Medicaid and Medicare are two different government health insurance programs

Medicaid and Medicare are not the same program. Medicare is a federal health insurance program for people 65 and older, regardless of income. Medicaid is a joint federal and state program that covers people with low income, regardless of age. The two programs have different rules, different income limits, and different coverage. You can be on both at the same time — this is called "dual may be able to access" — but being on one does not automatically put you on the other.

The confusion happens because the names are similar and both are government programs. But they are run separately, funded differently, and have different requirements. Understanding which one you might be on matters because each one covers different services and has different out-of-pocket costs.

Key Takeaways

  • Medicare covers people 65 and older and some younger people with disabilities, while Medicaid covers people with low income at any age.
  • Medicare is a federal program funded through payroll taxes; Medicaid is jointly funded by federal and state money and has different rules in each state.
  • You can be on both programs at the same time if you meet the income and age or disability requirements for each.
  • Medicare does not cover long-term care or dental care; Medicaid covers both in most states.

Who Medicare covers and how it works

Medicare is a federal program run by the Centers for Medicare and Medicaid Services (CMS). You become may be able to access for Medicare at age 65 if you or your spouse paid into Social Security for at least 10 years. You can also get Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS.

Medicare has four parts: Part A covers hospital stays and some skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs; and Part C (Medicare Advantage) is an alternative way to get Parts A, B, and D through a private insurance company. You pay premiums for Parts B and D, and you have deductibles and copays. Medicare is the same in every state because it is a federal program.

Who Medicaid covers and how it works

Medicaid is jointly funded by the federal government and each state, and each state runs its own program. Because of this, Medicaid rules are different in every state — the income limit in one state may be higher or lower than in another, and the services covered may vary. Generally, Medicaid covers people with low income, children, pregnant people, parents of dependent children, and people over 65 with low income.

In states that expanded Medicaid under the Affordable Care Act, adults under 65 with income up to 138 percent of the federal poverty level may be covered. In states that did not expand, the income limits are much lower and often explore only to parents or children. Medicaid covers doctor visits, hospital care, prescription drugs, and in most states, dental care and long-term care — services Medicare does not cover.

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. This is called being "dual may be able to access." When you are on both, Medicare is your primary insurance and pays first, then Medicaid covers some of what Medicare does not pay. Medicaid also covers services Medicare does not, like long-term care and dental work.

To be on both, you must meet the age or disability requirement for Medicare and the income requirement for Medicaid in your state. Your state Medicaid office determines whether you are dual may be able to access. If you are, you will have a Medicare card and a Medicaid card, and you will use both when you see a doctor or go to the hospital.

Services Medicare covers that Medicaid does not

Medicare covers hospital stays (Part A), doctor visits and outpatient care (Part B), and prescription drugs (Part D). It also covers some skilled nursing care after a hospital stay, home health care, and hospice. However, Medicare does not cover long-term care in a nursing home or assisted living facility, dental care, vision care, or hearing aids. It also does not cover routine foot care or most preventive screenings.

If you need these services and are not on Medicaid, you pay out of pocket or buy a supplemental insurance policy called Medigap. Medigap helps pay some of the costs Medicare does not cover, but it does not cover long-term care or dental work.

Services Medicaid covers that Medicare does not

Medicaid covers long-term care in a nursing home or assisted living facility, which is one of the biggest differences between the two programs. Medicaid also covers dental care in most states, vision care including glasses, and hearing aids. Medicaid covers transportation to medical appointments and personal care services like help with bathing and dressing.

Because Medicaid is state-run, the exact services covered vary by state. Some states cover more services than others. If you are on Medicaid, your state program will send you a handbook listing what is covered. If you are not sure whether a service is covered, call your state Medicaid office.

How to find out which program you are on

If you are 65 or older, you are likely on Medicare. You can check by looking for your Medicare card or by calling Social Security at 1-800-772-1213. If you have low income, you may also be on Medicaid. To find out, contact your state Medicaid office. You can find your state office by visiting Medicaid.gov and selecting your state, or by calling 211 and asking for Medicaid information.

If you are under 65 and have low income, you may be on Medicaid but not Medicare. If you are under 65 and have a disability, you may be on Medicare if you have been receiving SSDI for 24 months. If you are not sure which program covers you, your state Medicaid office or your local Social Security office can tell you.

Frequently Asked Questions

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

Yes. If you are 65 or older and have low income, you may be on both. Medicare pays first, and Medicaid covers some of what Medicare does not pay. Medicaid also covers services Medicare does not, like long-term care and dental care. Contact your state Medicaid office to learn about you are dual may be able to access.

Do I have to pay for Medicare if I am on Medicaid?

If you are on both programs, you still pay Medicare premiums for Part B and Part D, but Medicaid may help pay these premiums for you. Medicaid also covers some of your Medicare deductibles and copays. The exact amount Medicaid pays depends on your state and your income.

What is the income limit for Medicaid?

The income limit for Medicaid varies by state and by category. In states that expanded Medicaid, the limit is usually 138 percent of the federal poverty level. In states that did not expand, the limit is much lower. Contact your state Medicaid office to find out the income limit where you live.

Does Medicare cover dental work?

No, Medicare does not cover dental care. If you are on Medicaid, your state program may cover dental care. If you are only on Medicare, you can buy a separate dental insurance plan or pay out of pocket. Some dental schools offer low-cost care if you cannot afford private dentists.

How do I know if I should be on Medicaid?

If you have low income, you may be on Medicaid. The income limit depends on your state and your situation — whether you are a child, parent, pregnant, over 65, or disabled. Contact your state Medicaid office or call 211 to learn about you may be covered and what documents you need to provide.