Medicare and Medicaid are different programs run by different parts of the federal government

Medicare is a federal health insurance program for people age 65 and older, regardless of income. It is also available to some younger people with disabilities and to people with end-stage renal disease. Medicare is run by the Centers for Medicare & Medicaid Services (CMS), which is part of the Department of Health and Human Services.

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 coverage and income limits vary by state. You arrived here from the Medicaid section, so you likely already know Medicaid is means-tested — your income and assets determine whether you may have access to.

The programs overlap in one important way: some people are covered by both Medicare and Medicaid at the same time. These people are called "dual may be able to access." But the programs are funded differently, have different rules, and cover different services. Understanding which program you fall under matters because it changes what you pay, where you can go for care, and what paperwork you need to file.

Key Takeaways

  • Medicare is federal health insurance for people 65 and older; Medicaid is a state-run program for low-income people of any age.
  • Medicare is not means-tested — you do not have to be poor to get it, only old enough or disabled enough.
  • Medicaid income and asset limits are set by each state and change year to year.
  • Some people are covered by both programs at the same time and are called "dual may be able to access."
  • You pay premiums, deductibles, and copays under Medicare; Medicaid usually costs little or nothing out of pocket.

How Medicare works and who pays for it

Medicare is funded through payroll taxes that workers and employers pay during their working years. When you turn 65, you become may be able to access automatically if you or your spouse paid Medicare taxes for at least 10 years. You do not have to be retired, and your income does not matter.

Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, and some home health services. Part B covers doctor visits, outpatient care, and medical equipment. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurance companies.

You pay a monthly premium for Part B and Part D. Part A is usually free if you have worked long enough. You also pay deductibles and copays when you use services. The exact amounts change each year. In 2024, the Part B premium was $164.90 per month for most people, but this varies based on your income.

How Medicaid works and who pays for it

Medicaid is funded by federal and state tax dollars. Each state designs its own program, sets its own income limits, and decides which services to cover. This means a person who qualifies for Medicaid in one state may not may have access to in another state, and the services covered can differ.

To be covered by Medicaid, your income must fall below your state's limit. Most states also set asset limits — the total amount of money and property you can own. Some states have expanded Medicaid to cover more people; others have not. You can find your state's income limit and rules on your state Medicaid website or by calling your state's Medicaid office.

Medicaid usually costs you nothing or very little. You typically pay no premium, no deductible, and small or no copays. The state and federal government pay the providers directly. This is why Medicaid is often the first place people look when they cannot afford health insurance.

When someone is covered by both Medicare and Medicaid

People who are "dual may be able to access" have both Medicare and Medicaid coverage. This usually happens when someone turns 65 and becomes may be able to access for Medicare but still has a low enough income to also may have access to for Medicaid. It can also happen when a younger person with a disability qualifies for both programs.

If you are dual may be able to access, Medicare is your primary insurance — it pays first. Medicaid pays second and covers some costs that Medicare does not, such as long-term care and some prescription drugs. Dual may be able to access people often pay very little out of pocket because Medicaid covers Medicare's premiums, deductibles, and copays.

Some states offer special Medicaid programs just for dual may be able to access people. These programs coordinate care between Medicare and Medicaid and may offer extra services. Ask your state Medicaid office whether you are dual may be able to access and what programs are available to you.

What each program covers

Medicare covers hospital care, doctor visits, medical equipment, and prescription drugs. It does not cover dental, vision, or hearing aids in most cases. It also does not cover long-term care in a nursing home or assisted living facility, which is a major gap for older people.

Medicaid covers more services than Medicare in many states. Most Medicaid programs cover dental care, vision care, and long-term care in nursing homes. Medicaid also covers transportation to medical appointments and personal care services that Medicare does not. However, what Medicaid covers depends on your state. You need to check your state's Medicaid website or call your state Medicaid office to know what services you can use.

Some services are covered by both programs but with different rules. For example, both cover hospital stays, but Medicare limits how many days it will pay for, while Medicaid rules vary by state.

Income and asset limits by program

Medicare has no income or asset limit. If you are 65 or older and have worked long enough, you get Medicare no matter how much money you have.

Medicaid has both income and asset limits that vary by state. In 2024, most states set the income limit for a single adult between 100 and 138 percent of the federal poverty level, though some states are higher and some are lower. The federal poverty level for a single person in 2024 was $14,580 per year, so most states' limits fall between roughly $14,580 and $20,120 per year. Asset limits also vary — some states allow you to own up to $2,000 in countable assets; others allow more.

These numbers change each year. Your state Medicaid office or your state's Medicaid website will have the current limits. You can also call 211 to reach a local resource specialist who can tell you your state's limits and help you understand whether you might may have access to.

How to find out which program you fall under

If you are 65 or older, you are may be able to access for Medicare. You do not have to do anything — you become may be able to access automatically the month you turn 65. However, you do need to enroll in Part B and Part D, or you may face penalties. You can enroll through Medicare.gov or by calling 1-800-MEDICARE.

If you are under 65 and have a disability or end-stage renal disease, you may be may be able to access for Medicare. You will need to file a Social Security Disability Insurance (SSDI) claim or a Supplemental Security Income (SSI) claim. The Social Security Administration will determine whether you meet the disability standard.

To find out whether you may have access to for Medicaid, contact your state Medicaid office directly. You can find your state office on Medicaid.gov, or call 211 to be connected to your local Medicaid office. You will need to provide information about your income, assets, household size, and citizenship status. Many states now let you file online.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older and have a low income, you may may have access to for both. Medicaid will help pay your Medicare premiums and cover services Medicare does not, like long-term nursing home care. Contact your state Medicaid office to find out whether you may have access to for both programs.

Do I have to pay for Medicare?

Medicare Part A is usually free if you have worked long enough. You pay a monthly premium for Part B (around $165 in 2024) and Part D (prescription drugs). You also pay deductibles and copays when you use services. If you have Medicaid too, Medicaid may pay these costs for you.

What if I do not may have access to for Medicaid but cannot afford Medicare?

If you are 65 or older, you are may be able to access for Medicare regardless of income. However, you may be able to lower your costs. Medicare offers programs that help pay premiums and out-of-pocket costs for people with limited income. Ask Medicare about the Low-Income Subsidy program for Part D and the Medicare Savings Programs for Part B premiums.

Does Medicaid cover nursing home care?

Yes, Medicaid covers long-term nursing home care in most states, but Medicare does not. This is one major reason people look for Medicaid coverage. However, you must meet your state's income and asset limits, and Medicaid may require you to spend down your savings before it pays.

How do I know if my state expanded Medicaid?

Not all states have expanded Medicaid to cover more people. You can check your state's status on Medicaid.gov or call your state Medicaid office. If your state has not expanded, the income limit may be much lower, and you may not may have access to even if you have a low income. Some states are still deciding whether to expand.