Medicare and Medicaid are separate federal programs with different funding, may be able to access rules, and what they cover

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 or end-stage renal disease. You fund it through payroll taxes during your working years, and it pays for hospital care, doctor visits, and prescription drugs.

Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state sets its own income limits and decides which services to cover, so what Medicaid pays for in one state may differ from another. You do not pay into Medicaid through taxes; it is funded by federal and state government budgets.

The clearest way to think about the difference: Medicare is based on age or disability status and is the same nationwide. Medicaid is based on income and varies by state.

Key Takeaways

  • Medicare is for people 65 and older or those with certain disabilities, while Medicaid is for low-income individuals and families of any age.
  • Medicare is funded through payroll taxes and is uniform across all states; Medicaid is funded by federal and state budgets and rules differ by state.
  • You can have both Medicare and Medicaid at the same time, which is called "dual coverage" and can lower your out-of-pocket costs.
  • Medicare has standard deductibles and copayments nationwide; Medicaid copayments and coverage vary depending on which state you live in.

Who qualifies for each program

You may have access to for Medicare if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years. You also may have access to if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis).

You may have access to for Medicaid based on income. The income limit depends on your state and your household size. Some states expanded Medicaid under the Affordable Care Act to cover adults earning up to 138% of the federal poverty level; other states have not expanded and use lower income thresholds. You can check your state's specific rules through your state Medicaid office or by calling 211.

Income is not the only factor for Medicaid. You must also be a U.S. citizen or may have access to immigrant, and you must live in the state where you are applying. Some states also consider your assets (savings, property) when deciding whether you may have access to.

What each program covers

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 preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative way to receive Parts A, B, and D through a private insurance company.

Medicaid must cover certain core services in every state: hospital care, doctor visits, emergency services, and lab work. States can choose to cover additional services such as dental care, vision care, hearing aids, and mental health treatment. Some states cover more than others, so what you get depends on where you live.

Neither program covers long-term custodial care (help with daily living activities like bathing or dressing) as a standard benefit, though Medicaid in some states covers it under specific circumstances. Medicare covers skilled nursing care for a limited time after a hospital stay, but not ongoing custodial care.

Cost differences between the two programs

Medicare has standard costs nationwide: a Part B monthly premium (currently $164.90 for most people in 2024, though this changes yearly), an annual deductible, and copayments for services. You pay these costs out of pocket, though some people with low income use Medicaid to help cover them.

Medicaid costs vary by state. Some states charge no copayment for any service; others charge small copayments for doctor visits or prescriptions. Some states charge premiums for Medicaid coverage, though federal rules limit how much they can charge low-income people. You will need to check your state's Medicaid program to know what you will pay.

If you have both Medicare and Medicaid (dual coverage), Medicaid typically covers your Medicare premiums and copayments, which can significantly reduce your out-of-pocket costs.

When you can have both programs at the same time

You can be enrolled in both Medicare and Medicaid simultaneously. This happens most often when someone turns 65 and qualifies for Medicare but also has low enough income to may have access to for Medicaid in their state.

When you have both, Medicare is your primary payer — it pays first for covered services. Medicaid is secondary and can pay some or all of what Medicare does not cover, including Medicare premiums, deductibles, and copayments. This is why dual coverage can be valuable for people with limited income.

To have both, you must meet the income and other requirements for Medicaid in your state. You do not need to choose one or the other; you can have both if you may have access to.

How to find out which program you may have access to for

For Medicare, you can check your may be able to access through the Social Security Administration website or by calling Social Security at 1-800-772-1213. If you are already receiving Social Security benefits, you are automatically enrolled in Medicare Part A and Part B when you turn 65.

For Medicaid, contact your state Medicaid office directly. You can find your state office through the Centers for Medicare and Medicaid Services (CMS) website, or call 211 to be connected to local resources. You can also apply through your state's health insurance marketplace if your state uses one.

If you think you might may have access to for both programs, start by contacting your state Medicaid office. They can tell you whether you meet your state's income and other requirements and help you understand what coverage you would receive.

State differences in Medicaid that affect your coverage

Because Medicaid is run jointly by federal and state governments, the program you get depends on where you live. The most significant difference is whether your state expanded Medicaid under the Affordable Care Act. Expansion states cover more low-income adults; non-expansion states have stricter income limits and may only cover certain groups like children, pregnant people, and people with disabilities.

States also differ in what optional services they cover. Some states cover dental care, vision care, and hearing aids; others do not. Some states cover mental health and substance use treatment more broadly than others. Some states cover home and community-based services for people who would otherwise need nursing home care; others do not.

If you are moving to a different state, your Medicaid coverage may change. You will need to apply for Medicaid in your new state, and you may find that services you had covered are no longer available, or that new services are covered.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older and may have access to for both programs based on your income and other factors, you can be enrolled in both. Medicaid will help pay your Medicare premiums and copayments, reducing what you pay out of pocket.

Do I have to pay for Medicare?

Most people pay a monthly premium for Medicare Part B (doctor and outpatient care) and Part D (prescription drugs). Part A (hospital care) is usually free if you or your spouse paid Medicare taxes for at least 10 years. You also pay deductibles and copayments when you use services.

Do I have to pay for Medicaid?

Medicaid is free or very low-cost. Some states charge small copayments for certain services, and a few states charge small premiums, but Medicaid is designed for people with low income and costs far less than Medicare or private insurance.

What happens to my Medicaid if I turn 65?

You will become may be able to access for Medicare when you turn 65. You can keep your Medicaid if you still meet your state's income requirements. Many people have both programs; contact your state Medicaid office to make sure your coverage continues.

Does Medicare cover dental, vision, or hearing?

Original Medicare does not cover routine dental, vision, or hearing care. Some Medicare Advantage plans (Part C) include these services. Medicaid coverage of these services depends on your state; some states cover them, others do not.