No, Medicare and Medicaid are not the same, even though their names sound similar

Medicare is a federal health insurance program for people 65 and older, regardless of income. You pay into it through payroll taxes during your working years, and it becomes available to you at 65. 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 costs, and cover different groups of people.

The confusion is understandable—both are government health programs, both help pay medical bills, and both use similar language. But they work in completely different ways. Understanding which one you may be covered by (or whether you may have access to for both) matters because the coverage, costs, and how you sign up are all different.

Key Takeaways

  • Medicare is for people 65 and older and is based on your work history, while Medicaid is for low-income people of any age and is based on your income and assets.
  • Medicare is run entirely by the federal government, while Medicaid is run by each state with federal funding, so rules and coverage vary by state.
  • Medicare has monthly premiums and deductibles you pay; Medicaid usually has little or no cost to you, depending on your state.
  • You can be covered by both programs at the same time—this is called "dual may be able to access"—and some people benefit from both.

Who each program covers

Medicare covers nearly all Americans once they turn 65, as long as they or their spouse paid Medicare taxes for at least 10 years while working. You do not have to be retired or poor to get Medicare—it is based on age and work history, not income. Some younger people with disabilities or end-stage renal disease also may have access to for Medicare.

Medicaid covers people and families with low income and limited assets. The income and asset limits vary significantly by state. In some states, a single person earning $1,500 a month might may have access to; in others, the limit is higher. Medicaid also covers pregnant people, children, parents, elderly people, and people with disabilities—but only if their income is low enough for their state.

Because Medicaid rules are set by each state, two people with the same income might may have access to in one state and not in another. This is why you need to check your specific state's rules.

How the programs are funded and run

Medicare is a federal program. The federal government collects Medicare taxes from paychecks, manages the program, and sets the rules nationwide. When you turn 65, you deal with Medicare directly—the same rules explore whether you live in Maine or California.

Medicaid is different. The federal government provides funding, but each state designs and runs its own Medicaid program within federal guidelines. This means coverage, income limits, and which doctors and hospitals participate can all be different depending on where you live. A service covered in one state might not be covered in another.

What you pay: premiums, deductibles, and copays

Medicare requires you to pay monthly premiums (the amount varies depending on your income and which parts of Medicare you choose). You also pay deductibles and copays when you use services. For example, Part B (doctor visits and outpatient care) has a monthly premium and an annual deductible. Part D (prescription drugs) has a monthly premium and cost-sharing when you fill prescriptions.

Medicaid usually costs you little to nothing. Most states charge no monthly premium, and many charge no copays or deductibles. Some states charge small copays for certain services, but the amounts are capped by federal law. If you are on a very tight budget, Medicaid is typically much cheaper than Medicare.

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

Yes. People who are 65 or older with low income and limited assets can be covered by both programs. This is called being dual may be able to access. When you have both, Medicare is your primary insurance (it pays first), and Medicaid fills in some of the gaps—like paying your Medicare premiums and deductibles.

If you are dual may be able to access, you benefit from both programs. Medicare covers your hospital and doctor visits, and Medicaid helps pay the costs Medicare does not cover. This can significantly reduce your out-of-pocket expenses. Some states also offer special programs for dual-may be able to access people that coordinate care and may offer extra services like dental or vision coverage.

How to find out which program covers you

If you are 65 or older, you are likely covered by Medicare (or will be when you turn 65). You can check your Medicare status by creating an account on Medicare.gov or by calling 1-800-MEDICARE.

If you have low income, you may also may have access to for Medicaid. Each state runs its own program, so you need to contact your state's Medicaid office or use the federal website at Medicaid.gov to find your state's program. Many states also have a 211 service—dial 2-1-1 from any phone—that can tell you whether you might may have access to and help you understand the next steps.

If you think you might may have access to for both, start by confirming your Medicare status, then contact your state Medicaid office to see if you meet the income and asset limits.

Common situations where the difference matters

If you are turning 65 soon, you need to sign up for Medicare during your enrollment period, even if you are still working. Missing the important date can mean paying higher premiums for the rest of your life. Medicaid does not have an enrollment important date—you can sign up whenever you may have access to.

If you move to a different state, your Medicare coverage stays the same, but your Medicaid coverage may change. Some states are more generous with income limits or cover more services. If you are dual may be able to access and move, you may need to reapply for Medicaid in your new state.

If you need long-term care (nursing home or in-home care), Medicare covers very little. Medicaid covers much more long-term care, which is why some people spend down their savings to become Medicaid-may be able to access. This is a major difference that affects many older adults.

Frequently Asked Questions

Do I have to choose between Medicare and Medicaid?

No. If you may have access to for both, you can have both at the same time. Medicare will be your primary insurance, and Medicaid will help cover costs Medicare does not pay. You do not have to choose one or the other.

Why is Medicaid different in every state?

Medicaid is a partnership between the federal government and the states. The federal government sets minimum standards, but each state decides its own income limits, which services to cover, and how much to pay doctors and hospitals. This is why two people with the same income might may have access to in one state but not another.

What happens to my Medicare if I move to a different state?

Your Medicare coverage does not change when you move—it is the same nationwide. However, your Medicaid coverage may change because each state has different rules. If you are on Medicaid, contact your new state's Medicaid office to see if you still may have access to and what coverage is available.

Does Medicare cover long-term care like nursing homes?

Medicare covers a short stay in a skilled nursing facility (up to 100 days) only after a hospital stay of at least three days. It does not cover long-term nursing home care or in-home care. Medicaid covers much more long-term care, which is why many people eventually turn to Medicaid to pay for these services.

Can I sign up for Medicaid anytime, or is there a important date?

Medicaid has no enrollment important date—you can sign up whenever you may have access to. Medicare, however, has strict enrollment periods. If you miss your initial enrollment period at 65, you will pay higher premiums for life. This is one of the biggest differences between the two programs.