No, Medicare and Medicaid are two separate programs with different rules
Medicare and Medicaid sound similar, but they are run by different parts of the government, cover different groups of people, and work in completely different ways. The confusion is understandable — both are federal health insurance programs — but mixing them up can cost you money or leave you without coverage you thought you had.
Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS). It is primarily for people 65 and older, regardless of income. Medicaid is a joint federal and state program, also run by CMS but administered by each state differently. It is for people with low income, regardless of age. A person can have both, but being on one does not automatically put you on the other.
Key Takeaways
- Medicare is federal and based on age (65+) or disability; Medicaid is state-run and based on income.
- Medicare requires you to pay premiums and has deductibles; Medicaid is free or very low-cost in most states.
- Medicare covers hospital, doctor, and prescription drug services; Medicaid covers those plus long-term care and dental in many states.
- You can have both programs at the same time, and some people do — these people are called "dual may be able to access."
- Each state runs Medicaid differently, so what is covered and who qualifies varies by where you live.
Who each program covers
Medicare covers people who are 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease (ESRD). You do not have to be poor to get Medicare — it is based on age and work history, not income. If you or your spouse paid Medicare taxes for at least 10 years, you are covered.
Medicaid covers people with low income. The income limit varies by state and by family size. Some states are more generous than others. Medicaid also covers pregnant people, children, parents, and people with disabilities in most states, but the exact rules depend on where you live. A few states have not expanded Medicaid under the Affordable Care Act, which means fewer people there may have access to.
The key difference: Medicare asks "Are you old enough or disabled enough?" Medicaid asks "Are you poor enough?" You can answer yes to both questions and have both programs.
What each program costs you
Medicare requires you to pay monthly premiums, deductibles, and copayments. Part A (hospital insurance) is free for most people 65 and older. Part B (doctor visits) costs about $165 per month in 2024, though the exact amount changes each year. Part D (prescription drugs) costs vary by plan. You also pay a deductible before Medicare starts paying — for Part A, that is $1,676 per hospital stay in 2024; for Part B, it is $240 per year.
Medicaid is free or very low-cost in all states. You may pay a small copayment when you see a doctor or fill a prescription, but many states waive copayments for people with very low income. Medicaid does not have monthly premiums or annual deductibles the way Medicare does.
If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid usually pays the Medicare premiums and deductibles you cannot afford. This is one reason some people actively look for Medicaid coverage even if they are already on Medicare.
What services each program covers
| Service | Medicare | Medicaid |
|---|---|---|
| Hospital stays | Yes | Yes |
| Doctor visits | Yes | Yes |
| Prescription drugs | Yes (Part D) | Yes |
| Nursing home care | Limited (up to 100 days) | Yes, long-term |
| Home health care | Yes, if homebound | Yes |
| Dental | No | Yes (varies by state) |
| Vision | Limited | Yes (varies by state) |
| Hearing aids | No | Some states |
Medicare covers hospital care, doctor visits, and prescription drugs, but it does not cover long-term nursing home care or dental work. If you need to stay in a nursing home for more than 100 days, Medicare stops paying and you pay out of pocket — unless you have Medicaid, which covers long-term care.
Medicaid covers everything Medicare covers, plus nursing home care, dental, vision, and hearing aids in many states. However, what Medicaid covers varies significantly by state. Some states cover dental for adults; others do not. Some cover hearing aids; others do not. You need to check your state's Medicaid program to know what you get.
How to know which program you are on
If you turned 65 and started receiving Social Security, you were automatically enrolled in Medicare Part A and Part B. You should have received a Medicare card in the mail. If you did not, you can check your status by creating an account on Medicare.gov or calling 1-800-MEDICARE.
If you think you might may have access to for Medicaid, you explore through your state. Each state has its own process process and website. You can find your state's Medicaid office by visiting Medicaid.gov or calling 211 (a free referral service). The process asks about your income, family size, and sometimes your assets. Processing usually takes 30 to 45 days.
If you are on both programs, you will have both a Medicare card and a Medicaid card (or a state-specific Medicaid ID). Some states issue a combined card. Check both cards to make sure the names and dates of birth match your records.
What happens if you are on both programs
If you are 65 or older and have low income, you may may have access to for both Medicare and Medicaid. This is called being dual may be able to access. When you have both, Medicare is your primary insurance and Medicaid is secondary — Medicare pays first, and Medicaid covers what Medicare does not.
Dual may be able to access people often get extra help. Medicaid may pay your Medicare premiums, deductibles, and copayments. Some states offer special programs for dual may be able to access seniors that include dental, vision, and hearing coverage that neither program normally provides. If you are 65 or older with low income, it is worth checking whether you may have access to for Medicaid even if you already have Medicare.
Common mistakes to avoid
The biggest mistake is assuming you are on both programs when you are only on one. Many people turn 65, get Medicare, and assume Medicaid is automatic. It is not. You have to explore for Medicaid separately, and you have to meet your state's income and asset limits.
Another mistake is not knowing what your state's Medicaid covers. Medicaid rules vary dramatically by state. What is covered in one state may not be covered in another. If you move to a different state, your Medicaid coverage may change. Always check your new state's Medicaid website or call 211 to find out what changed.
A third mistake is not updating your information when your income or family situation changes. Both programs require you to report changes. If you do not, you may lose coverage or owe money back. Report changes to Medicare through Medicare.gov and to Medicaid through your state's Medicaid office.
Frequently Asked Questions
Can I have Medicare and Medicaid at the same time?
Yes. If you are 65 or older and have low income, you may may have access to for both. When you have both, Medicare pays first and Medicaid covers what Medicare does not pay. Medicaid may also pay your Medicare premiums and deductibles.
Do I have to pay for Medicaid?
No. Medicaid is free in all states. You may pay small copayments when you see a doctor or fill a prescription, but there are no monthly premiums or annual deductibles. Some states waive copayments for people with very low income.
What if I turn 65 but do not have 10 years of work history?
You may still get Medicare Part A (hospital insurance) for free if your spouse or ex-spouse worked and paid Medicare taxes for 10 years. If neither applies, you can buy Part A. You should also check whether you may have access to for Medicaid based on income.
Does Medicaid cover nursing home care?
Yes, Medicaid covers long-term nursing home care in all states. Medicare only covers up to 100 days. If you need care longer than that, Medicaid is usually what pays. You may have to spend down your savings first, depending on your state's rules.
What if I move to a different state?
Your Medicare coverage stays the same — it is federal. Your Medicaid coverage may change because each state runs its own program. Contact your new state's Medicaid office or call 211 to find out what you are covered for and whether you need to reapply.