Medicare and Medicaid are two different government health insurance programs, not parts of each other

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 two programs have different rules, different may be able to access requirements, and different coverage — they operate independently.

The confusion is understandable because both are government health programs with similar names. But they are funded differently, run differently, and cover different groups of people. You may be covered by one, both, or neither, depending on your age and income.

Key Takeaways

  • Medicare is for people 65 and older; Medicaid is for low-income people of any age — they are separate programs with separate rules.
  • Medicare is run entirely by the federal government; Medicaid is run jointly by federal and state governments, so coverage varies by state.
  • Some people may have access to for both programs at the same time, which is called being "dual may be able to access."
  • Medicare has the same basic coverage nationwide; Medicaid coverage and income limits differ depending on which state you live in.

How Medicare Works

Medicare is a federal program funded through payroll taxes. You become covered automatically at age 65 if you or your spouse paid Medicare taxes while working. The program has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, 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.

Medicare does not ask about your income. A person with a million dollars in the bank and a person with no savings both pay the same Medicare premiums at age 65, assuming they both worked long enough to earn coverage. The program is based on work history, not financial need.

How Medicaid Works

Medicaid is jointly funded and run by the federal government and individual states. Each state sets its own income limits, decides which groups of people it will cover, and determines what services it pays for. This means Medicaid in one state may look very different from Medicaid in another state.

Medicaid is income-based. To be covered, your household income must fall below your state's limit. The limit varies by state and by family size. Some states expanded Medicaid to cover more low-income adults; others did not. Some states cover dental care through Medicaid; others do not. You must live in the state where you are explore, and you must be a U.S. citizen or may have access to immigrant.

When You Can Have Both Medicare and Medicaid

Some people may have access to for both programs at the same time. This happens most often when someone turns 65, becomes covered by Medicare, but still has a low enough income to also may have access to for Medicaid. These people are called "dual may be able to access."

If you are dual may be able to access, Medicare is your primary insurance — it pays first. Medicaid pays second, covering some costs that Medicare does not pay. This can reduce your out-of-pocket costs significantly. To learn about you may have access to for both, you will need to check your state's Medicaid income limits and contact your state Medicaid office.

Income Limits and Coverage Differences

Medicare has no income limit. Medicaid income limits are set by each state and change periodically. For example, one state might cover a single adult with income up to 138% of the federal poverty level, while another state covers only up to 100%. You can find your state's current limits by contacting your state Medicaid office or visiting its website.

Coverage also differs. Medicare covers the same basic services in all states. Medicaid coverage varies — some states cover vision care, dental care, and hearing aids; others do not. Some states cover more mental health services or therapy than others. If you are on Medicaid, your state's program determines what you can access.

How to Find Out Which Program You Might may have access to For

If you are 65 or older and worked long enough to earn Medicare credits, you will be covered by Medicare automatically. You do not need to do anything — coverage starts the month you turn 65. If you are younger than 65 and have a disability or end-stage renal disease, you may still may have access to for Medicare; contact Social Security to ask.

To learn about you may have access to for Medicaid, contact your state Medicaid office directly. You can find it by searching "[your state] Medicaid" online, or by calling 211 (a free referral service). Have your income information and household size ready. Your state will tell you whether your income falls within the limit and what documents you need to provide.

What Happens If You Lose One Program

If you are on Medicaid and turn 65, you become covered by Medicare automatically. You keep Medicaid too if your income is still low enough — you do not lose it just because you turned 65. If your income rises above your state's Medicaid limit, you lose Medicaid coverage but keep Medicare.

If you are on Medicare and your income drops, you may become newly covered by Medicaid. This can happen if you retire, lose a job, or have a major expense. Contact your state Medicaid office to report the change in income and ask whether you now may have access to.

Frequently Asked Questions

Is Medicaid part of Medicare?

No. Medicare and Medicaid are two separate programs. Medicare is for people 65 and older; Medicaid is for low-income people of any age. They have different rules, different funding, and different coverage.

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

Yes. If you are 65 or older and your income is low enough to meet your state's Medicaid limit, you can be covered by both. Medicare pays first, and Medicaid covers some remaining costs. Contact your state Medicaid office to learn about you may have access to.

Does Medicare ask about my income?

No. Medicare does not have an income limit. Anyone 65 or older who worked long enough to earn Medicare credits is covered, regardless of how much money they have. Medicaid, by contrast, is based entirely on income.

Why are the rules different in each state for Medicaid but the same for Medicare?

Medicare is run by the federal government, so the rules are the same everywhere. Medicaid is run jointly by states and the federal government, so each state sets its own income limits and decides what services to cover. This is why you need to check your specific state's rules.

What if I turn 65 and I am on Medicaid — do I lose coverage?

No. When you turn 65, Medicare covers you automatically. If your income is still low enough to meet your state's Medicaid limit, you keep Medicaid too. You will have both programs working together.