Medicaid and Medicare are separate programs with different rules, funding, and who they cover

Medicare is a federal insurance program for people 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and the program covers hospital stays, doctor visits, and prescription drugs.

Medicaid is a joint federal and state program for people with low income. There is no age requirement — it covers children, working-age adults, seniors, and people with disabilities. Each state runs its own Medicaid program within federal guidelines, so coverage and income limits vary by state. Medicaid is funded through general tax revenue, not payroll deductions.

The two programs can overlap: a person can be on both Medicare and Medicaid at the same time. This happens when someone is 65 or older (or qualifies for Medicare through disability) and also has low enough income to meet their state's Medicaid rules. People enrolled in both are sometimes called "dual may be able to access."

Key Takeaways

  • Medicare is based on age or disability status and is the same nationwide; Medicaid is based on income and varies by state.
  • Medicare is funded through payroll taxes you pay during work; Medicaid is funded through general tax revenue and is free to those who meet income limits.
  • Medicare covers hospital care, doctor visits, and prescription drugs; Medicaid covers those services plus long-term care and dental in many states.
  • You can be on both programs at the same time if you are 65 or older (or disabled) and have low income.
  • Each state sets its own Medicaid income limits and decides which services to cover beyond the federal minimum.

How Medicare may be able to access works

You become may be able to access for Medicare automatically when you turn 65, as long as you or your spouse worked and paid Medicare taxes for at least 10 years. You do not have to be retired. If you are under 65, you can get Medicare if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS.

Medicare has four parts. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies. Most people pay a monthly premium for Part B and Part D, though Part A is usually free if you meet the work history requirement.

You sign up for Medicare during your initial enrollment period, which starts three months before the month you turn 65. If you miss this window, you may pay a penalty for late enrollment. You can also switch plans during the annual open enrollment period in the fall.

How Medicaid may be able to access works

Medicaid is based on income, and the income limit depends on which state you live in and which category you fall into. Most states cover children up to a certain age, pregnant people, parents of dependent children, seniors, and people with disabilities. Some states have expanded Medicaid to cover working-age adults with no dependents; others have not.

To learn about you meet your state's income limit, you will need to contact your state Medicaid office or use your state's online screening tool. Income limits change each year. A person who does not meet the limit one year may meet it the next year if the limit increases or their income decreases.

Medicaid is free — there are no premiums or enrollment fees. Some states charge small copays for certain services, but these are usually waived for people with very low income. Once you are found to meet the income and category requirements, coverage begins when ready or on the first day of the following month, depending on when you explore.

What each program covers

Medicare covers hospital stays (Part A), doctor visits and preventive care (Part B), and prescription drugs (Part D). It does not cover dental, vision, or hearing aids, though some Medicare Advantage plans include these. Medicare also does not cover long-term care in a nursing home or assisted living facility, though it does cover a limited stay in a skilled nursing facility after a hospital stay.

Medicaid covers the same basic services as Medicare — hospital care, doctor visits, and prescription drugs — but the specific services and copays vary by state. Medicaid also covers services Medicare does not: dental care, vision care, hearing aids, and long-term care in a nursing home or assisted living facility. This is why Medicaid is often more comprehensive for seniors and people with disabilities who need ongoing support.

Both programs cover preventive services like vaccinations and cancer screenings at no cost to you. Both also cover emergency care regardless of whether you are in-network. The main difference is that Medicaid covers services related to long-term care and daily living support, while Medicare focuses on acute medical care.

Cost differences between the two programs

Medicare requires you to pay premiums, deductibles, and copays. Part B premium is about $165 per month in 2024, though it is higher if your income is above a certain threshold. Part A has a deductible of about $1,600 per hospital stay. Part D premiums vary by plan and range from $5 to $100 per month. You also pay copays when you see a doctor or fill a prescription.

Medicaid is free or very low cost. There are no premiums in most states. Some states charge small copays — usually $1 to $5 per doctor visit or prescription — but these are often waived for people with income below the poverty line. Medicaid does not have deductibles the way Medicare does.

If you are on both Medicare and Medicaid, Medicaid usually pays the Medicare premiums and cost-sharing on your behalf. This is called "Medicare savings programs" or "full dual coverage," depending on your income level. This is one reason dual-may be able to access people often have lower out-of-pocket costs than people on Medicare alone.

What happens if you are on both programs

If you are 65 or older and have low income, you may be on both Medicare and Medicaid. Medicare is your primary insurance, meaning it pays first. Medicaid is secondary and covers what Medicare does not pay. In many cases, Medicaid will also pay your Medicare premiums and deductibles, which can save you hundreds of dollars per year.

To be on both programs, you must meet Medicare may be able to access (age 65 or older, or disabled) and your state's Medicaid income limit. Income limits for dual-may be able to access people are usually higher than for working-age Medicaid recipients, but they vary by state. Some states have special programs for dual-may be able to access seniors that offer additional benefits like vision or dental care.

If you think you may be on both programs, contact your state Medicaid office or call 1-800-MEDICARE to find out. You do not have to choose between them — if you meet the requirements for both, you are automatically enrolled in both.

State differences in Medicaid coverage

Because Medicaid is run by each state, the rules are not the same everywhere. Income limits vary — a person might meet the limit in one state but not in another. The services covered also vary. Some states cover dental care for all Medicaid recipients; others cover it only for children or pregnant people. Some states cover vision care; others do not.

If you move to a different state, your Medicaid coverage may change. Your income might no longer meet the new state's limit, or the services you were receiving might not be covered. You will need to explore for Medicaid in your new state and may have a gap in coverage while the process is processed.

To find your state's specific rules, contact your state Medicaid office directly or visit your state's health department website. You can also call 211 to be connected to local resources that can explain your state's program.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older (or disabled) and have low income, you may meet the requirements for both programs. Medicare is your primary insurance, and Medicaid covers costs Medicare does not pay. In many cases, Medicaid also pays your Medicare premiums and deductibles.

Do I have to pay for Medicaid?

No. Medicaid is free to people who meet the income and category requirements. Some states charge small copays for certain services, but these are usually $1 to $5 and are often waived for people with very low income. There are no premiums or enrollment fees.

What if I am under 65 and do not have Medicare?

If you are under 65 and do not have Medicare, you may still be able to get Medicaid if your income is low enough. Medicaid covers working-age adults in most states, though income limits vary. You can also look into health insurance through the Affordable Care Act marketplace if you do not meet Medicaid income limits.

Does Medicare cover dental and vision care?

Original Medicare does not cover dental, vision, or hearing aids. Some Medicare Advantage plans include these services, but coverage varies by plan. If you are on both Medicare and Medicaid, Medicaid may cover dental and vision care depending on your state.

What is the income limit for Medicaid?

Income limits vary by state and by category (children, adults, seniors, disabled people). There is no single national limit. To find your state's limit, contact your state Medicaid office or use your state's online screening tool. Income limits change each year and are based on the federal poverty level.