium and varying copays by drug tier. These costs add up, especially if you use many services or take multiple medications.

Medicaid typically has no monthly premium or a very small one. Many states charge no copay or a small copay (often $1 to $3) for doctor visits and prescriptions. Some states charge more for non-emergency emergency room visits. The out-of-pocket cost for Medicaid is usually much lower than Medicare, though coverage itself may be narrower in some states.

When someone has both Medicare and Medicaid

A person can be on both programs if they are 65 or older (or disabled and on Medicare) and have low income. This person is called a "dual may be able to access" or "dually may be able to access." Medicare is the primary payer — it pays first — and Medicaid fills in gaps, covering copays, deductibles, and services Medicare does not cover.

For a low-income senior, dual coverage can mean much lower out-of-pocket costs than Medicare alone. Medicaid covers the Part B premium, the Part D premium, and many of the copays. Some states offer special programs for dual-may be able to access people that coordinate care between the two programs.

How to find out which program covers you

If you are 65 or older and worked in the United States, you are likely covered by Medicare. You can check your Social Security account online or call Social Security at 1-800-772-1213 to confirm your coverage and enroll if you have not already.

To learn about you may have access to for Medicaid, contact your state's Medicaid office or visit your state health department website. You can also call 211 (a free referral line) and ask for your state's Medicaid program. Be ready to provide information about your income, household size, and age or disability status. Medicaid rules change by state and sometimes by month, so asking directly is the only way to know for certain.

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 covered by both. Medicare pays first, and Medicaid covers costs Medicare does not pay. This is common for low-income seniors and can significantly reduce your out-of-pocket costs.

Do I have to pay for Medicare?

Yes. Most people pay a monthly premium for Part B (doctor and outpatient care) and Part D (prescription drugs). You also pay deductibles and copays when you use services. If you worked and paid Medicare taxes for 10 years, Part A (hospital care) is usually free.

Do I have to pay for Medicaid?

Most states do not charge a monthly premium for Medicaid, though some do. Copays are typically very low or zero. If you have Medicaid, you usually pay much less out of pocket than someone on Medicare alone, though coverage varies by state.

What if I am under 65 and not disabled — can I get Medicare?

No, unless you have end-stage renal disease or ALS. If you are under 65 and have low income, you may be covered by Medicaid instead. Check with your state's Medicaid program to see if you meet the income and other requirements.

Does my state's Medicaid cover the same things as another state's?

No. Medicaid rules and coverage vary significantly by state. One state may cover dental and vision; another may not. Income limits differ. The only way to know what your state covers is to contact your state's Medicaid office or visit its website.