Medicaid and Medicare are two separate programs that cover different groups of people

Medicare is a federal health insurance program for people age 65 and older, regardless of income. It also covers some younger people with disabilities and people with end-stage renal disease. Medicaid is a joint federal and state program that covers low-income individuals and families of any age. The programs have different rules, different may be able to access requirements, and different coverage — and you cannot mix them up when looking for coverage.

The confusion happens because both are government health programs with similar names. But Medicare is based on age or disability status. Medicaid is based on income and family size. A person can have both programs at the same time, but that is not the same as one program being "for" the other.

Key Takeaways

  • Medicare covers people 65 and older, some younger people with disabilities, and people with end-stage renal disease, regardless of how much money they have.
  • Medicaid covers low-income individuals and families of any age, with income limits that vary by state.
  • Some people may have access to for both programs at the same time, which is called "dual may be able to access" status.
  • Your state runs its own Medicaid program with its own rules, so coverage and income limits differ from state to state.
  • You cannot use one program's rules to understand the other — they are separate systems with separate enrollment processes.

Who Medicare covers and how it works

Medicare is an earned-benefit program. You become may be able to access when you turn 65, even if you are still working and have a high income. You do not have to be retired or poor. If you paid into Social Security through payroll taxes for at least 10 years, you get Medicare Part A (hospital insurance) automatically when you turn 65. Part B (medical insurance) is optional but most people enroll.

Medicare also covers people under 65 who have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, and people of any age with end-stage renal disease or ALS. Income does not matter for any of these groups. A 40-year-old with a disability and a six-figure income still qualifies for Medicare if they meet the disability requirement.

Medicare is run by the federal government through the Centers for Medicare & Medicaid Services (CMS). The same rules apply in every state. You enroll through Social Security or Medicare.gov, and coverage begins on the first day of the month you turn 65 or become may be able to access.

Who Medicaid covers and how it works

Medicaid covers low-income individuals and families. The income limit depends on your state and your family size. In some states, a single adult with no children can earn up to roughly $1,500 per month and still may have access to. In other states, the limit is much lower. A parent with children may have a higher income limit than a childless adult in the same state.

Medicaid is run by each state, with federal funding and federal rules as a floor. This means your state can offer more coverage than the federal minimum requires, but not less. One state's Medicaid program may cover dental care; another may not. One state may cover people up to 138% of the federal poverty line; another may cover only up to 100%. You must check your own state's rules.

You enroll in Medicaid through your state's health department or social services office, not through a federal website. Processing times vary by state, but many states can process an application within 30 to 45 days. Some states have online portals; others require you to apply by mail or in person.

What happens if you have both Medicare and Medicaid

Some people may have access to for both programs at the same time. These people are called "dual may be able to access." This usually happens when someone turns 65 while already receiving Medicaid, or when a Medicare beneficiary's income drops low enough to may have access to for Medicaid later.

If you are dual may be able to access, Medicare is your primary insurance and pays first. Medicaid is secondary and may cover costs that Medicare does not, such as copayments, coinsurance, or services Medicare does not cover. Having both programs typically means lower out-of-pocket costs than having either one alone.

You do not need to do anything special to coordinate the two programs — they communicate automatically. But you must stay enrolled in both. If you lose Medicaid may be able to access because your income rose, you keep Medicare. If you lose Medicare may be able to access (which is rare), you keep Medicaid if you still meet the income requirement.

Income limits and asset rules differ between the programs

Medicare has no income limit. You can earn any amount and still have Medicare at 65. There is no asset test — your savings, home, or investments do not affect your may be able to access.

Medicaid has both an income limit and, in most states, an asset limit. The income limit varies by state and family size. The asset limit also varies by state but typically allows you to have a certain amount in savings (often $2,000 to $3,000 for an individual) without losing coverage. Your home and one vehicle are usually not counted as assets.

These differences matter because someone with a high income and large savings can have Medicare but not Medicaid. Someone with low income and low assets can have Medicaid but not Medicare (unless they are over 65 or disabled).

Coverage differences between the programs

Medicare covers hospital stays, doctor visits, some preventive care, and prescription drugs (through Part D, which you must enroll in separately). It does not cover dental care, vision care, hearing aids, or long-term care in a nursing home.

Medicaid coverage varies by state, but most state programs cover doctor visits, hospital stays, prescription drugs, and some preventive care. Many states also cover dental care, vision care, and nursing home care — services Medicare does not cover. This is one reason dual-may be able to access people often have lower costs: Medicaid fills in gaps that Medicare leaves.

The copayments and coinsurance amounts also differ. Medicare typically has higher out-of-pocket costs than Medicaid. If you have both, Medicaid usually covers the costs Medicare leaves behind.

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

If you are 65 or older, you may have access to for Medicare. You do not need to check income or assets. Contact Social Security or go to Medicare.gov to enroll. If you are under 65 and have a disability, check whether you receive or have applied for SSDI. If you do, you may may have access to for Medicare after 24 months of receiving benefits.

To find out about Medicaid, contact your state's Medicaid office or health department. You can also call 211 (a free referral service) and ask for your state's Medicaid contact information. Have your income and family size ready. Your state will tell you the income limit for your situation and whether you may may have access to.

If you think you might may have access to for both, start with Medicare if you are 65 or older — that is automatic. Then check Medicaid separately through your state. Do not assume that having one program means you cannot have the other.

Frequently Asked Questions

Is Medicare the same as Medicaid?

No. Medicare is a federal program for people 65 and older or with certain disabilities. Medicaid is a state program for low-income individuals and families. They are separate programs with different may be able to access rules, different coverage, and different enrollment processes.

Can I have both Medicare and Medicaid at the same time?

Yes. People who may have access to for both are called dual may be able to access. Medicare pays first, and Medicaid covers some costs Medicare does not, which usually lowers your total out-of-pocket expenses.

Do I have to pay for Medicare?

Part A (hospital insurance) is free if you paid into Social Security for 10 years. Part B (medical insurance) has a monthly premium, usually deducted from your Social Security check. Part D (prescription drug coverage) has a separate premium you choose when you enroll.

What if my income is too high for Medicaid but I am not 65 yet?

If you are under 65 and do not have a disability, you would not may have access to for Medicaid based on income alone in most states. You might be able to purchase coverage through the health insurance marketplace (Healthcare.gov) or through an employer. Some states have expanded Medicaid to cover more people; check your state's rules.

Does Medicaid cover the same things in every state?

No. Each state runs its own Medicaid program and can cover more services than the federal minimum requires. Dental care, vision care, and nursing home coverage vary by state. Check your state's Medicaid website or call your state office to see what is covered where you live.