Medicare and Medicaid Are Completely Different Programs — Here's What That Means for You

Medicare and Medicaid sound similar, but they're run by different government agencies, cover different people, and work in almost opposite ways

Medicare is a federal health insurance program for people 65 and older, regardless of income. It's also available to some younger people with disabilities or end-stage renal disease. You pay into Medicare through payroll taxes while you work, and it becomes your insurance when you turn 65.

Medicaid is a joint federal and state program for people with low incomes. Your state runs its own Medicaid program within federal guidelines, so may be able to access and coverage vary significantly depending on where you live. Unlike Medicare, Medicaid is not based on age — it's based on income and sometimes other factors like disability or family size.

The confusion happens because both programs help pay for health care, both have "care" in the name, and both are federal programs. But if you're trying to figure out which one covers you, the first question is always your age and income, not the name.

Key Takeaways

• Medicare is for people 65 and older (or younger people with certain disabilities), while Medicaid is for people with low incomes, regardless of age.
• Medicare is the same nationwide because it's run entirely by the federal government; Medicaid rules change by state because states design and run their own programs.
• You pay into Medicare through taxes while working; Medicaid is funded by federal and state taxes but doesn't require you to have paid into it.
• Some people may have access to for both programs at the same time, which is called "dual may be able to access" status.
• The deductibles, copays, and what doctors accept each program vary widely, so you need to check your specific plan.

Who each program covers

Medicare covers you automatically when you turn 65, as long as you or your spouse paid Medicare taxes for at least 10 years while working. If you're under 65, you may still may have access to if you've received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS.

Medicaid covers people whose income falls below a certain threshold set by their state. Most states also cover people who are pregnant, children under a certain age, people receiving SSDI, and people who are blind or have disabilities. But the income limits and exact rules differ by state — what qualifies you in one state might not in another.

Some people are "dual may be able to access," meaning they may have access to for both Medicare and Medicaid at the same time. This usually happens when someone is 65 or older and has a low income. In this case, Medicare is your primary insurance and Medicaid covers some of what Medicare doesn't.

How each program is structured and funded

Medicare is a federal program with the same rules everywhere. It has four parts: Part A (hospital insurance), Part B (medical insurance), Part D (prescription drugs), and Part C (an alternative private plan option). You enroll in Medicare through Social Security, and the program is funded through payroll taxes that you and your employer paid while you were working.

Medicaid is run by each state within federal guidelines, which is why it looks different depending on where you live. Your state decides which doctors and hospitals participate, what services are covered, how much you pay out of pocket, and how much providers are reimbursed. Medicaid is funded by both federal and state taxes.

Because Medicaid is state-run, moving to a different state means you may lose your Medicaid coverage and have to reapply in your new state. Medicare, by contrast, follows you anywhere in the United States.

What you pay out of pocket

Medicare requires you to pay premiums (monthly fees), deductibles (amounts you pay before coverage kicks in), and copays or coinsurance (your share of each service). The exact amounts change every year. Part B and Part D have premiums; Part A typically doesn't if you paid Medicare taxes long enough. If your income is low, you may may have access to for programs that help pay these costs.

Medicaid typically has lower or no premiums, deductibles, and copays than Medicare, especially for people with very low incomes. Some states charge small copays for certain services, but many Medicaid programs charge nothing. This is one reason Medicaid is often more affordable for people with low incomes, even though it covers fewer services in some states.

If you're dual may be able to access, Medicare pays first, and Medicaid covers some of the costs Medicare doesn't — like copays and deductibles. This can make your out-of-pocket costs much lower than if you had Medicare alone.

What services each program covers

Medicare covers hospital stays, doctor visits, lab tests, imaging, mental health care, and prescription drugs (under Part D). It does not cover dental, vision, or hearing care, though some private Medicare plans (Part C) add these benefits. Medicare also doesn't cover long-term care or custodial care in a nursing home.

Medicaid covers many of the same services as Medicare, but the specifics depend on your state. All states must cover hospital care, doctor visits, lab tests, and imaging. Most states also cover dental, vision, and hearing care through Medicaid — services Medicare doesn't cover. Medicaid also covers long-term care and nursing home care, which Medicare does not, making it the program that actually pays for extended nursing home stays for people with low incomes.

This is a major practical difference: if you need a nursing home and have low income, Medicaid is the program that will pay for it. Medicare will only pay for a short rehabilitation stay after a hospital visit.

How to enroll and when coverage starts

You enroll in Medicare through Social Security, either online, by phone, or in person at a Social Security office. You can enroll starting three months before you turn 65. If you don't enroll when you're first may be able to access, you may face penalties on your premiums later. Coverage typically starts the first day of the month you turn 65 or the month you become may be able to access.

Medicaid enrollment happens through your state's Medicaid office or through your state's health insurance marketplace. The process and timeline vary by state. Some states have continuous enrollment, meaning you can apply anytime; others have specific enrollment periods. Once you're approved, coverage usually starts on the first day of the month after you apply, though some states backdate coverage.

If you're already on Medicaid and turn 65, you'll need to enroll in Medicare as well. Your state Medicaid office can usually help you understand how the two programs will work together.

What happens if you move to a different state

Medicare coverage follows you anywhere in the United States. You don't need to do anything if you move — your coverage continues the same. You may want to update your address with Social Security and Medicare so they have your current information.

Medicaid does not follow you. If you move to a different state, your Medicaid coverage ends, and you'll need to apply for Medicaid in your new state. The new state's rules, income limits, and covered services may be different. You should apply for Medicaid in your new state before your old coverage ends to avoid a gap. Some states have programs to help people transition between state Medicaid programs.

Frequently Asked Questions

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

Yes. If you're 65 or older and have a low income, you may may have access to for both. Medicare is your primary insurance, and Medicaid helps cover costs that Medicare doesn't pay. People with both programs are called "dual may be able to access."

Do I have to pay for Medicare if I didn't work long enough to pay Medicare taxes?

You can still get Medicare at 65, but you'll pay higher premiums because you didn't pay the required taxes while working. You may also may have access to for Medicaid to help cover those premiums if your income is low enough.

What if I'm under 65 and don't have health insurance?

You may may have access to for Medicaid based on your income, regardless of age. You can also look for coverage through your state's health insurance marketplace. Contact your state Medicaid office or call 211 to learn what programs may be available where you live.

Does Medicaid cover dental and vision care?

It depends on your state. Most states cover some dental and vision services through Medicaid, but the scope varies. Medicare does not cover routine dental, vision, or hearing care. Check with your state Medicaid program or your Medicare plan to see what's covered.

What if I can't afford my Medicare premiums?

If your income is low, you may may have access to for programs like the Medicare Savings Program or Extra Help that pay some or all of your premiums and cost-sharing. Contact your state Medicaid office or Medicare directly to learn if you may have access to.