The core difference: who pays and who gets covered

Medicare is a federal insurance program you pay into through payroll taxes while you work. You become covered at 65, regardless of income. Medicaid is a joint federal and state program that pays for medical care for people with low income, at any age. The two programs have almost nothing in common except the word.

Medicare is insurance you've already bought. Medicaid is a needs-based program. If you're over 65, you're likely on Medicare. If you're under 65 and have low income, you might be on Medicaid. Some people are on both — this is called "dual coverage" and it's common.

The programs cover different things, work with different doctors, and have different costs. Understanding which one you're on (or whether you're on both) changes what you actually pay and where you can go for care.

Key Takeaways

  • Medicare is a federal program for people 65 and older, funded by payroll taxes you paid while working; Medicaid is a state-run program for people with low income at any age.
  • Medicare has the same rules nationwide; Medicaid rules vary significantly by state, including what services are covered and income limits.
  • Medicare requires monthly premiums and has deductibles and copays; Medicaid usually has no premium and minimal or no copays, depending on your state.
  • Medicare covers hospital care, doctor visits, and some prescription drugs; Medicaid covers those plus dental, vision, and long-term care in most states.
  • You can be on both programs at the same time if you're 65 or older with low income.

How you become covered: age versus income

You get Medicare automatically at 65 if you've worked and paid Social Security taxes for at least 10 years (40 quarters). You don't apply based on need — age and work history are the only requirements. If you're not yet 65, you can get Medicare early if you've been on Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS.

Medicaid is based on income and household size. The income limit varies by state — some states cover people up to 138% of the federal poverty line, others go lower. In 2024, the federal poverty line for a single person is about $14,600 per year, but your state's Medicaid program may have a different cutoff. You must apply through your state's Medicaid office or through your state's health insurance marketplace.

If you're 65 or older and your income is low enough, you can be on both. Your state's Medicaid program will help pay your Medicare premiums and cover costs Medicare doesn't, like copays and deductibles.

What each program actually covers

Medicare has four parts. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and some preventive services. Part D covers prescription drugs (you choose a plan). Part C (Medicare Advantage) is an alternative to A and B offered by private insurers — it usually includes drug coverage and sometimes dental or vision, but has network restrictions.

Medicaid covers all of those things, but the exact list depends on your state. Most states cover dental care, vision care, and hearing aids — Medicare does not. Most states also cover long-term care in nursing homes and home care, which Medicare covers only for short stays after a hospital admission. Some states cover more mental health services or substance use treatment than Medicare does.

The practical difference: if you're on Medicare alone and need a root canal or new glasses, you pay out of pocket. If you're on Medicaid, your state probably covers it. If you're on both, Medicaid fills in many of Medicare's gaps.

Costs: premiums, deductibles, and copays

Medicare Part B costs $164.90 per month in 2024 (higher earners pay more). Part D (drug coverage) costs $7 to $100+ per month depending on the plan. You also pay a deductible before coverage kicks in — $240 for Part B, $505 for Part A hospital stays. After that, you pay copays or coinsurance for each service.

Medicaid has no monthly premium in most states. Some states charge small copays ($1 to $5 per doctor visit), but many charge nothing. There's no deductible. This makes Medicaid much cheaper out-of-pocket, especially if you see doctors frequently or take many medications.

If you're on both programs, Medicare is your primary payer and Medicaid is secondary. Medicaid typically covers your Medicare premiums and the costs Medicare doesn't cover, which can save you hundreds of dollars per month.

How the programs work with doctors and hospitals

Medicare is nationwide and standardized. Any doctor or hospital that accepts Medicare accepts it the same way everywhere. You can see any provider who accepts Medicare — there's no network restriction, though some doctors don't accept Medicare patients.

Medicaid varies by state. Each state has its own payment rates, covered services, and network of providers. A doctor who accepts Medicaid in one state may not accept it in another. Some states use managed care (you pick a plan and have a network), others let you see any Medicaid provider. You need to check your specific state's rules.

If you move to a different state, your Medicare coverage moves with you. Your Medicaid coverage does not — you'll need to apply in your new state and may face a waiting period.

Income limits and how they work in your state

Medicaid income limits are set by each state. As of 2024, most states that expanded Medicaid under the Affordable Care Act cover people earning up to 138% of the federal poverty line (about $20,120 for a single person). States that did not expand cover lower amounts — some as low as 50% of poverty. A few states have no Medicaid program for adults without children.

Your state's Medicaid office or your state health insurance marketplace can tell you the exact income limit and whether you might be covered. Income limits also change yearly, so you should check each year even if you were denied before.

Medicare has no income limit. You can be a millionaire and still get Medicare at 65. However, higher earners pay higher premiums for Part B and Part D.

What happens if you're on both programs

If you're 65 or older and your income is low enough for Medicaid, you're called a "dual may be able to access" or "Medicare-Medicaid enrollee." Medicaid becomes your secondary payer and covers costs Medicare doesn't. This includes Medicare premiums, deductibles, and copays. It also includes services Medicare doesn't cover, like dental and vision.

Some states have special programs for dual may be able to access people that coordinate care between the two programs. Others require you to enroll in a Medicare Advantage plan paired with Medicaid. The details depend on your state. Your local Area Agency on Aging or your state Medicaid office can explain what's available to you.

Being on both programs is common and not a problem — it's actually the most complete coverage available. You don't have to choose one or the other.

Frequently Asked Questions

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

Yes. If you're 65 or older and your income is low enough for Medicaid, you can be on both. Medicaid will pay your Medicare premiums and cover costs Medicare doesn't, like copays and deductibles. This is called dual coverage and is common.

What's the income limit for Medicaid in my state?

Income limits vary by state. Most states that expanded Medicaid cover people earning up to 138% of the federal poverty line (about $20,120 for a single person in 2024). Some states cover less. Contact your state Medicaid office or visit your state health insurance marketplace to find your state's exact limit.

Do I have to pay for Medicare?

Yes. Part B costs about $165 per month, and Part D (drug coverage) costs $7 to $100+ per month depending on the plan. You also pay deductibles and copays when you use services. Medicaid has no premium and usually has minimal or no copays.

If I move to another state, do I keep my Medicaid coverage?

No. Medicaid is run by each state, so you'll need to apply in your new state. Your Medicare coverage moves with you automatically. You should apply for Medicaid in your new state right away to avoid a gap in coverage.

Does Medicare cover dental and vision care?

Medicare does not cover routine dental, vision, or hearing care. Most state Medicaid programs do cover these services. If you're on both programs, Medicaid will usually cover them.