Key Takeaways

• Medicare is federal health insurance primarily for people age 65+ and those with qualifying disabilities — it’s not based on income
• Medicaid is a joint federal-state program for people with low income — age doesn’t matter (children, adults, and seniors can all qualify)
• You can have both Medicare and Medicaid at the same time — called “dual eligibility”
• Medicare has premiums, deductibles, and copays; Medicaid is free or near-free for most enrollees
• SNAP and SSI recipients often automatically qualify for Medicaid

Table of Contents

1. Quick Comparison: Medicare vs. Medicaid
2. What Is Medicare?
3. What Is Medicaid?
4. Who Qualifies for Each
5. What Each Program Covers
6. Costs: What You Pay
7. Dual Eligibility: Having Both
8. How to Apply
9. FAQ

Quick Comparison: Medicare vs. Medicaid

What Is Medicare?

Medicare is the federal health insurance program created in 1965 for Americans age 65 and older, plus certain younger people with disabilities or End-Stage Renal Disease (ESRD). It is funded through Medicare payroll taxes (1.45% each from employee and employer) and premiums.

Medicare has four parts:

Part A — Hospital Insurance

• Covers: Inpatient hospital stays, skilled nursing facility care (limited), hospice, home health
• Premium: $0 for most people who paid Medicare taxes for 40+ quarters
• 2026 hospital deductible: $1,676 per benefit period

Part B — Medical Insurance

• Covers: Doctor visits, outpatient services, preventive care, durable medical equipment
• Premium: $202.90/month in 2026 (higher for higher incomes — IRMAA)
• 2026 deductible: $257/year; then 20% coinsurance

Part C — Medicare Advantage

• Combines Parts A and B (and usually D) through private insurance companies
• Often includes extra benefits (dental, vision, hearing, gym memberships)
• Must still pay Part B premium

Part D — Prescription Drugs

• Separate prescription drug coverage through private plans
• Monthly premium varies by plan (typically $20–$60/month)
• Income-related surcharges (IRMAA) apply for higher earners

What Is Medicaid?

Medicaid is a joint federal-state health insurance program for people with limited income and resources. It’s the largest health insurance program in the United States, covering over 90 million people including children, pregnant women, adults, seniors, and people with disabilities.

Unlike Medicare, Medicaid is means-tested — you must have income and assets below program limits to qualify. Each state administers its own Medicaid program, which means benefits, income limits, and rules vary significantly by state.

Key features:

• No monthly premiums for most enrollees
• Minimal or no copays in most states
• Covers a broad range of services including long-term care
• Available to qualifying individuals of any age

Who Qualifies for Each

Medicare Eligibility

You qualify for Medicare if:

• You are age 65 or older AND are a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 years, OR
• You have received Social Security Disability Insurance (SSDI) for 24 months, OR
• You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There is no income test for Medicare.

Medicaid Eligibility

Medicaid eligibility depends on your state and household situation:

ACA Expansion States (40 + D.C.): Income at or below 138% of the Federal Poverty Level:

Non-Expansion States (10 states): Much stricter limits — generally only covering children, pregnant women, and extremely low-income parents. See Medicaid Eligibility 2026.

Special populations always covered:

• Children through CHIP (up to 200–300% FPL in most states)
• Pregnant women
• SSI recipients (automatic in most states)
• People in nursing homes (under asset limits)

What Each Program Covers

Medicare Coverage Summary

Medicaid Coverage Summary

Medicaid must cover certain “mandatory benefits” in all states:

• Inpatient and outpatient hospital services
• Physician services
• Lab and X-ray services
• Nursing facility services for adults 21+
• Early and periodic screening, diagnostic, and treatment for children (EPSDT)
• Family planning services
• Federally qualified health center services

States may also offer “optional benefits” that most states include:

• Prescription drugs
• Dental care
• Vision care
• Personal care services
• Home and community-based services

Costs: What You Pay

Medicare Costs (2026)

See Medicare Part B Premium 2026 for IRMAA surcharges for higher-income beneficiaries.

Medicaid Costs (2026)

For most Medicaid enrollees:

• Monthly premium: $0
• Copays: $0–$4 for most services (states may charge minimal copays for non-emergency ER use)
• Deductible: Generally $0
• Out-of-pocket maximum: Very low, federally capped

Dual Eligibility: Having Both Medicare and Medicaid

If you qualify for both Medicare and Medicaid, you are “dual eligible.” This applies to many low-income seniors and people with disabilities.

What it means for you:

• Medicaid pays Medicare’s premiums, deductibles, and copays (through Medicare Savings Programs)
• Medicaid covers services Medicare doesn’t (dental, vision, long-term care)
• You pay little or nothing out-of-pocket for healthcare

Medicare Savings Programs (MSPs) pay Medicare costs for dual-eligible beneficiaries:

If you receive SSI: You are automatically enrolled in QMB in most states — Medicare is effectively free for you.

How to Apply

Apply for Medicare

• Most people are automatically enrolled at 65 if they receive Social Security
• If not automatic: Apply at SSA.gov or call 1-800-772-1213, three months before turning 65
• SSDI recipients: automatically enrolled after 24 months of disability benefits

Apply for Medicaid

• Apply at healthcare.gov or your state’s Medicaid portal
• Call 211 for help finding your state’s application
• SNAP and SSI recipients: check if your state automatically enrolls you in Medicaid

FAQ

I’m 62 and lost my job. Can I get Medicaid until I’m eligible for Medicare? Possibly. If your income is below 138% FPL (in expansion states), you qualify for Medicaid regardless of age. If you’re between 138% and 400% FPL, you may qualify for subsidized ACA Marketplace coverage. See ACA Marketplace 2026.

Can I use my Medicare card at any doctor? Medicare is accepted by most U.S. physicians, but not all. Doctors can “opt out” of Medicare entirely. Always confirm a provider accepts Medicare before your appointment.

Does Medicaid pay for nursing home care? Yes — Medicaid is the primary payer for long-term nursing home care in the U.S. This is a major distinction from Medicare, which only covers short-term skilled nursing care (up to 100 days after a qualifying hospital stay). Medicaid’s nursing home coverage requires meeting income and asset limits, which often means a “spend-down” of assets first.

Sources

1. CMS. Medicare. CMS.gov.
2. Medicaid.gov. Medicaid Eligibility. Medicaid.gov.
3. CMS. Dual Eligible Beneficiaries. CMS.gov.
4. KFF. Medicare Savings Programs. KFF.org.

Related Articles:

• Medicaid Eligibility 2026
• Medicare Part B Premium 2026
• SSI vs. SSDI
• Social Security COLA 2026
• Benefits for Seniors 2026

Source: CMS.gov; Medicaid.gov. Last verified: March 2026.