The Core Difference Between Medicare and Medicaid

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 and to people with end-stage renal disease. You pay into Medicare through payroll taxes during your working years, and the program covers 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 runs its own Medicaid program within federal guidelines, so what Medicaid covers and who qualifies varies by state. Medicaid is funded through general tax revenue, not payroll deductions.

The simplest way to remember the difference: Medicare is based on age or disability status; Medicaid is based on income. You can have both programs at the same time — this is called being "dual may be able to access."

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, but income limits and covered services differ from state to state.
  • Medicare has the same rules nationwide because it is run by the federal government; Medicaid rules change depending on which state you live in.
  • You can be enrolled in both Medicare and Medicaid at the same time if you meet the age or disability requirements for Medicare and the income requirements for Medicaid in your state.

Who Medicare Covers

You become may be able to access for Medicare automatically when you turn 65, as long as you or your spouse paid Medicare taxes for at least 10 years while working. If you are under 65, you may still may have access to if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease, or if you have amyotrophic lateral sclerosis (ALS).

Medicare does not check your income or assets. A person with a million dollars in the bank and a person with no savings both pay the same Medicare premiums if they are the same age. You do not have to be a U.S. citizen, but you must be a permanent resident who has lived in the United States for at least five years.

Who Medicaid Covers

Medicaid covers low-income individuals and families, but the income limit depends on your state and your family size. In some states, a single adult with no children cannot get Medicaid at any income level; in others, Medicaid covers adults earning up to 138% of the federal poverty line. A parent of two children may have a higher income limit than a single adult in the same state.

Medicaid also covers people who are blind, disabled, or over 65 with limited income and resources. Each state sets its own resource limits — the amount of money and property you can own and still may have access to. Some states are more generous than others.

You must be a U.S. citizen or a may have access to immigrant to get Medicaid in most states. Proof of citizenship or immigration status is required when you explore.

What Medicare Covers

Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative to Parts A, B, and D offered by private insurance companies — it bundles coverage differently and often includes dental, vision, or hearing benefits that Original Medicare does not.

Original Medicare (Parts A and B) has a deductible and copayments. You pay a deductible before Medicare starts paying, and you pay a percentage of costs for some services. Part D has its own deductible and copayment structure. Medicare Advantage plans have different cost structures set by each insurance company.

What Medicaid Covers

Medicaid must cover certain services in every state: hospital care, doctor visits, emergency services, lab work, X-rays, family planning, and nursing home care for people over 21. States can add coverage beyond these basics. Some states cover dental care, vision care, hearing aids, and mental health services; others do not.

Medicaid copayments are usually lower than Medicare copayments, and many Medicaid programs charge no copayment at all for preventive care or for people with very low incomes. Because Medicaid is state-run, the exact services covered and the cost-sharing rules change depending on where you live.

How Premiums and Costs Work

Medicare Part B and Part D have monthly premiums that you pay to the federal government. The standard Part B premium in 2024 is $164.90 per month, though it is higher for people with higher incomes. Part A is free for most people who paid Medicare taxes for 10 years. If you choose Medicare Advantage (Part C), you pay the Part B premium plus whatever premium the insurance company charges.

Medicaid has no monthly premium in most states — you pay nothing to enroll. Some states charge small copayments when you use services, but many waive copayments for low-income people. Because Medicaid is funded by state and federal taxes rather than individual premiums, the cost structure is different from Medicare.

State-by-State Differences in Medicaid

Medicaid rules are not the same everywhere. Income limits vary: a family of three might may have access to in one state but not in a neighboring state. Covered services differ — one state may cover dental care and another may not. The process for explore and the documents you need also change by state.

Some states expanded Medicaid under the Affordable Care Act to cover more low-income adults; others did not. This means a 40-year-old with no children and an income of $20,000 per year might may have access to for Medicaid in an expansion state but not in a non-expansion state. You need to check your specific state's rules to understand what you may be able to access.

Frequently Asked Questions

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

Yes. If you are 65 or older or have a may have access to disability, and your income and resources are low enough to meet your state's Medicaid limits, you can be enrolled in both. People with both programs are called "dual may be able to access." Medicaid typically pays Medicare premiums and cost-sharing on behalf of dual-may be able to access people.

What happens to my Medicare when I turn 65?

You do not have to do anything if you are already receiving Social Security. Medicare enrollment happens automatically three months before the month you turn 65. If you are not receiving Social Security, you must enroll yourself through Social Security or Medicare.gov during your initial enrollment period, which is seven months long (three months before, the month of, and three months after your 65th birthday).

How do I know if I may have access to for Medicaid in my state?

Contact your state Medicaid office or visit your state's health department website. You can also call 211 to be connected to local resources. Each state has different income limits and rules, so you need information specific to where you live. Many states also have online tools that let you check whether you may be able to access Medicaid based on your income and family size.

Does Medicare cover dental, vision, or hearing care?

Original Medicare (Parts A and B) does not cover routine dental, vision, or hearing care. Some Medicare Advantage plans include these benefits, but coverage varies by plan. Medicaid coverage of dental, vision, and hearing services depends on your state — some states cover all three, some cover one or two, and some cover none.

Can I switch from Medicare to Medicaid or vice versa?

No. Medicare and Medicaid are separate programs with different rules. You cannot "switch" from one to the other. If your circumstances change — for example, if your income drops and you become may be able to access for Medicaid — you can enroll in Medicaid while keeping Medicare. If you lose Medicaid may be able to access because your income rises, you keep Medicare if you are 65 or older or have a may have access to disability.